Ectopic pregnancy is one of the more serious complications of pregnancy and it is one of the most common reasons for an early pregnancy scan. An ectopic pregnancy happens when the products of fertilization implants and develops beyond the confines of the uterus. Ectopic pregnancy is almost always not viable, except for very few instances. This condition can bring bleeding within the abdominal cavity which can be fatal for the mother. The most common form of ectopic pregnancy is one that takes places within the fallopian tubes, which is also called a tubal pregnancy. Other locations of implantation are the ovaries, cervix, and the abdomen. As has been mentioned, this condition can bring bleeding and death, and as such should be treated as an emergency. The course of a normal uterine pregnancy starts when the uterus receives the newly fertilized egg. The egg implants itself in the nutrient-rich uterine lining where it will eventually develop. On the other hand, in ectopic pregnancy, this process does not take place in the uterus: 98% of the time it happens in the Fallopian tubes. Diagnosis With the current advances in diagnostic tools and procedures such as the early pregnancy scan, ectopic pregnancy can be detected and addressed earlier. However, in spite of the diagnostic advances, this condition is still the main cause of morbidity and mortality among mothers all over the world. An increase in the incidence of ectopic pregnancy can be found in countries with substandard prenatal imaging and care. International Ultrasound Services offers same day early pregnancy scans as well as other private pregnancy scans in an effort to speed up diagnosis and treatment. Ectopic pregnancy takes place when the fertilized egg implants into the lining of the Fallopian tube. The egg eventually erodes into the surrounding blood vessels, bringing about bleeding. The bleeding that takes places within the Fallopian tube will push the egg out of the tube, ending up in what is called a tubal abortion. The Fallopian tube does not undergo inflammation in this case, and the pain is brought about by the prostaglandins present at the actual area of implantation and the irritation due to the presence of blood in the peritoneum. When bleeding becomes more profuse, it can bring about the threat to the mother. While the common cause of the increase in bleeding is the delay in the diagnosis of ectopic pregnancy, some bleeding takes place a little faster. This is especially true when the implantation takes place in the proximal area of the Fallopian tube. In this case, the egg may eventually erode into the Sampson artery located in close proximity to the tube. In 50% of cases, ectopic pregnancies resolve by itself, without intervention. This is especially true with tubal abortions. Currently, the need to perform the surgery has been drastically reduced with the introduction of methotrexate in the treatment of ectopic pregnancy. It should be remembered, though, that surgery will still have to be performed when the Fallopian tubes is near rupture or have already ruptured. Surgery may entail a limited incision via a laparoscopic method, or a larger incision may be used, in which case it is called a laparotomy. Ectopic Pregnancy Signs and Symptoms The early signs and symptoms of ectopic pregnancy are usually so subtle, if they are even present, which is why it is quite difficult to make an early diagnosis. The average time for the signs and symptoms of ectopic pregnancy to present themselves is about 7.2 weeks following the last menstruation, and the range is from 5 to 8 weeks. Diagnosis may come in even later for areas where facilities are insufficient. The following are the early presentations of ectopic pregnancy: Hypogastric pain accompanied by a sensation of swelling. The pain may be perceived as intense stomach pain, but the pain may also occur in the form of a strong cramping sensation.Dysuria, or pain when urinatingA vague abdominal discomfort which is similar to symptoms brought about by the presence of corpus luteum in the ovaryMild vaginal bleeding. This is a form of withdrawal bleeding, a phenomenon that occurs when progesterone levels go down. This symptom may also be noted during the early stage of pregnancy (also called “implantation bleed”) or during a miscarriage.Abdominal pain during a bowel movement.Later on, ectopic pregnancy presents itself as pain and bleeding, which may be vaginal or abdominal, or both. The causes of bleeding are as follows: Hormonal trigger, i.e., a drop in the level of progesterone• Peritoneal bleeding secondary to rupture of the Fallopian tube Some of the differential diagnoses are miscarriage and normal pregnancy in its early stage. Pelvic inflammatory disease, or PID, is the most common faulty diagnosis for ectopic pregnancy. To rule out the presence of PID, a pregnancy test can be performed. A positive pregnancy test essentially rules out PID because a pregnancy that is concurrent with an active pelvic infection is very rare. When bleeding becomes more profuse, the following symptoms may occur: • Pain which may be located at the lower back, abdomen, and pelvis • Shoulder pain. This is regarded as a dangerous sign because it indicates irritation of the diaphragm secondary to the blood that is filling up the abdomen. • Unilateral pelvic tenderness and cramping sensation • The pain is comparatively acute as opposed to other more chronic pelvic pain, which worsens with time. Ectopic pregnancy should also be differentiated from other conditions like pelvic inflammatory disease, appendicitis, and other gynaecological, gastrointestinal, and urinary problems. Ectopic Pregnancy Causes While a number of risk factors for ectopic pregnancy have been identified in previous studies, no particular risk factor can be singled out in 30 to 50 per cent of cases. Infertility, smoking, endometriosis, a previous history of pelvic inflammatory disease, prior use of DES, a history of D & C or other uterine surgeries, tubal surgery, use of an IUD or intrauterine device, tubal ligation, and a history of ectopic pregnancy are just some of the risk factors enumerated. Ectopic Pregnancy Treatment Medical Methotrexate has been used for the nonsurgical treatment of ectopic pregnancy since 1993. Methotrexate can halt the growth of the embryo, inducing either an abortion or resorption of the embryologic tissue or the passage of the products of conception during the woman's regular menstrual period. If administered early enough, methotrexate is effective in terminating ectopic pregnancy. Surgical Surgical treatment may have to be initiated once bleeding has set in. In a patient with only little bleeding seen on ultrasound, however, the decision to perform surgery turns into a dilemma. Studies to back this up will have to be identified. Two surgical procedures, laparoscopy and laparotomy, can be used by the surgeons. Both approaches can provide a visualization of the pelvis and the affected Fallopian tube. The tube can then be incised either by taking out only the portion where the embryo has implanted (salpingostomy) or by taking out the entire tube (salpingectomy). Robert Lawson Tait is credited for doing the first successful surgery for an ectopic pregnancy, which took place in 1883.
Ultrasound in Pregnancy Ultrasound is a ubiquitous technology in all areas of medicine but many people are either ignorant of the nature of the technology or have a misguided notion of it. It is not unusual to find people putting it in the same bracket as an x-ray. This misguided impression can quite understandably evoke significant anxiety, especially where pregnancy is concerned. Let’s start by stating a simple but important fact. Ultrasound does not involve ionising radiation.Ultrasound is a form of sound waves generated at very high frequency. This will be in the range of 3.5 to 7 million cycles per second (Megahertz). Normal sound waves audible to the ear are at a much lower frequency of fewer than 20 thousand cycles per second. How Ultrasound Works The sound waves are produced by a crystal built in the probe used for the test. The waves are then reflected from the various structures they encounter as they travel through the body. The data produced by the reflected waves is then processed by the computer in the scanning machine to produce an image on the screen representative of the reflecting structures. That is how the detailed image of the pregnant uterus and baby within, complete with movements, is produced and seen in real-time. The conventional position for an obstetric ultrasound is on your back, usually propped up comfortably to allow you a clear view of the monitor screen. A clear, water-based conducting gel is applied to the abdomen. The gel helps transmit the sound waves. A hand-held probe is then moved over the area in a systematic way. Alternatively, the ultrasound scan is performed with the probe placed in the vagina (transvaginal ultrasound scanning). This technique often complements conventional transabdominal ultrasound techniques by providing better detail especially in the very early phase of pregnancy such as in the early pregnancy scan. A woman will normally be advised accordingly if this is deemed to be the more appropriate route or sometimes as an additional measure if the abdominal route has not provided all the required information. Preparation A full bladder is necessary to get a good picture. Therefore, the person due to being scanned will be asked to drink a few glasses of water (or similar) an hour or so before the test and to refrain from urinating before the procedure. A full bladder is, however, not necessary for the transvaginal Ultrasound. There may be some slight discomfort from pressure on the full bladder otherwise the procedure is perfectly painless. The conducting gel may feel slightly cold and wet. There is no perception of the sound waves and of-course you cannot hear them. When to have a Scan Scans may be performed in the First Trimester to: Confirm a normal pregnancy Confirm viability Assess the baby's age (gestation) Assess potential problems such as threatened miscarriage, ectopic pregnancy etc. Assess the baby's heartbeat Confirm the number of embryos/fetuses Identify any abnormalities of the placenta, uterus, and other pelvic structures The main early trimester scans are the early pregnancy scan and the dating scan. In the Second Trimester (after 13 weeks) Assess the baby's age, growth, position, and sometimes gender. A detailed look at the baby’s vital organs and limbs to identify or rule out any possible congenital problems. Identify any developmental (growth) problems Rule out multiple pregnancies Evaluate the placenta, amniotic fluid, and other pelvic organs. In the Third Trimester (after 26 weeks):Scans not normally required at this stage except when monitoring pregnancy development and fetal wellbeing in special situations: these may include: Multiple pregnancies Suspected fetal growth problems Chronic medical conditions such as diabetes, hypertension, epilepsy etc. Pre-eclampsiaOther situations where a scan may be called for are when there is a need to: Detect cervical changes that might predict preterm labour. Verify breech presentation or other uncommon fetal or cord position before delivery. Get valuable information leading to treatment of any conditions arising in the course of a pregnancy in a bid to improve a woman’s chances of having a healthy baby. Scan Aided Tests and Procedures Pregnancy ultrasound plays a crucial role in antenatal care. Some tests which are routinely done for diagnostic purposes are directly ultrasound-guided. Such tests include: Amniocentesis: This is the most well-known and commonest invasive test used to make a diagnosis of any condition that may be affecting the fetus. It is commonly performed in the early second trimester (15 – 16 weeks) and is now routinely ultrasound-guided. An amniocentesis is a test in which the cells that are floating in the fluid surrounding the fetus are examined for the chromosomal pattern of the fetus. The operator will have the ultrasound probe on the abdomen and will guide the fine needle used under direct ultrasound guidance into the womb. Once the tip is seen to be inside a pool of amniotic fluid, a sample will be drawn for the test. Normally this takes a few short minutes and in the vast majority, only one attempt is sufficient.Amniocentesis results are usually available two to three weeks after the test. Amniocentesis carries a risk of losing the pregnancy of about 0.5 - 1% (1 in 100-200). Age is probably the commonest indication for requesting amniocentesis usually for the diagnosis of Down’s Syndrome. This is because, all other factors being normal, the older the mother, the higher the risk of Down’s and other chromosomal disorders. A 21-year-old mother has a 1:1700 risk of having a baby with Down’s Syndrome, a 30 year old 1:950, at 40 the risk is almost 1:100 and by 45 years of age, it is 1:30.As mentioned earlier while these statistics refer to the most recognized chromosomal anomaly, there are other anomalies, some of them incompatible with life. It is therefore important for any prospective mother to be aware that the overall risk of all chromosomal anomalies is significantly higher than that of Down’s alone at any stage of life. A 201-year-old will, therefore, have an overall chromosomal abnormalities risk (for her baby) of about 1:500 and at 40 the risk would have risen to 1:66.CVS: This stands for Chorionic Villus Sampling which simply means taking a biopsy from the developing placenta. It is also ultrasound-guided. The procedure is also performed under direct ultrasound guidance. It differs from amniocentesis in three major aspects: It can and is usually performed earlier in the pregnancy. This is towards the end of the first trimester. Results are available much more rapidly with a normal turnaround of 48 – 72 hours. It has a significantly higher procedure associated miscarriage rate which could be as much as twice that of amniocentesis. Fetal Echocardiography: Congenital heart defects occur in about 1% of live births. Causes are multiple and sometimes cannot be identified. Whilst a routine detailed ultrasound scan performed at 18-20 weeks will focus on the heart among other major organs, not all defects will be detected. It is also sometimes necessary to perform a much more detailed study of the baby’s heart. This specialised structural study using ultrasound is called echocardiography or popularly just shortened as ‘echo’. Situations, where this may be recommended, include: A family history of congenital heart disease An abnormal fetal heart rhythm detected during a routine examination. Fetal heart abnormalities detected during a routine pregnancy ultrasound scan Abnormality of another major organ system such as the gut or lungs. Insulin-dependent (type 1) diabetes Exposure to some drugs in very early pregnancy. For example, some anticonvulsants used to treat epilepsy can damage the developing heart. If the mother has abused alcohol or drugs during pregnancy If a mother has diabetes, phenylketonuria, or a connective tissue disease such as lupus If the mother has had rubella during pregnancy Diagnosis of some chromosomal abnormalities Cordocentesis Sometimes it becomes necessary to obtain a sample of blood from the umbilical cord of the unborn baby, usually for diagnostic purposes. This requires direct ultrasound visualization. This would simply not be feasible without the aid of ultrasound. In some condition, transfusion of blood into the unborn baby is performed. Again, this is directly dependent on ultrasound.There are many other areas where ultrasound in pregnancy is not only useful but indispensable. These include localization of the placenta which could help determine the safest mode and timing of delivery, checking pattern of blood flow in the cord, a useful feature in monitoring fetal well-being in at-risk fetuses, estimating fetal weight which could be useful in making important decisions and many more. Biophysical ProfileSometimes there is concern about the unborn baby’s wellbeing. This may be because the baby is not moving well, growth is unsatisfactory or the pregnant mother is suffering from such conditions as pre-eclampsia, diabetes etc. It may, in such circumstances, be deemed necessary to monitor the baby closely and one of the strategies sometimes adopted is to perform what is known as a biophysical profile > With this one checks the baby’s movements, general muscle tone, breathing movements and fetal heart pattern. Apart from the latter, the rest is all done by using ultrasound. Transvaginal Ultrasound scanning The idea of having the scan performed vaginally can and does provoke anxiety for some women. It is important to say that this is a safe procedure and does not in any way pose a risk to either mother or baby.In very early pregnancy, this may be the preferable method of scanning as it produces sharper details and may give crucial information otherwise unobtainable (using trans-abdominal scanning). It is also the case that a transvaginal scan does not require a full bladder, not the most comfortable of requirement especially for an expectant mother struggling with perpetual nausea. A vaginal scan also circumvents the difficulties with obtaining a good view of the embryo/fetus in early pregnancy for women who are overweight or obese. Amniotic FluidUltrasound scanning is quite useful in estimating the amniotic fluid volume. This is easy to do and in most cases, this will be normal. However, where the volume is found to be reduced or increased, it could be a very important gauge of the baby’s wellbeing. It may also be the first warning that something is not quite right with the baby and could trigger further, more specific, tests. Serial ultrasound scan monitoring of fluid volume is sometimes used to monitor the progress of a pregnancy and together with other tests could be used to make a decision on the timing and/or mode of delivery. Placental locationIt is not possible through a physical examination to tell the exact location of a placenta in the womb. For the majority of pregnant women, this is really of no importance. However, about 1 in 50 mothers (2%) will have placenta praevia (low-lying placenta) at term. This is a potentially dangerous condition for both mother and baby and most of those affected will need close antenatal observation and delivery by caesarean section. Ultrasound scanning does accurately locate the placenta and aid in making these crucial decisions.It is important to stress that almost one in five women will be found to have a ‘low-lying’ placenta at their 20 weeks pregnancy scan. This is no cause for panic as for the vast majority of them, the placenta will be normally located by the time they get to the third trimester. Many units offer a repeat ultrasound scan at around 32-34 weeks as a form of reassurance. Placental abruptionPlacenta praevia (above) is not to be confused with Placental abruption (abruption placenta). The two conditions are not related even though for both the main concern is severe haemorrhage that is associated with them. In placental abruption, the placenta gets partly or wholly detached from the womb. That will cause bleeding and in most cases, pain. The extent of the bleeding and therefore its effect on the baby will depend on the degree of placental detachment. Ultrasound scanning has a limited role in placental abruption. The diagnosis is mainly secured on a clinical presentation rather than ultrasound findings. Twins and ultrasound scanningIn days gone by, it was not unusual for twins and rarely other forms of multiple pregnancies not to be discovered until the time of delivery. Ultrasound changed all that. It is exceedingly unusual for that to happen in modern times in most developed countries. Over 95% of mothers in the United Kingdom have antenatal ultrasound scans and the figure is just over 70% in the USA. Even in those countries where ultrasound scans are not offered as a matter of course, the obstetrician or midwife looking after the pregnant woman will suspect the presence of multiple pregnancies in the course of examining her abdomen. This will usually trigger a recommendation for an ultrasound scan. Confirming the number of fetuses is then, in most cases, a straightforward affair. Identical or not?Many prospective mothers carrying twins are anxious to know whether the babies are identical or not. In many (but not all) cases it is possible to tell whether they are or not using ultrasound scanning.If the twins are sharing the same gestation sac or even if they are in different sacs but sharing the same placenta, they are then definitely identical. This is, however, not that common (and a good thing too).Most twins have separate placentas and sacs. These could be identical or non-identical. It is sometimes possible to tell with a fair degree of confidence whether such twins are identical or not depending on the timing of the ultrasound scan. Of-course if the twins are of different sex, that is confirmatory that they are non-identical. However, it is only possible to tell the gender of a fetus after about 16-17 weeks. The babies have also got to be in a favourable position to be able to do this.Sharing a sac or placenta not good?This is not the best form for twins as there are significant potential complications unique to this type of twins. Some of these complications can be life-threatening for the one or both babies. The subject is discussed further in the section on multiple pregnancies. Doppler UltrasoundWhen there are problems or suspected complications, this special type of ultrasound may be employed to try to get important information which may aid in decision making. It takes its name from the 19th-century Austrian physicist Christian Doppler who was the first to describe the phenomenon. So, what is it?Doppler ultrasound is a form of ultrasound that can detect and measure blood flow. Doppler ultrasound depends on the Doppler effect, a change in the frequency of a wave resulting here from the motion of a reflector, in this case, the red blood cells.If you are keen to know what the various types of Doppler Ultrasound are, here we will attempt to explain. It is not a walk in the park. Don’t say you haven’t been warned. Colour Doppler -- This technique estimates the average velocity of flow within a vessel by colour coding the information. The direction of blood flow is assigned the colour red or blue, indicating flow toward or away from the ultrasound probe (transducer). Pulsed Doppler -- This method allows a sampling volume or "gate" to be positioned in a vessel visualized on the grey-scale image, and displays a graph of the full range of blood velocities within the gate versus time. The amplitude of the signal is approximately proportional to the number of red blood cells and is indicated, not in colour, but simply as a shade of grey. Power Doppler -- This device depicts the amplitude, or power, of Doppler signals rather than the frequency shift. This allows detection of a larger range of Doppler shifts and thus better visualisation of small vessels, but at the expense of directional and velocity information. Color Doppler depicts blood flow in a region and is used as a guide for the placement of the pulsed Doppler gate for more detailed analysis at a particular site.Doppler ultrasound has many applications including, for example, the detection and measurement of decreased or obstructed blood flow to the legs as in suspected DVT. Colour Doppler ultrasound is done first to evaluate vessels rapidly for abnormalities and to guide placement of the pulsed Doppler to gain sample volume for detailed analysis of velocities. The bottom line:It is very difficult to imagine modern obstetrics without ultrasound. It is an integral part of the care of the pregnant mother and her unborn baby and there is no doubt at all that millions of people across the globe arguably owe their lives to this technology which is now taken as a matter of course. Twins and other forms of multiple pregnancies FrequencyAbout 1% of spontaneous conceptions among the Caucasian population will be twins or other less common forms of multiple pregnancies. The rate is slightly higher for those of black African ancestry and somewhat lower for Japanese and others of oriental ancestry. The rate of multiple pregnancies in assisted conception such as IVF is significantly higher. For any individual woman, family history is a significant factor. If a woman is a twin herself, she has a much higher chance than average of having twins herself. The same applies to a woman who has first-degree twin relatives i.e. siblings or parents. The rate of identical twins is however constant and is not influenced by age, race, family history or any other factors. Monozygotic twins is another term to describe identical twins. The rate is roughly 4 per 1,000 births. Twin IssuesTwins may be exciting but these pregnancies also have their own specific challenges. It is important to stress up-front that the majority of twin pregnancies, upwards of 85%, have a completely successful outcome and dispel the impression that twin pregnancy is automatically bad news.That done, let's turn to the common saying, which happens to be largely true, that doctors and midwives like repeating when speaking about twin pregnancies. The saying goes “all pregnancy complications are commoner in twins apart from prolonged pregnancy”. That is an important and honest starting point. So, when you talk of prematurity, pre-eclampsia, placental abruption, growth restriction, antepartum haemorrhage, postpartum haemorrhage, it is a true general statement that the risk of any of these is higher, the bigger the number of babies a woman is carrying. Unique Twin Issues: Increased risk of pregnancy complications is not the only issue that needs to be dealt with. There are problems that are unique to twin pregnancy. The most important one of these is a twin-to-twin transfusion. This condition occurs only in identical (monozygotic twins) and specifically those who share a placenta. The medical term for a common placenta in twins is monochorionic. It is true that twins that share a placenta have got multiple blood vessel communications within that placenta. These communications are not always a problem and in many if not most cases there is no problem as there is physiological equilibration of the blood flow in both. However, for some, these communications are a problem which is sometimes lethal for one or both. This is brought about by an imbalance in the blood flow whereby one ends up as a ‘donor’ and the other a ‘recipient’. It means there is a net flow of blood to the recipient and this is the one at greatest risk as he/she gets overloaded. Can anything be done? When twin-to-twin transfusion is suspected or diagnosed, the care becomes a specialist issue. There will be serial ultrasound scanning to track the progress of the condition of the twins. Other tests will also be done to keep a close eye on the babies. Sometimes intervention is required to try to reduce the severity of the condition. In most cases, delivery is early to try to prevent further deterioration. Not all cases of twin-to-twin transfusion are that severe. Some are mild enough not to require any intervention. Vanishing twin It is true but probably not widely recognised that twin pregnancies in the second and third trimester represent at most two-third of pregnancies that start as such. What does this mean? Basically, it means, a lot more pregnancies start as twins. For a variety of reasons some embryos in twin pregnancies do not make it beyond the first few weeks and these pregnancies continue as singleton pregnancies. Some of these women would have had early ultrasound scans say at 6 or 7 weeks. Presence of twins would have been identified then and a repeat scan a few weeks down the line a repeat scan shows, not two, but one fetus. The other twin has ‘vanished’.As mentioned earlier, this phenomenon is estimated to affect up to a third of all twins that start as such. Mercifully, this vanishing occurs fairly early before the first scan for most affected mothers and therefore these will be oblivious of the fact that they started off with twins. The loss of the one twin is usually accompanied by very mild or no noticeable symptoms.
Scan Anxiety- Scanxiety and the truth There have been lots of talks lately on the newspapers and online about scanxiety - someone created a fancy word to describe anxiety before diagnostic scans such as CT and MRI. The term quickly included private ultrasound scans mainly private pregnancy scans in a newspaper attempt to grab the reader’s attention. The Guardian headline reads:"Scanxiety: why private baby scans are on the riseMany pregnant women are paying for extra ultrasounds, for reassurance or for ‘souvenir scans’. But does multiple scanning pose a risk to the unborn child?" The MailOnline article reads:Pregnant women with 'scanxiety' are told to avoid private ultrasounds as firms offer multiple scans to assuage their fears Study found almost a third of mothers-to-be pay for extra scans while pregnant Many do so due to anxiety, despite NHS offering scans at 12 weeks and 20 weeks Parent site ChannelMum.com says ‘pop-up’ firms target women with 'scanxiety' Another article on MailOnline reads:The rise of 'scanxiety': Pregnant women are risking their babies' health by paying for unnecessary scans UK and US guidelines advise getting two scans: one at 12 weeks, one at 20 weeks A new study shows a third of mothers-to-be pay for extra private ultrasounds Too many high-intensity scans may cause harm to the foetus, experts warn Anxiety over the baby's health may be doing more harm than good, they say Going through these articles as a qualified sonographer with more than 15 years experience, i found out that they were full of inaccuracies, misinformation and scaremongering. Ultrasound is used in pregnancy since the late 70s. There were a few research publications suggesting that ultrasound might affect the growth of the unborn baby but with no conclusive evidence and consequent studies failed to duplicate the results. The medical community, therefore, is suggesting that ultrasound should be used where clinically indicated. NICE recommends 2 scans at 12 and 20 weeks as sufficient during the pregnancy. A new study in England, however, shows that almost a third of expectant mothers are paying for additional private scans. So NICE knows better than the pregnant mothers or is it because NICE has to take into account the lack of NHS sonographers and midwives and try to alleviate the stress on the NHS? If two ultrasound scans are enough in the UK, why they are not enough in the USA, Australia and most other European countries? So would you say to an expectant mother and her partner who had a miscarriage and sometimes, unfortunately, multiple ones, who are in the waiting room shaking waiting to find out if their baby has a heartbeat that is overreacting and suffering from scanxiety? Do you think that the ultrasound scan is clinically indicated? I would say yes as the ultrasound scan will either reassure them, that their baby is alive or at the worst case scenario will confirm their fear but at least they will know and they will be able to deal with it. In very anxious patients, sometimes a quick scan is the best option for alleviating stress which is helpful in so many other ways. In our London ultrasound clinic, we do not just do pregnancy scans such the early pregnancy/reassurance scan but we do a variety of other ultrasonic examinations such as abdominal, pelvic and musculoskeletal examinations. We have clients from all walks of life including health care professionals who are not willing to wait 6+ weeks to have a scan on the NHS as they want to find out if there is something wrong with them and treat it ASAP. We assume that these clients are suffering from scanxiety too but all these articles concentrated on expecting mothers as a soft target. Never the less anxiety associated with the results of a scan either ultrasound, CT or MRI between cancer patients is well documented. Some concerns on these articles arise from the intensity of the ultrasound beam and the length of ultrasound scanning. The intensity of the ultrasound beam is significantly higher on 4D scans than 2D scans as is the scanning time. In our London ultrasound clinic we do not offer 4D ultrasound scans but most of the ultrasound clinics that do offer them, they offer them later in pregnancy at 20+ weeks, when the baby is well developed and the effects of ultrasound intensity are minimal. The most valid point of these articles is the use of untrained/unqualified sonographers. I am not aware of any ultrasound clinics in the UK that uses unqualified sonographers and as far as I know, most of the ultrasound clinics are registered with CQC. Never the less the DailyMail has compiled a list with tips on finding a reputable scanning clinic: TIPS ON FINDING A REPUTABLE SCANNING CLINIC · Check that your ultrasound clinic is registered with the Care Quality Commission, to ensure it meets professional standards.· Look online for clinic reviews and check how long the company has been established.· Ask the clinic about staff qualifications and experience. Any reputable firm will be happy to help. Your sonographer should be HCPC qualified.· Some clinics do offer discounts to make the treatment affordable for everyone. However if you are being pressured to buy more packages than you need or can afford, consider going elsewhere. It's your body, your baby and your choice.· If you feel overly anxious, speak with your midwife. Your ultrasound clinic will work with him or her. If you have any questions please feel free to contact us. What can be seen on ultrasound during the early Pregnancy Scan Pregnancy or baby ultrasound scans are a routine part of prenatal care. Ultrasound scans are completely painless, have no known side effects on mothers or babies, and can be carried out at any stage of pregnancy: in early pregnancy, ultrasound is being used to confirm the baby's heartbeat and exclude any early stage abnormalities; later in pregnancy ultrasound is being used to evaluate the baby's overall health. It may be worth noting that spotting is common in pregnancy. Usually, it's nothing to worry about, but it's always best to double check with your doctor or midwife.What can be seen during the early scan: At 5 weeks gestation (i.e 3 weeks after conception) a small gestation sac might be visible. At 6 weeks, the yolk sac, the embryo (foetal pole) and the heartbeat might be visible. At 7 weeks the embryo will be around 10mm with a fast heartbeat. At 8 weeks, the embryo will be around 16mm and the body and the head might be distinguishable. The embryonic movement might also be seen. At 9 weeks, the embryo is now a foetus and head, body and limbs start to form.
6-week Pregnancy Scan Congratulations on your pregnancy and welcome to the world of pregnancy ultrasounds. The 6 weeks early pregnancy or the early pregnancy scan as more commonly known will possibly be the first time the parents will meet their baby. Reasons for the 6 Week Ultrasound scan 6-week ultrasound scans are not routinely offered by the NHS. You might want to have a private 6 weeks ultrasound scan if you suspect that your pregnancy is not progressing well or if you would like a definite pregnancy dating confirmation. Most common reasons for a 6 Week Ultrasound Scan Previous miscarriage. You had fertility treatment. Pelvic pain on one side Vaginal spotting or bleeding. you are unsure how far along you are in your pregnancy. What should you see on a 6-week scan? At 6 weeks, the yolk sac, the embryo (foetal pole) and the heartbeat might be visible. At 6 weeks, you won't, in general, be able to see much detail of your baby. The ultrasound scan, however, should be able to confirm the gestation age by measuring either the gestation sac or the foetal pole if visible. Sometimes but not always you will be able to see the baby's heartbeat. Most importantly the sonographer will be able to check that your baby is within the endometrial cavity and that you do not have an ectopic pregnancy. Ectopic pregnancy is when the fertilized egg attaches itself outside of the uterus with the most common location being the fallopian tube on the side where you ovulated from. Everyone obviously is different and sometimes a follow-up ultrasound in a week to 10 days later might be necessary to give you more information. Your baby at 6 weeks How many MM is a 6 week old foetus? At 6 weeks, your baby should measure approximately 5-9mms in length. Can you see the baby at 6 weeks? 6 weeks into your pregnancy is also the earliest time you might be able to see the foetal pole and the foetal heartbeat. Can you see the baby heartbeat at 6 week scan? The foetal heartbeat is seen like two parallel lines flickering. Most literature is saying that the foetal heartbeat should be around 90-110 beats per minute but we have seen slower heartbeats with positive pregnancy outcomes. The yolk sac, a ring shape bright circle might also be visible. The yolk sac is where your baby is feeding on at this early stage in pregnancy. Sometimes only the gestation sac is visible with no foetal pole or yolk sac and you might be asked to come back in a week to 10 days as you might be earlier in your pregnancy than you think. What is the earliest You can have a pregnancy scan? The 6-week scan is the most common gestation age that an ultrasound is performed. We do not recommend a scan before the 6 weeks gestation unless you are worried about a miscarriage or an ectopic pregnancy, as at 5 weeks gestation you will possibly see the endometrium being thickened and echo bright and possibly a gestation sac. You may want also want to read more about the 7 week scan and the 8+ week scan. What happens at a 6 week scan? It is more likely that at 6 weeks gestation age you will need to have a transvaginal or internal ultrasound scan instead of a transabdominal scan (through the abdomen). This is because it is early stage and everything is still small. The transvaginal scan will be able to get closer to the endometrium and produce a better clearer image of the pregnancy insitu. A 6-week ultrasound can also help to find the cause for any early pregnancy pain or bleeding. Feeling nervous about having an ultrasound scan so early in your pregnancy is normal. Try to stay calm and prepare yourself for what may happen. Bringing with you your partner or a close family member for extra support might be a good idea. How many scans will I have during pregnancy through the NHS? You will have at least two ultrasound scans during your pregnancy provided by the NHS: a 12-week dating scan and a 20-week anomaly scan. The 12-week scan will provide confirmation and dating for your pregnancy. The 20-week scan will provide information about your baby's growth and development. About Pregnancy Scans A pregnancy ultrasound scan is the same as a ‘normal’ scan but it is being used to evaluate the overall health of your baby instead of looking at other organs such as gallbladder for gallstones or kidney for kidney stones. So in pregnancy ultrasound scans are being used to visualise the baby, the placenta, the uterus and cervix and your ovaries.Pregnancy ultrasound scans or prenatal ultrasounds are very common and being carried in any stage of the pregnancy. If you have any questions or you want to know more about our private ultrasound please leave a comment and we will do our best to answer. At our private ultrasound clinic, we offer pregnancy scans from as early as 5-6 weeks in times to suit you. Who interprets the results of the early pregnancy scan and how do I get them? A Sonographer, a Health Care Professional specifically trained to perform and understand the ultrasound images, will most likely do your exam and provide you with a written report that you can take it your doctor. About Ultrasound Diagnostic Medical ultrasound scan or medical sonography as otherwise known is a painless imaging technique utilising sound waves to produce internal images of the body.It is called ultrasound as the sound frequency being used is at the region of 1 to 20MHz. The human ear cant can’t hear these frequencies.The sound waves are produced by the transducer or the probe as most commonly known. As they travel through the body they bounce back to the transducer due to various sound transmissions differences in tissues. The returning echoes are picked up by the probe and a powerful computer analyses the echoes and creates the 2d image on the screen.There are various kinds of ultrasound scans that can be performed and each looks at different organs of the body such as tendons, muscles, joints, blood vessels, liver, kidneys, uterus and ovaries to confirm or exclude possible pathology.Unlike Ct and MRI, ultrasound does not use radiation and therefore is pregnancy-friendly. It is also live and is ideal for musculoskeletal exams to evaluate moving joints. Other ultrasound scans related to pregnancy? Some mothers to be will, unfortunately, get various complications during pregnancy such as high blood pressure, kidney infections and abnormal liver function tests. As ultrasound scans are pregnancy-friendly your doctor might refer you for an abdominal/liver scan or a kidney scan to check for anything that might explain your symptoms. Although these ultrasound scans are not pregnancy scans, they are related to pregnancy and in most cases, all the complications resolve after delivery. But like everything else related to your health and your baby’s health: better safe than sorry. What are ultrasound scans used for in pregnancy? Depending on your stage of pregnancy, ultrasounds will be used to give you and your doctor or midwife answers about your pregnancy. First Trimester Ultrasounds Check that you are pregnant and that your baby has a heartbeat. Check if you have a singleton or twins Make sure that the pregnancy is not an ectopic located within the endometrial cavity and is not outside the womb such as in the fallopian tube. Look for the cause of any bleeding you might have. Date the pregnancy by measuring the crown-rump length of the foetal pole. Second Trimester Ultrasounds Verify dates and growth Estimate the baby's risk of Down's syndrome by measuring fluid at the back of your baby’s neck between about 10 weeks and 14 weeks Help with diagnostic tests by showing the position of the baby and placenta. Check your baby to see if all his organs are normal. Diagnose abnormalities Assess the amount of amniotic fluid and the location of the placenta. Evaluation of fetal well-being Third-trimester Ultrasounds Make sure your baby is growing at the expected rate. Confirm if your baby is a boy or a girl.