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An obstetrician is a doctor who helps with the management of pregnancies and deliveries. In order to optimize ones’ chances of having a smooth pregnancy and delivery, having knowledge of pregnancy and fertility issues even before conception will allow couples to plan and prepare better for the delivery of a healthy baby.
We know from scientific studies that babies born at the extremes of birthweight either under 2.5kg or over 4.5kg are at an increased risk of developing chronic diseases later in life such as diabetes and heart disease. Studies have also found that food chemicals can act to switch certain genes on and off in the developing fetus during pregnancy through a process called ‘epigenetics’. A mother’s nutrition is therefore important even before she is pregnant as it can affect the development and subsequent health of her baby.
Being overweight or underweight can also affect fertility. Hence, optimizing ones’ health and observing a healthy diet and lifestyle should begin even before conception and pregnancy as it can affect a couples’ chance of getting pregnant in the first place.
If you have plans to start trying to conceive, consider making an appointment with us for a Prepregnancy or Preconception health screen and consultation, where we can address your concerns, and discuss diet and lifestyle issues for a healthy pregnancy.
Going for a prepregnancy health screening package is ideal to ensure that any health issues are addressed before pregnancy. This usually comprises a thorough examination and investigations. We will then review the investigation results and provide the necessary advice with regards to fertility and pregnancy. For example, if a patient is found to lack immunity against rubella, vaccination is advisable as infection during pregnancy can cause congenital defects in the baby.
Prenatal pregnancy tests are performed during pregnancy for several reasons: 1) to diagnose and treat any pregnancy conditions that may affect fetal development e.g. diabetes or high blood pressure, and 2) to detect any health problems in the growing fetus.
Prenatal tests are performed throughout pregnancy. The exact tests ordered will depend on the stage of the pregnancy, the age and health of the mother, the medical history of both parents, and the family history. Ideally, mums-to-be should seek a consultation with their obstetrician & gynaecologist as soon as they are pregnant in order to allow the appropriate tests to be scheduled.
At every prenatal visit, an assessment of the mum- to-be’s weight, height, blood pressure and urine- analysis are performed. These help to screen for any high blood pressure, infections or gestational diabetes. In many cases, complications can be avoided if early diagnosis is made and treatment initiated.
Routine Prenatal Pregnancy Blood tests include the following:
There is a small risk of fetal abnormality with every pregnancy. Unfortunately, this risk increases as the mother gets older. Prenatal screening is offered to all pregnant women to determine more accurately, the risk of having a baby with a chromosomal disorder such as Down’s Syndrome.
Screening tests for chromosomal disorders:
This test is also known as the OSCAR (One- Stop Clinic for Assessment of Risks of Fetal Anomalies). This includes a scan of the nuchal translucency or fluid filled space behind the fetal neck. A nasal bone assessment is also usually done as babies with Down Syndrome may have absence of the nasal bone. The scans may be combined with a blood test from the mother for hormone and biochemical markers for a more accurate risk assessment.
This involves a simple blood test from the mother which may be interpreted alone, or in combination with the First trimester screening scan for a more accurate risk assessment.
This is a highly sensitive screening test for fetal genetic conditions including Trisomy 21, 13 and 18. It can detect these conditions with a sensitivity of 99%. It involves a simple blood test from the mother and detects the free fetal DNA present in the mother’s circulation, thereby assessing if there may be a genetic abnormality in the baby. The blood test can be drawn from the mother as early as 10 weeks of pregnancy and the results are available in 2 weeks.
Diagnostic tests for fetal chromosomal disorders
Depending on the final risk assessment, the patient may be advised to undergo a diagnostic test such as chorionic villus sampling (CVS) or amniocentesis. The amniocentesis is normally carried out from 15 weeks of pregnancy. A needle is inserted into the amniotic cavity and amniotic fluid is sampled, allowing culture and assessment of fetal cells in the fluid. Fetal cells in the amniotic fluid can then be analysed. There is however a risk of miscarriage of around 0.5%
The CVS can be carried out earlier - usually between 10-13 weeks of pregnancy. It involves sampling of the developing placenta and again the same type of analysis of fetal cells to detect chromosomal, genetically inherited and endocrine or metabolic conditions can be performed. There is a risk of miscarriage of 1-2%. While these diagnostic tests help to confirm if the baby truly carries a chromosomal disorder, these tests are invasive and carry a small risk of miscarriage. Hence, they are not offered as a routine.
Dating and Viability Pregnancy Scan
At around 6 weeks of pregnancy, an early dating ultrasound scan will help confirm the location and gestational age of the embryo and check whether it is a single or twin pregnancy.
Fetal Anomaly Screening Scan
At around 20 weeks of pregnancy, a fetal anomaly scan is usually performed to assess the baby’s growth, anatomy, placental position and cervical status. This scan can usually detect up to 90% of the major abnormalities.
Pregnancy Growth Scan
From 24 weeks of pregnancy, patients are usually seen on a monthly basis up to 32 weeks, fortnightly up to 36 weeks, and finally weekly until delivery.
Pregnancy growth scans are usually performed after 24 weeks of pregnancy to ensure that your baby is growing well. They also evaluate the placental location and amniotic fluid volume. The use of colour Doppler ultrasound helps to assess the blood flow in the umbilical cord and other blood vessels in the baby. The results from such scans can help determine if the blood is circulating properly and if the baby is under stress.
3D and 4D scans
A 3D scan provides a life-like image of your baby while a 4D scan is a real-time moving image of the baby. These scans may take around 30 minutes or longer depending on your baby’s position and movement. They may help to provide reassurance that baby is growing well, but are not meant to replace the screening scans which are advised in the second trimester.
This is a recording of the fetal heart rate. It is performed to determine the baby’s well being. It also helps to assess for the presence of uterine contractions.
The 3 modes of delivery are normal vaginal delivery, assisted or instrumental delivery, and Caesarean. Most women are encouraged to try for a normal vaginal delivery. Occasionally, some require help with forceps or a vacuum cup. Others may require a Caesarean section.
Each mode of delivery has its benefits and risks. Every woman is unique with different pain thresholds and perceptions of how their delivery should be conducted. Do share with us your birth plan so that we can work with you towards the safe delivery of your child.
Following delivery, we are strong advocates of breast feeding and will be happy to provide advice and support in this area.