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where you find more answers .........



Heart beat gone at 10 weeks.
Nuchal skin thickness.
White spots in the baby's bowel.
Shiny bright spot in the baby's heart.
Going back for a retake?
Slow heart rate of the fetus
Biochemical screening
A smaller abdominal circumference
Intracardiac echogenic foci
Enlarged kidneys
Left-handedness
3-D ultrasound



My wife has recently had a trans-vaginal scan and we were told that no heartbeat could be detected, she is 10 weeks pregnant by her dates. Her cycle varied between 28 & 32 days and we were told that the fetus was equivalent to 9 weeks only. We have been told to expect the worse for the repeat scan next week. How accurate is the scan relating to these matters and is it possible to miss the heartbeat at this stage? Will the fetus continue to grow without the heartbeat?

Answer:

Well, if the measurements indeed indicate a gestational age of 9 weeks, then it would be most unlikely not to be able to see the heart beat at this time. Very likely fetal demise has occurred. Don't expect the fetus will carry on growing without a pumping heart.



Question:

Can you tell me what the nuchal skin fold is for and what would be the use of measuring it during an ultrasound examination?

Answer:

The nuchal skin fold thickness or nuchal translucency is the thickness of the skin fold behind the nape of the neck. In chromosomal abnormalities this may be thickened due to venous or lymphatic engorgement. It is now almost routinely measured between 11 to 14 weeks to detect the presence of Down syndrome and fetuses with other chromosomal abnormalities. Read also The 11-14 weeks Scan from the Fetal Medicine Foundation, United Kingdom.



Question:

I am 18 weeks at dates. I had an ultrasound scan last week and the technician told me that the baby's intestines looked whitier than they should be. She said she could not find any other peculiarity about my baby but suggested that I should come back for an amniocentesis this week. What does that mean? Does my baby have Down syndrome?

Answer:

I believe she is referring to 'echogenicities' in the fetal bowel which is considered to be one of the ultrasonic "soft signs" suggesting that the fetus may be suffering from chromosomal abnomalities the most common one of course is Down syndrome. The cause of the echogenicities is not clearly known but would appear to be due to calcified meconium or a maldevelopment of the gut of the fetus. The risk of Down syndrome in the presence of the findings of echogenic bowel is only 1.4% according to a study form the Benacerraf group in Boston. Other groups however had quoted a higher incidence. Counselling and genetic amniocentesis appear to be justified in the presence of such findings. A summary of this finding can be found here. Also check out the page Prenatal testing for Down Syndrome for related information.



Question:

I am going for a 'level 2' examination next week because my obstetrician said she could see a shiny bright spot in my fetus heart. I was told this could indicate Down syndrome. Is the risk really great? I am 15 weeks today.

Answer:

'Echogenicities' in the fetal heart is considered as another sonographic "soft sign" in the diagnosis of fetal chromosomal abnormalities. The echogenic areas probably represent calcifications at malformed areas in the papillary muscles of the heart. As reported by different authors, the presence of an intraventricular echogenic focus carries a relative risk of Down syndrome roughly 0 - 4 times as compared to a woman of similar age. Counselling, further ultrasonic assessment and amniocentesis will be considered in the presence of such findings. At the same time, the vast majority of fetuses who are chromosomally normal with an intraventricular echogenic focus do not have congenital heart disease.

Try to read this article in the Birth.com.au


Question:

I just had my 20 week ultrasound, and the technician told me everything looked fine, but he could not get a good look at the heart.?He wants to see me back in 3 weeks.?Is that routine?

Answer:

Yes. It is. Looking for abnormalities in the fetal heart is difficult and very much dependent on fetal position and clarity of the ultrasound picture at that time. It is common to ask patients to return for another scan particular the first examination was not reasurring of a normal cardiac configuration. Good sonologists or sonographers are very careful with malfornations. They won't let go until they are almost 100% certain things are normal or that the neccessary ultrasonic views have been taken.



Question:

I am 7 weeks pregnant. My scan yesterday showed that the fetal heart beat was only 80 per minute and the technologist said this was not good. She asked me to return for another scan next week. Should I be worred?

Answer:

A slow fetal heart beat is generally speaking significant and indicates unwell in the fetus. Normal heart rate at 6 weeks is 90-113 bpm and at 9 weeks is 144-170 bpm. At 5-8 weeks a bradycardia (<90 bpm) is associated with a high risk of spontaneous abortion of some 80%. (Benson CB, Doubilet PM. Radiology 1994; 192: 343-4). Other signs are also important in the assessment such as the size of the yolk sac and the amount of amniotic fluid.



Question:

I know the question is not directly related to ultrasound but can you tell me a bit more about the 'double' and 'triple' test, and more recently the first trimester blood tests in the screening for Down syndrome?

Answer:

Read this informative article on biochemical screening for Down Syndrome.



Question:

I am currently 31 weeks pregnant. To date I have had 2 ultrasounds - one at 18 weeks, and one more recently at 30 weeks. According to the results of the latest the gestational age of the baby was 30 weeks, so my dates are correct. My concern is measurements of the baby - namely abdominal circumference. According to my doctor the head and femur measurements were above the 60th percentile, however the abdominal circumferance was only in the 9th. What concerns should I have regarding this? Is this considered abnormal intrauterine growth, and if so what may result? This is my second child. The first weighed 6lb 7oz at birth.

Answer:

This is a very common concern. Although in theory the baby appears to be asymmetrically small it can be interpretated as just a 'thin' baby. In general the birth weight of the second baby closely resembles the first. If your first baby was only 6 lb 7 oz then this baby is likely to have a similar weight. It doesn't sound 'thin' but figure-wise it is. The average weight of babies at term is around 7 lbs, so theoretically any weight below that will have an abdominal circumference falling below the 50th centile mark. 10th percentile at term is around 6 lbs so your results merely reflect that you will have a similar size baby as last time. Of course one should also pay attention to the amount of liquor and the exclusion of any congenital abormalitities.



Question:

I am 22 weeks pregnant and was told during my 20 week sonogram that my baby has a echogenic intracardiac focus in its left ventricle. Because of my timing, I was advised to have aminiocentesis for down syndrome. I am told my chances are slim because of my triple screen test was negative and my age of 29 years.
I would like to know what percentage and probability of my baby having the down syndrome.?I have been told this is still contraversial and it seems there is not much information out there. I am now waiting for my results from my aminio with great anxiety. Could you please advise me on this?

Answer:

Representing mineralisation of the papillary muscle, this soft sign for aneuploidy was not a common finding in this group of 6995 women (incidence 2.1%). The incidence of echogenic cardiac foci in 2nd trimester ultrasounds ranges from 0.17% to 7.4% in other studies. Estimates of the chance of Down Syndrome among fetuses with echogenic cardiac foci have varied from no increased risk up to a 4-fold increase in the age-related risk with several studies suggesting a risk of 1%. In one recent study of the 150 fetuses with the heart foci, 76% proceeded to karyotyping by chorionic villus sampling or amniocentisis or both and one had cordocentesis. The positive predictive value of an echogenic intracardiac focus for chromosomal abnormality in all patients was 3% (5/150). Only one of the five chromosomaly abnormal fetuses had an echogenic intracardiac focus as the only sonographic marker for chromosomal aberration.? Therefore, of the 92 cases where an echogenic focus was the only ultrasound marker, there was only one chromosomal abnormality (1%). Ninety-six percent of the echogenic foci were within the left ventricle.

With the controversy surrounding this ultrasound finding it is difficult to know what, if anything, is best fo each patients. Genetic Counseling is recommended. Many centers will not routinely recommend amniocentesis if this is an isolated finding and the patient is otherwise low risk.

You can also read this article on intraventricular echogenic focus.



Question:

I am 20 weeks pregnant and my doctor said that the baby had slightly enlarged kidneys. He was apparently referring to the inside measurements of the kidneys.?Could you tell me what this could mean? to my baby.

Answer:

The renal pelvis is the are in the kidney where urine collects before being passed down the ureter into the bladder. Renal pelvis dilatation, or pyelectasis is the term used to describe a visible renal pelvis, usually greater than 4 mm at 18 weeks. Most of them are transient and because they appear to disappear in time it is though that they are due to immaturity of the renal collecting system, and not harmful. Some are thought to arise from compression of the ureter as it descends into the pelvis and in to the pelvis. This may be a transient phenomenon but which may cause harm to the kidney over time.

Some of the dilatation appears to be due to reflux. In these cases, the urine flowing down into the bladder refluxes (comes back up the ureter) when the fetus empties its bladder. However renal anomalies or deviations from the normal renal anatomy have also been identified as markers for Down syndrome. It has been reported that the presence of isolated pyelectasis (enlarged collecting system) prenatally did not warrant amniocentesis for assessment of fetal karyotype. Subsequently, however, Nicolaides and associates reported that the presence of isolated pyelectasis was specifically associated with a 3-fold increase over the maternal age-related risk for chromosomal anomalies. In a 1996 evaluatio the association between isolated pyelectasis and an increased risk for Down syndrome was confirmed in gestational ages between 16 and 20 weeks, beginning at a maternal age of 31 years.

The incidence of chromosome abnormalities is greatest if any other structural malformation is present.

Most would agree that a renal pelvic diameter greater than 10 mm is more likely to have a worse outcome. Between 4 and 10 mm, it is more difficult to accurately predict the outcome. All fetuses with pyelectasis need a repeat scan later in pregnancy.



Question:

I have read from news magazines that there is an increase in left-handedness in babies in whom the mother had ultrasound scans a in pregnancy, and there may also be speech problems too. Is this true?

Answer:

Please refer to the Safety References for a discussion on the safety and possible harmful effects of Ultrasound..




Question:

I was told that the 3-D scan will not give me more information as to whether my baby is normal or not than the usual 2-D ultrasound scan. Is this true and if that is the case why do we need the 3-D scan?

Answer:

3-D ultrasound has resulted largely from the advancement in computer technology and the vastly improving speed of the micro-processors. Indeed the benefits that 3-D has bought to ultrasound diagnosis has often been debated. The recognised advantages of 3-D over conventional 2-D ultrasound as it is at the turn of the millenium are its ability to enhance maternal-fetal bonding, improved comprehension of certain fetal anomalies by parents, Improved recognition and better confirmation of certain anomalies such as cleft lips, polydactyl, micrognathia, malformed ears, club foot, vertebral malformations and other anomalies appearing on the 'exterior' of the fetus, consequent to the benefit of volume and surface rendering. The development of transvaginal 3-D probes have further enhanced its value in the early diagnosis of congenital malformations.

In a recent article by Professor Asim Kurjak and his team in Europe, "Three-dimensional sonography in prenatal diagnosis: a luxury or a necessity?" (Journal of Perinatology, issue 3, 2000), he concluded,

".... the main advantages of three-dimensional ultrasound in perinatal medicine and antenatal diagnosis include scanning in the coronal plane, improved assessment of complex anatomic structures, surface analysis of minor defects, volumetric measuring of organs, "plastic" transparent imaging of fetal skeleton, spatial presentation of blood flow arborization and, finally, storage of scanned volumes and images. It is our decided opinion that three-dimensional sonography has gained a valuable place in prenatal diagnosis, becoming a necessity for every modern perinatal unit .... ".

Professor Stuart Campbell in London was one of the early proponents for the 3-D scan to be an important catalyst for mothers to bond to their babies. What are known as 're-assurance scans' and the perhaps misnamed entertainment scans' have started to develop. The attraction of being able to look at the face of your baby before birth was enthusiastically reported in lay parenting and health magazines. Manufacturers had adopted an unprecedented "profit marketing" strategy to advertise to providers and "reverse marketing" strategy to advertise to consumers, particularly after the arrival of the 4-D (dynamic or motion 3-D) machines.

Barbara Maier and her group (Horst Steiner, Alf Staudach etc.) in Austria reported in 1996 that mothers are more incentive to endure pregnancy-related difficulties, reduced anxiety, and improved capacity to cope. Dolores Pretorius in San Francisco reported in the same year that improved bonding between the mother and fetus could motivate mothers to refrain from smoking and other harmful behaviors during pregnancy.









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