Fetal Medicine

All the necessary ultrasounds throughout the monitoring of a pregnancy.

Viability ultrasound (6-11 weeks)

It is also called an early pregnancy ultrasound and its purpose is:

to determine whether it is a singleton or multiple pregnancy and the chorionicity in the case of a multiple pregnancy;
to confirm that the pregnancy is inside the uterus and progressing smoothly.

Ultrasound is useful in cases where there is a suspicion of a poor outcome of the pregnancy (such as bleeding, pain, a history of previous miscarriages or ectopic pregnancies) but it can also be done to reassure the parents that everything is progressing smoothly, without any specific medical indication.

1st trimester ultrasound (11-13+6 weeks)

It is also called a cervical transparency ultrasound and its purpose is:

to determine whether it is a singleton or multiple pregnancy (and the chorionicity in case of multiple pregnancy) and to confirm the normal progress of the pregnancy;
to accurately date the pregnancy according to the length of the fetus;
to diagnose major anatomical abnormalities that can be seen at this particular stage of pregnancy;
to determine the chances of chromosomal abnormalities (such as Down syndrome). For each pregnant woman, an individualized probability for the current pregnancy is calculated. This is done by combining the mother’s age and history, ultrasound findings (the thickness of the nuchal translucency, the presence or absence of the nasal bone, the flow of blood through the tricuspid valve of the heart, the flow of blood in the ductus venosus and the presence or absence of major anatomical abnormalities) and the measurement of two biochemical markers (PAPP-A and free β-HCG) in maternal blood. Nuchal translucency is an ultrasound term that describes the fluid at the back of the neck and is normally present in all fetuses. But when this amount is increased, the possibility of chromosomal abnormalities, anatomical abnormalities of the heart, genetic syndroms, etc;
to determine the possibility of preeclampsia or intrauterine growth retardation later in pregnancy. This is done by combining the history, blood pressure measurement, measurement of a protein in the mother’s blood (PAPP-A) and ultrasound measurement of resistance in the mother’s uterine arteries. In case of increased risk (>1/100) of preeclampsia, there is the possibility of prophylactic administration of aspirin 160mg/day up to 36 weeks.

This ultrasound is one of the most important tests in pregnancy and is recommended for all pregnant women. At the end of the test, parents will receive full counseling about the findings and their options for further testing (such as invasive testing or testing with free fetal DNA), as well as a detailed report describing all findings.

B level ultrasound (20-24 weeks)

It is the detailed ultrasound examination of the anatomy of the fetus and its purpose is:

to confirm the correct development of the fetus by calculating its weight;
to examine the anatomy of the fetus. Every system of the fetus is examined (brain, heart, chest, gastrointestinal, urinary-genital, face, spine, limbs, etc.) based on international protocols that ensure we can accurately exclude major anatomical anomalies;
to screen for low markers for Down syndrome. These are mild anatomical abnormalities, often without significant clinical significance, that have been observed to occur more frequently in fetuses with Down syndrome. They allow us to recalculate the probabilities for this syndrome and, therefore, the ultrasound is also called "Genetic";
to check the placenta (position, morphology) and the amount of amniotic fluid;
to estimate the risk of preterm labor through the transvaginal measurement of the length of the cervix. In cases where the cervix is short, it is possible to improve the chances of preterm delivery with the administration of progesterone (or with cervical ligation, depending on the history of the pregnant woman). The examination is offered to all pregnant women undergoing B-level ultrasound but is highly recommended in cases of increased risk (multiple pregnancy, history of preterm birth / B trimester miscarriage, history of cervical surgery, anatomical abnormalities of the uterus);
to redefine the risk of developing preeclampsia or intrauterine growth retardation later in pregnancy. This is achieved by ultrasound measurement of blood flow resistance in the mother’s uterine arteries and in cases where the risk is found to be increased, more frequent follow-up with development ultrasounds is recommended, starting at 28 weeks.

B-level ultrasound is recommended for all pregnant women and is one of the most important examinations in pregnancy. A normal B-level ultrasound does not necessarily guarantee us that the fetus is normal (since it is not possible to detect all possible anatomical anomalies and genetic syndromes), but it significantly reduces the possibility of a poor pregnancy outcome. If an abnormality is found, there will be counseling regarding the prognosis, further testing that may be needed (e.g. amniocentesis or testing with free fetal DNA) and the care that the newborn will need after birth.

Developmental Ultrasound – Doppler (32-34 weeks)

It is the ultrasound control of the growth and well-being of the fetus and its purpose is:

to calculate the weight of the fetus obtained by measuring the circumferences of the head and abdomen, as well as the length of the femur of the fetus. The measurements are placed on specific growth curves and we can assess whether the fetus is growing properly;
to check the blood flow in specific vessels (umbilical artery, middle cerebral artery, ductus venosus and uterine arteries) using color Doppler. This helps us assess that the placenta is functioning satisfactorily and that the fetus is receiving the necessary nutrients;
to estimate the amount of amniotic fluid, the position and the morphology of the placenta;
to assess fetal movements.

Developmental Doppler ultrasound is ideally recommended to all pregnant women in order to detect fetuses with delayed development in time. In special cases of increased risk, a more frequent ultrasound check starting earlier in pregnancy is recommended. This ultrasound cannot necessarily guarantee us the birth of a healthy and fit newborn, but it significantly reduces the possibility of a poor perinatal outcome.

Amniocentesis

Amniocentesis is an invasive method for examining the genetic material of the fetus. Unlike ultrasound and free fetal DNA testing – which assess the chances – amniocentesis offers us a diagnosis regarding the chromosomes of the fetus.

A fine needle is inserted, under ultrasound guidance, into the uterine cavity and a small amount of amniotic fluid, which surrounds the fetus, is aspirated. The cells contained in the amniotic fluid are of fetal origin, so their examination gives us information about the chromosomes and other proteins of the fetus.

The procedure is very short and the amount of amniotic fluid we receive is quickly replenished as the amniotic fluid consists, for the most part, of the fetus's urine.

Amniocentesis is performed from the 16th week until the end of pregnancy and its most common reasons are:

The control of the genetic material of the fetus.
The control of fetal infections.
The control of other diseases (e.g. metabolic diseases) of the fetus.

Amniocentesis is a painless test, as the needle inserted is extremely thin. Most women report a mild discomfort for the first few days after surgery, which is managed with simple pain medication. If there is severe acute pain, fever, vaginal bleeding, or discharge from the vagina, immediate evaluation is needed.

Like all operations, amniocentesis is accompanied by a very small percentage of complications. Most of them are treatable, but there remains - according to the international literature - a percentage of about 0.1-0.5% of miscarriage, usually in the first 5 days after the operation.

Chorionic Villus Biopsy (CVS)

Chorionic Villus Biopsy is an invasive method in the first trimester of pregnancy to examine the genetic material of the fetus. Unlike the first-trimester ultrasound and the free fetal DNA test – which assess the chances – the chorionic villus biopsy gives us a diagnosis about the chromosomes of the fetus.

A fine needle is inserted, under ultrasound guidance and local anaesthesia, into the placenta and a small section of placental tissue (chorionic villi) is aspirated. Considering that the placenta and the fetus have the same genetic material, the test allows us to evaluate the chromosomes of the fetus.

The examination is carried out from 11 to 15 weeks. It is not painful, but there is often a mild feeling of discomfort – like period pain – which is treated with simple painkillers, as well as vaginal bleeding in the first few days after the operation. If severe pain, bleeding, or fever occurs, immediate evaluation should be done.

As with all operations, there is a small risk of complications with chorionic villus biopsy. In a small percentage (ranging from 0.1 – 0.5%) a miscarriage may occur due to the examination, which usually occurs within the first 5 days. Also, in a small percentage (about 1%) there is a risk of not having an answer - due to the phenomenon of placental mosaicism - and needing an amniocentesis at 16 weeks of pregnancy.

Associate Physicians

FETAL

MEDICINE