FAQs

• 1st trimester is the period of organogenesis.
• Cardiac volume increases by approximately 40 to 50 percent from the beginning to the of the pregnancy, causing an increased cardiac output may cause an increased pulse rate
• An increased cardiac output may cause an increased pulse rate during pregnancy. The increase in blood volume is needed for extra blood flow to the uterus
• It is not necessary to spend whole day in bed. Keep up your normal level of activity and carry on with normal housework
• If you are working – CONTINUE. No need to take off from the job
• You can climb up and down stairs any number of times.
• Try not to lift heavy weights. If you have to carry your older kid, pick him/her from a chair or ask someone to hand it over to you. Avoid taking medication on your own.

  By the end of 5 weeks your baby is developing

  • All major systems and organs begin to form
  • The neural tube (which becomes the brain and the spinal cord), the digestive system,and the heart and circulatory system begins to form.
  • The beginnings of the eyes and ears starts developing
  • Arm and leg buds begin to develop

  
  At 7-8 weeks your baby is developing

  • The baby’s heart begins to beat
  • All major body systems continue to develop and function, including the circulatory, nervous, digestive and urinary systems.
  • The embryo takes on a human shape, although the head is larger in proportion to the rest of the body.
  • The mouth develops into the tooth buds.
  • The arms and legs grow longer
  • Fingers and toes have begun to form
  • The face begins to develop features
  • The umbilical cord is clearly visible

  
  At the end of 8 weeks your baby is a fetus and nearly 1- 1.5 inches long weighing less than 1/8 of an ounce.

  At 9- 12 weeks

  • The nerves and muscles begin to work together.
  • Your baby can make a fist
  • Eyelids close to protect the developing eyes. They will not open until week 28
  • Finger and toe nails appear
  • Your baby is about 6 to 7 cm long by the end of 12 weeks.
  • Fetus has jerky and unstructured movements. Remember you will not feel these movements.
  • The fetus is most vulnerable during first 12 weeks of pregnancy as all the major organs and body systems are forming. The fetus can be damaged if exposed to certain drugs, radiation, chemicals,
          toxic substances, radiation and infections like German measles (rubella), chicken pox etc.

           Myths and misconceptions

• • Eating papaya, pineapple and sesame seeds may cause abortion – not true
  • Complete bed rest advised in first 3 months of pregnancy – not true
  • You have to eat for two – not true
  • You should not climb stairs – not true
  • Having intercourse during pregnancy will cause abortion-Not true.
  • It is ok to have as long as you are comfortable. If you have bleeding or spotting then your doctor will advise you to avoid intercourse.

            Precautions to be taken during first trimester of pregnancy:

• • Avoid the consumption of alcohol. It negatively affects the mental and physical development of the fetus.
  • Avoid the intake of caffeine. High caffeine consumption has been linked to an increased risk of miscarriage.
  • Certain foods like fish, raw eggs and unpasteurized milk should be avoided as it contains some toxins which can cause harm to the fetus.
  • Smoking and use of certain medications should be completely avoided.
  • Dyeing/highlighting/colouring the hair is not recommended as little quantity of chemical enters the blood through your skin. However this fact has not been scientifically proven.
  • Any kind of high impact exercises such as sit-ups, jogging, lifting heavy objects etc. should be avoided as it can increase pressure inside the uterus leading to premature labour or bleeding.

Physical and emotional changes in a women in 2^nd trimester are:

• • Back ,abdomen, groin, or thigh aches and pains
  • Stretch marks on your abdomen, breasts, thighs, or buttocks
  • Darkening of the skin around your nipples
  • A line of the skin running from belly button to pubic hairline (linea nigra)
  • Patches of darker skin, usually over cheeks, forehead, nose or upper lip.
  • This is sometimes called the mask of pregnancy. ( Melasma or chloasma facies)
  • Numb or tingling hands (Carpel tunnel syndrome)
  • Itching on the abdomen, palms and soles of the feet. (Call your doctor if you have nausea, loss of appetite, vomiting yellowing of skin or fatigue combined with itching.
  • These can be signs of a liver problem.)
  • Swelling of the ankles, fingers, and face. (If you notice any sudden or extreme swelling or if you) if you gain a lot of weight quickly, Call your doctor immediately

2nd Trimester stages of fetal development :

•  At 16 Weeks
  
  • The musculoskeletal system continues to form
  • Skin begins to form and it is nearly translucent
  • Meconium develops in your baby’s intestinal tract. This will be your baby’s first bowel movement.
  • Your baby begins sucking movements with the mouth
  • Your baby is about 4 to 5 inches long and weighs almost 3 ounces.
    
    
• At 20 weeks
  • Your baby is more active. You might feel movement or kicking
  • Your baby is covered by fine feathery hair called lanugo and a waxy protective coating called vernix.
  • Eyebrows, eyelashes, finger nails, toe nails have formed.
  • Your baby can even scratch itself.
  • Your baby can hear and swallow.
  • Now half way through your pregnancy your baby is about 6 inches long and weighs about 9 ounces.
    
    
• At 24 weeks
  
  • The baby’s bone marrow begins to make blood cells.
  • Taste buds form on your baby’s tongue.
  • Foot prints and finger prints have formed.
  • Hair begins to grow on your baby’s head.
  • The lungs are formed but donot yet work
  • Your baby has regular sleep cycle.
  • Baby stores fat and weighs about 1 ½ pounds and is 12 inches long

Pregnancy is a wonderful time filled with joy and excitement and anticipation of a new addition to the family. At the same time, you may want to reassure that your baby will be normal and healthy. At various stages of pregnancy your doctor will suggest and or recommend different tests to check your health and to ensure that your baby is developing normally.

First visit: As early as possible.
What will be done?

Doctor will take detailed history about your

• Periods and last menstrual period – to date the pregnancy
• Consanguinity of marriage
• Preexisting health issues if any (like hypertension, diabetes, thyroid dysfunction) which will help to take necessary preventive measures
• Whether you are on any regular medication which may need to be discontinued or dose need to be adjusted or may be need to be changed which is safe in pregnancy
• Family history of any diseases, genetic disorders and history of twins
• History of previous pregnancies: any complications during antenatal, intrapartum and postnatal period.
• Drug allergy

You will undergo detailed physical examination

Investigations include:

• CBC (complete blood count)
• Urine routine and microscopy
• Blood group
• TSH
• OGCT
• Antibody screen
• HIV
• Hepatitis B
• HCV
• VDRL
• PT APTT

Other investigations depending on risk factors.

Screening tests are done to assess the risk of having an abnormality. If the report comes as screen negative, the risk of having that abnormality is low. If the test result indicates that it is screen positive then further diagnostic test has to be done to confirm.

Diagnostic tests includes:

SCREENING FOR BABY’S HEALTH

For chromosomal conditions
For birth defects
Growth and fetal well being

SCREENING FOR MOTHER’S HEALTH

Screening for hematological conditions

Blood grouping and red-cell alloantibodies

Screening for haemoglobinopathies

Screening for infections

Screening for clinical conditions like Gestational diabetes, pre-eclampsia, preterm birth and placenta previa.

Tests which tell if your baby has a particular disease or condition with certainty are called diagnostic tests. On the other hand, screening tests only show if your baby’s chance is high or low for a specific disease or condition. If the chance is increased, you can then choose to have a diagnostic testing.
It is important to understand that the screening test does not give a definite ‘yes’ or ‘no’ answer. To find out for sure, you would have to decide whether to have a DIAGNOSTIC test.
Every woman has the risk. A screening test is offered to all women during early pregnancy to look at the risk in this pregnancy of the baby being born with any of the conditions.

A carrier is a person who carries a defective gene but does not manifest the disease and can pass the defective genes to the children.

Carrier screening testing is done to see if husband, wife or both carry a defective gene for certain inherited genetic disorders If there is a strong family history of particular disorder like sickle cell disease, thalassaemia, cystic fibrosis, Duchene muscular dystrophy, Huntington’s disease and fragile X syndrome.

This type of testing is available only for a limited number of disorders.

For this test blood of both the parents are taken and processed in genetic lab. If the test shows that parents are carriers, genetic counselors can provide more information about the risk of having a baby with the disorder.

There is an increased risk of having a baby with a birth defect if:

• There is a family or personal history of birth defects
• A previous child with birth defect or genetic condition
• Used certain medication during early part of pregnancy
• Diabetes before pregnancy
• Women aged more than 35 at the time of delivery
• If women is exposed to certain medicines or chemicals early in the pregnancy

Prenatal screening are blood tests with an ultrasound, which are done between 11 weeks to 13wks and 6 days of pregnancy and they tell you your chance of having a baby with Down syndrome, trisomy 18 or 13 and few structural abnormalities.

Combined First Trimester screening

We perform the First Trimester Screening according to the standards laid down by the Fetal Medicine Foundation UK.
It involves two tests, a blood test and an ultrasound between 11 weeks to 13weeks and 6 days.

Ultrasound – We recommend the ultrasound is performed at week 12 of pregnancy. However, the ultrasound can be performed from 11 weeks through to 13 weeks and 6 days of pregnancy. It is a highly specialized ultrasound. It takes about 30-40 minutes.

The sonogram will confirm how far along your pregnancy is. In addition, a measurement of the fluid underneath the skin along the back of the baby’s neck, called the nuchal translucency (NT), will be taken. The sonogram will also determine if your baby’s nasal bone is present or absent. It will also check the blood flow across the valve of the right heart chamber and look for regurgitation ( tricuspid regurgitation) and blood across the ductus venous, the physiological valve regulating blood to the heart.

Combining your age-related risk with the NT measurement, nasal bone data, and blood work, provides you with one risk figure for Down syndrome and one risk figure for trisomy 13 or trisomy 18.

This special scan also provides other very useful information:

• Accurate dating of the pregnancy
• Fetal heart rate
• Number of fetuses present and, if twins, whether they are identical or not o Detects obvious fetal abnormalities

This probability or chance is based on the following criteria:

• Your age
• Nuchal Translucency (amount of fluid behind the neck of the fetus on ultrasound)
• Presence or absence of any physical abnormalities on ultrasound
• Level of three proteins (Fß-hCG, PAPP-A ) in your blood.

The vast majority of babies are normal. However all women, whatever their age, have a small risk of delivering a baby with a physical or a mental abnormality. In some cases this may be due to chromosomal problems such as Down syndrome, Trisomy 13 or Trisomy 18. These conditions are mainly looked for in the first trimester screening.

Chromosomes contain the genetic information we require to grow and develop normally. Each cell contains 23 pairs of chromosomes. Down syndrome usually occurs by having 3 copies of chromosome 21.

Who should be screened?

Leading medical professional organizations recommend first trimester screening for all pregnant women, regardless of age.

It is important to remember that most women will have normal babies, even if they are grouped as high risk.

The first trimester screen’s overall detection rate is approximately 96%. There is a 5% false positive rate for the test. Parents should be aware of the possibility of receiving abnormal results and then finding, after further testing, that the baby is normal. In our unit, we take a cut-off of T21 at 1:250 thus the results are either screened +ve or _ve.

Finally, this screen is not designed to provide information about the possibility of other chromosome conditions, nor about many other genetic syndromes, genetic disorders, birth defects, or causes of intellectual disability.

UNDERSTANDING YOUR RESULTS

What does a “screen negative” result mean?

Screen negative means that the probability that your baby has Down syndrome is better than 1:250 It is important to remember that a screening test does not guarantee a normal baby. If your First Trimester Screen is “screen negative”, you will be provided with routine obstetrical care.

What does a “screen positive” result mean?

A screen positive result means that there is an increased risk for Down syndrome, trisomy 13, or trisomy 18 in the pregnancy. A screen positive result does not mean that the fetus is affected with the condition, only that a pregnancy has an increased risk for the condition. Most women with “screen positive” results have healthy babies.

When the result is “screen positive”, the following options are available:

• Diagnostic testing by chorionic villus sampling (CVS) performed between 10-13 weeks
• Diagnostic testing by amniocentesis performed after 15 weeks
• Second trimester maternal serum screening drawn after 15 weeks to obtain a combined first and second trimester screening result
• Detailed anatomy ultrasound performed at approximately 18-20 weeks
• NIPT (non-invasive prenatal testing)

This testing analyzes small fragments of cell free fetal DNA (cfDNA) that are circulating in a pregnant woman’s blood.

During pregnancy, the mother’s bloodstream contains a mix of cfDNA that comes from her cells and cells from the placenta. The DNA in placental cells is usually identical to the DNA of the fetus. Analyzing cfDNA from the placenta provides an opportunity for early detection of certain genetic abnormalities without harming the fetus.

NIPT may include screening for additional chromosomal disorders that are caused by missing (deleted) or copied (duplicated) sections of a chromosome.

NIPT is a screening test,

Clinical sensitivity of NIPT in the average-risk or general population is around 99.5% for trisomy 21, 93% for trisomy 18, and 92% for trisomy 13. The clinical specificity for any trisomy is 99.9%.

Compared with traditional prenatal screening, NIPT is more accurate in detecting trisomies 21, 18, and 13, and decreased the need for diagnostic testing. Positive NIPT results should be confirmed by diagnostic testing

Diagnostic tests will usually involve amniocentesis or chorionic villus sampling, which take a small amount of fluid or tissue from around the baby for chromosomal analysis.

Both tests have a small risk of miscarriage.

CVS and amniocentesis are diagnostic tests that can tell you with greater than 99% accuracy whether or not a baby has a chromosome abnormality.

Final results from the chromosomal analysis may take 2-3 weeks. Usually an interim result may be available in a few days. We will discuss the results with you and assist you in making decisions.

It is a safe and noninvasive test where a very high frequency sound waves are converted into images. Sound waves are safe to the baby and to date no harmful effects have been documented.

It is done at:

• Between 7 to 8
• NT scan at 11 weeks to 13+6 weeks
• Anomaly scan at 18 to 20 weeks
• Growth with Doppler scan at 28 weeks and 36 weeks
• Additional scan may be advised depending on risk

To diagnose the pregnancy.

Gestational sac can be seen as early as 4 to 5 weeks, yolk sac by 6 weeks and fetal pole with cardiac activity by 6.5 to 7 weeks. This will help to date the pregnancy especially when the periods are irregular and or when the last menstrual period is unknown.

To confirm that pregnancy is growing inside the uterus and not in the fallopian tubes.

To diagnose the multiple pregnancies like twins or triplets and to determine the chorionicity which will help to monitor the growth and to monitor for specific complications.

To diagnose miscarriage

To diagnose ovarian pathology like cysts and or uterine pathology like fibroids, anamolies etc.

To screen for chromosomal anamolies like Down’s syndrome (NT scan).

Few major birth defects can be detected in first trimester.

It is done at 18 to 20 weeks.

To rule out major congenital anamolies.

Ultrasound cannot diagnose all the malformations in the baby. A normal scan does not necessarily mean that baby will be normal. Some of the abnormalities are difficult to find.

Few abnormalities develop later in pregnancy like hydrocephalous where fluid is collected in the brain of the baby. Hence may not be obvious in early pregnancy.

Obesity, fetal position may also make it difficult at times to visualize clearly

Myths and misconceptions about anomalies

Birth defects are not caused by Eating certain foods

If exposed to eclipse

Using cell phone, microwave or computers Air travel

Having bad thoughts