Ultrasound in Pregnancy

Before 14 weeks, ultrasound is use for dating purposes.
Dating becomes inaccurate after 14 weeks.

A fetal abnormality scan is done at 20 weeks. This will pick up deformities such as ancephaly ( absence of skull/brain), cleft lip or club foot ( congenital talipes equinovarus). Polyhydramnios (excessive amniotic fluid) can also be picked up during this stage.

The ultrasound can also measure for nuchal tranluceny from 11 to 14 weeks as a screening test for Down's syndrome.

Screening test in pregnacy

When the doctor talks about screening test, this often confuses people. Patients get very worried when screening test are positive. However this does not mean the disease is confirmed


A screening test checks the chances of the fetus having a certain disease. When screening test results are positive, it means that the fetus has a higher chance of having the disease, but this is not confirmed.

Confirmation is via a diagnostic test. Why not do a diagnostic test right the from start then?
This is because diagnostic test are usually more expensive, or more difficult to perform and often carry a higher risk.

A screening test should be:

• Widely available
• Cheap
• Sensitive
  
• Specific
• Non invasive
• safe
• there must be a diagnostic test for follow up

Common symptoms of pregnancy

• Itching is common in pregnancy.

• Abdominal pain is almost always present and is usually benign.

• Heart burn affects up to 2/3 of pregnant women
• Backache is present in almost all pregnant women
• Constipation is common and is usually worsen by any iron supplement.
• Leg swelling is common but needs to be followed up by a doctor
• Leg cramps happens to approximately 1/3 of the ladies.
• Carpal tunnel syndrome may happen due to fluid retention
• Candida infection of the vagina may happen
  

APGAR Soring in neonates

The APGAR scoring is done when baby is born and at 5 minutes
The first scoring decides if any further rescue is needed for the baby
The 2nd scoring helps to give a prognostication of the baby's health

Heart rate
0 - Absent
1 - <100
2 - >100

Respiratory Effort
0 - Absent
1 - Weak
2 Strong Cry

Muscle
0 - Absent
1 - Limb flexion
2- Active Motion

Colour
0 - All Blue
1- Extremities Blue
2- All Pink

Reflex
0 - No response
1 - Grimace
2- Cry

Advice for pregnant women

There are a few common questions as to what the pregnancy women can consume during pregnancy. These are the general advice

Medications should be generally avoided, particularly in the first trimester. All pregnant women should be on folic acid supplement of 0.4mg per day. This should continue till at least 12 weeks of pregnancy.

Pregnant lady should generally avoid alcohol completely, although there is no known evidence of problems for drinking less than 2 units of alcohol a week.

Caffeine (coffee) is also generally avoided, again 1 cup a day seem to be the maximum allowed amount.

Smoking is an absolute no go and all women should stop smoking completely during the pregnancy. Smoking is known to increase the risk of miscarriage, pre-term labour and growth problems in the baby.

Light exercise is generally advised. Sexual intercourse is allowed unless the pregnant lady has certain conditions like placenta previa of which the doctor will advise the couple to avoid coitus.

Pregnancy Signs

These are the signs of pregnancy

• Menses not here (Amenorrhoea)
• Nausea and or vomiting
• Breast tenderness
• Urinary Frequency (Late sign)
  

How to estimate gestation age

• From the Last menstrual period (LMP)and using Nagle's rule

- Provided the menses is regular
- Need to adjust if usual period is more or less than 28 days

• Using Ultrasound scan

- Measuring the crown rump length (week 7 to week 14)
- Parietal diameter or femur length (Week 14 to week 20)
- Not useful for dating beyond 20 weeks
- More accurate than LMP

First visit to the obstetric doctor

The fist visit to the obstetric doctor is often scary. But this is one of the times when visiting the doctor does not mean you are sick. Here is what to expect on your first visit to the doctor. He will first begin by asking a series of questions known as history.

History

Personal
Name
Age
Occupation
Gestation (previous pregnancy)
Parity (previous child birth)

Present Pregnancy
Last Menstrual Period (LMP) :
- was it regular
- Any recent use of Oral Contraceptive (OCP)
Calculated Estimated Delivery date (EDD):
- Add 1 year and 7 days and subtract 3 months (Nagle's rule)
- Use an obstetric wheel

Complication of pregnancy
Any bleeding
Diabetes
Hypertension
Anemia or thalessemia
Urine infection
Concerns

Past Obstetric History
Mode of delivery
Gestation age
Birthweight and sex
Any complications
Any infection
Any gynaecological history

Physical Examinations
Height and weight
Temperature
Oedema/swelling of the ankle
Any pallor/anemia
Blood pressure
Cardiovascular examination
Abdominal examination
- Uterus palpable at 12-14 weeks
- Fundus (top of uterus felt) at umbilical at 20 weeks
- Any scars
- Any Linear Nigra
- Lie and presentation
- Fetal movement
Doppler Ultrasound: to listen to fetal heart beat

That is summary is the first visit to the doctor