Frequently Asked Questions (FAQs)

1.  Is it Doctor or Mister?
2.  When is the best time to have my Nuchal scan?
3.  Do I have to have the bloods also or can I just have the scan?
4.  Does the Nuchal scan and the blood test and the quadruple blood test at 15 to 22 weeks screen for anything else besides Down’s?
5.  Do I need to have an early pregnancy scan or can I just come for the Nuchal?
6.  What is the risk of miscarriage when doing a CVS or Amniocentesis?
7.  What is the accuracy of my CVS/Amniocentesis results?
8.  How long rest is needed after the CVS/Amniocentesis procedure?
9.  When is it harmful to have a scan/which stage of pregnancy?
10.How many scans during my pregnancy do I need?
11.How accurate is the gender scan?
12.Is it safe to travel in pregnancy?
13.Can I fly during pregnancy?

1. Is it Doctor or Mister?

In the UK, consultants in obstetrics and gynaecology are also surgeons and therefore are entitled to be called Mister instead of Doctor. The Australian system has not followed this trend. Being an Australian graduate as well as holding membership of both the UK and Australian Royal Colleges, Mr. Maxwell can be called by either title and has no personal preference.

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2. When is the best time to have my Nuchal scan?

The nuchal translucency scan is combined with a blood test and an early examination of baby. The research data on which this type of screening is based tells us that the scan should be done between 11 weeks and 13 weeks and 6 days. More precisely this equates to a quite narrow range for the fetal head to bottom measurement (crown rump length). Scan information outside this range is not interpretable in the same way.

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3. Do I have to have the bloods also or can I just have the scan?

The Down Syndrome screen at 11 to 14 weeks is more accurate if the results of the blood test are analysed at the same time. However, some people will not want to screen for Down and there is no reason why they should not have a scan to confirm the viability of the baby and dates as a base for subsequent pregnancy management.

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4. Does the Nuchal scan and the blood test and the quadruple blood test at 15 to 22 weeks screen for anything else besides Down’s?

During the scan, the sonographer will measure the head to bottom measurement of the baby (crown rump length) from which the due date can be predicted as confirmation of menstrual dates.

An examination of the baby’s anatomy is always performed and a checklist of anatomy seen completed. Fetal position may not always allow everything to be seen at the earlier scans.

Very low or very high levels in the biochemistry at the nuchal scan may prompt the person doing the scan to suggest followup scans for fetal growth or welfare later in the pregnancy.

High AFP levels on the quadruple biochemistry from 15 weeks to 22 weeks may raise the suspicion of a spina bifida lesion, which may be helpful for the person performing the 18 to 20 week scan to look more closely for this lesion and other anomalies.

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5. Do I need to have an early pregnancy scan or can I just come for the Nuchal?

It is not necessary to have a scan prior to the nuchal translucence screen. However the scan does need to be done within a relatively narrow date between 11 weeks and 13 weeks and 6 days. Therefore if there is any uncertainty with dates, particularly if the pregnancy could be more advanced, then an earlier scan to confirm dates may be indicated so that the screening opportunity is not lost.

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6. What is the risk of miscarriage when doing a CVS or Amniocentesis?

The inherent risk of an invasive test of this type is 1%. However the Royal College of Obstetricians and Gynaecologists suggest that a figure of ½ to 1% should be quoted for an amniocentesis and a slightly higher risk of 1-2% for a chorion villus sampling (CVS). This is because the risk of a miscarriage occurring is higher earlier in pregnancy when the CVS is done.

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7. What is the accuracy of my CVS/Amniocentesis results?

The usual reason for performing one of these tests is to check the fetal chromosomes (the karyotype). Both are very accurate. Misleading results are measured in terms of false positives (the test detects something when the baby is unaffected) and false negatives (the test is normal when the baby is actually affected). False positives and false negatives are lower for an amniocentesis than for a CVS.

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8. How long rest is needed after the CVS/Amniocentesis procedure?

It is sensible to rest at home for the remainder of the day after having an invasive procedure and to indulge in only light activity for 2 or 3 days. There is no research data that underpins this advice but common sense should apply. If people were not to rest and did miscarry they may tend to blame themselves which may make them feel worse.

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9. When is it harmful to have a scan/which stage of pregnancy?

An ultrasound examination performed by a qualified practitioner is not thought to be harmful to the baby at any stage of the pregnancy.

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10. How many scans during my pregnancy do I need?

It is not necessary to have any scans at all in an uncomplicated pregnancy.

However, in an uncomplicated pregnancy, most maternity professionals suggest that women have 2 or more scans.

The first at 11 to 14 weeks will confirm dates, allow an early examination of the baby and screen for Down Syndrome and other more obvious anomalies.

A second more detailed examination of the baby’s anatomy is performed between 18 to 22 weeks.

Women who have miscarried in a previous pregnancy or have worrying bleeding may require a scan before 11 weeks and those in whom a small baby is suspected may require growth or welfare scans after 22 weeks.

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11. How accurate is the gender scan?

Gender prediction from 18 weeks is very accurate, at least 98%. From this gestation it is possible to positively identify a boy or a girl from their different genitalia - as long as the baby cooperates by being in a helpful position!

In early pregnancy, prediction is indirect and the accuracy less. The genital tubercle which becomes the penis in a boy and the clitoris in a girl are of similar size and mistakes can easily be made if one simply looks for the conventional signs. However the genital tubercle does point up in boys and down in girls. Experienced sonographers can use this information from 14 weeks to differentiate between a boy and a girl with 93% accuracy. The scan is more accurate at predicting boys than girls at this early stage.

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12. Is it safe to travel in pregnancy?

This is increasingly a medical opinion that pregnant women seek. The answer they hope to receive is reassurance that the risks involved are very small. For most, this is true and the planned journey is usually trouble-free. However, no pregnancy can ever be guaranteed to be medically straightforward and, if hospitalisation or medical treatment is required, the consequences can be substantial. Pregnancy is a vulnerable time for women and the additional factors of being away from home, away from more familiar medical assistance, experiencing language difficulty and incurring considerable cost while trying to cope with a pregnancy complication would pose considerable challenges to even the most assured traveller.

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13. Can I fly during pregnancy?

There are cautions around air travel when pregnant especially long-haul journeys of flight time of more than three hours. Women should seek medical advice prior to travel.

In the absence of any medical or obstetric complications, pregnant women should observe the same precautions as all passengers during air travel and be aware of a potential increased risk of venous thrombo embolism (VTE) and the need for preventative mobilisation and hydration. As for any ‘at-risk’ group, including those with cardiac or vascular problems, pregnant women should maintain adequate hydration and wear compression stockings with regular mobilisation.  Some obstetricians may even go as far as to suggest prophylactic low-molecular weight heparin or low-dose aspirin have been suggested to prevent VTE. As for all passengers, pregnant women are advised to keep their seatbelts on for the duration of the flight over their lap and not their abdomen to prevent abdominal trauma with turbulence, and during take off and landing

Individual airlines will have their own rules about the stage of pregnancy at which they will no longer wish to carry a woman with uncomplicated singleton pregnancies. They will be stricter with multiple pregnancies. Travel is contraindicated in late pregnancy and up to a week postnatally.  Many airlines also require a doctor’s certificate detailing the due date and health of the pregnancy. Such precautions are to prevent delivery during flights as apposed to preventing harm to the fetus.

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