First Trimester Screening

The following was a letter to the local national newspaper The Star that was not published.

Dear Editor

I find the article "New scan in town' StarTwo 10.7.2007, Women, T16 somewhat misleading and I like to share the following points to assist pregnant women in their decision on the appropriate test that they may decide.

1. Firstly it is not a new scan in town as it has been offered by several Medical Centres for over a year now.

2. The Nuchal Translucency (NT) scan and the First Trimester Screening Test ( NT, free beta HcG and PAPP-A) is a SCREENING test and hence it is not diagnostic which means if the NT scan showed an abnormal result one has to still undergo an amniocentesis to confirm the diagnosis.

3. The NT scan has its limitations as it is dependent on the accuracy of the gestational age of the fetus, the abdominal size of the pregnant women, the training of the operator, the type of machines used and the strict adherence to guidelines on measurements of the NT. In comparison there are less limitations on the Amniocentesis procedure.

4. The second-trimester "quad" screening using four serum markers (MSAFP, total or beta-hCG, unconjugated estradiol, and serum inhibin A) offer a comparable detection rate to the First Trimester Screening ( NT, free beta HcG and PAPP-A) which is 79% detection rate of Down Syndrome with a 5% false positive rate. In comparison Amniocentesis detects 100% of Down Syndrome with a 0% false positive rate.

5. The First Trimester Screening Test is a screening test ONLY for Down Syndrome and in some instances for Trisomy 13 and 18. The Amniocentesis detects ALL known Chromosomal defects

6. The Integrated Test incorporating the First and Second Trimester blood markers have a 88% detection rate which is HIGHER than the First Trimester Screening and it DOES NOT incorporate NT.

7. The nasal bone is more difficult to detect and seems to have a less prominent role in identifying the fetus at risk for Down Syndrome due to its lower detection rate

8. A large recent trial (FASTER) has demonstrated that the miscarriage rate from amniocentesis is indeed only 0.15% and not 0.5% as always believed, Thus making it a very safe option.

9. There are several prenatal test available and there is not one that fits all including the NT. The tests have to be individualized according to the patients risk profile.

There is no doubt that NT and First Trimester screening have an important role in screening for Down Syndrome but pregnant women should be given accurate information about the detection rates and false positive rates of any Down's syndrome screening test and the further diagnostic tests that may be offered. They should also be offered BOTH screening and diagnostic test as options and the woman's right to accept or decline the test should be made clear.

Lastly the authors and the people appearing in the feature should declare their association with the centres offering the test to accurately reflect the unbiasness of the reporting.

DR GUNASEGARAN

The Ultrasound Scan

Ultrasound in pregnancy is an examination of the baby using safe sound waves.

4D Colour Scan (NEW)
This is 3D scan that is live as in you will see the fetus in 3D that is actually mobile on the monitor.

3D Colour Scan
This is a special scan which uses a special computer technology to give you a 3 dimensional view of the fetus and its features. Views are dependent of the position and the activity of the fetus.

Special Scan
In special cases you may be asked to go detail, scan to rule out abnormalities. Special scan include Doppler studies of the umbilical vessels to asses the health of the fetus.

The Early Scan
The early scan will confirm that you are pregnancy. It is also important to confirm if it is a multiple pregnancy or an ectopic pregnancy (pregnancy outside the womb which is serious).

Miscarriages are also diagnosed at this time. This scan is important to establish accurately the age of the fetus and the expected date of delivery.

The Detail Scan
This scan is done at 20 weeks. At this time the doctor will check thoroughly for abnormalities and a large number of abnormalities can be detected from the brain to the feet. The accuracy is as high as 90% and of course there will be a few abnormalities that are not possible to diagnose. All doctors here are specially trained in this field.

Other information that can be obtained are the position of the placenta, the adequacy of the amniotic fluid, the umbilical cord and the sex of the baby.

Sometimes due to the position of the fetus it may not be possible to see all of the features in which case you will be asked to return for a repeat scan.

Different Pregnancy Test

TEST FOR CERVICAL CANCER (NEW)
HPV DNA Test - Helps to detect human Papilloma Virus that is closely linked to cervical cancers.

PAP SMEAR
It is a simple test to detect cancer of the cervix. Now improved by Liquid Based Cytology (LBC) method of detection.
Recommended annual pap smear until 65 years.
Recommended include HPV DNA test as virus linked to cancer of cervix.

TRIPLE TEST FOR DOWN’S SYNDROME
Detects risk of Downs in your pregancy
For mums below 35 yrs old
Optional test.

BIOCHEMICAL ANTENATAL SCREENING TESTS
This is a screening test which is offered to all pregnant women between 16 and 20 weeks of pregnancy. A sample of blood is taken and the levels of alphafetoprotein (AFP), and Estriol (E3) Human Chorionic Gonadotrophin (HCG) are measured. Hence the name triple test it may be taken by your family doctor or gynaecologist and the results will normally be available in 10 days.

AMNIOCENTESIS TEST
This is a test in which a small amount of fluid which surrounds the baby in the womb is taken off and sent to the laboratory for genetic analysis.
This test is advisable for those who are over 35 years of age.

CHORIONIC VILLUS SAMPLING
This is a test in which a few cells are taken from the developing placenta (chorion) and tested for chromosomal abnormalities in the baby.
This test is advisable for those who are over 35 years of age.
The cells are tested for chromosomal disorders, of which Down’s Syndrome is the most important.

Food Tips

Foods rich in DHA
Nuts: Almonds, walnuts
Fish: tuna, sardines, salmon, cod

What NOT to consume during pregnancy?
Excessive alcohol
Excessive coffee
Raw meat
Raw dairy
Raw Salads

Pregnancy food
Milk, yoghurt
Eggs
Orange juice
Wholemeal Bread
Brown rice
Lentils
Lean red meat, chicken
Cereals
Broccoli
Spinach
Bananas, oranges, prunes
Nuts
Salmon sardines, cod

Damansara Specialist Hospital

When to come here?
1. When there is leaking of clear fluid.
2. When there is bleeding.
3. When there strong regular contractions.
There is no rush. You have between 1 – 2 hours to get here.

Who to contact in labour?
1. Make your way to the Maternity wing at 2ND Floor OR
2. Make your way to the A & E.
There is no need to call anyone. After the assessment the midwife will call the Doctor.

What to bring to hospital?
1. Two-day stay loose clothings/ nightwear
2. Toiletries
3. Sandals
4. Admission Letter
5. Credit card

What is provided?
1. Sanitary pads
2. Baby’s clothings
3. Beddings
4. Three meals

Common beliefs

1. Sex will hurt my baby.
- NO. It is safe for most couples.

2. Computers will hurt my baby.
- NO. Proven scientifically.

3. Increase baby movements are risky.
- NO. Only reduced movements are worrying.

4. Flying is risky.
- NO. You can safely fly till 34 weeks in pressurized cabins.

5. Reduce salts in leg swellings.
- NO. It is a normal change. Just make sure blood pressure is normal.

6. Douching is recommended.
- NO. It is not necessary and may be harmful.

Some tips during pregnancy

Stretch Marks
You CAN'T AVOID them. There are no magic creams. However, you can minimize it by
(a) Plenty fluids
(b) Plenty fruits and vegetables
(c) Simple massage oils
(d) Exercise

Exercise in Pregnancy
(a) Keep heart rate below 120
(b) Avoid overexertion
(c) Avoid extreme sports
(d) Avoid lying down
(e) Ensure plenty fluids

How to avoid Constipation
TAKE: (a) Two litres of fluids & juices
(b) Plenty fruits, prunes, vegetables
(c) Gentle exercise