Newcastle Fertility Specialists : Dr Myvanwy McIlveen & Dr Robert Woolcott

Once you are pregnant it can often be helpful to monitor the early pregnancy. This is true whether you have fallen pregnant naturally or through IVF.

For patients with recurrent miscarriage early pregnancy monitoring is particularly helpful. That next pregnancy once treatment has been put in place is going to be stressful. We are here to help you through that next stage.

For patients who do experience difficulty conceiving, we are ideally placed to offer assistance, with options ranging from counselling and advice to ovulation induction and IVF. Once a pregnancy is achieved monitoring its progress carefully is important.

During the early stages of pregnancy we are able to closely monitor your progress with weekly blood tests and regular ultrasounds. We understand that the next pregnancy after a miscarriage is a time of great anxiety and stress. Along with the scientific testing, we offer support. Your counsellor is available to talk to you and your nurse coordinator will be there to speak to or see you throughout the stressful early part of the pregnancy.

Blood tests

With your next pregnancy we will do regular blood tests monitoring your hormone levels. We generally monitor two hormones progesterone and βHCG. Progesterone is vital to pregnancy and sometimes if levels are less than optimal we may use progesterone pessaries to support the early pregnancy. βHCG or pregnancy hormone is made by the developing pregnancy itself. Levels should roughly double every two days. If βHCG levels start to fal it may be an early indication of pregnancy failure.

Early Dating Ultrasound

The purpose of this examination is to assess:

• Position of pregnancy (i.e. inside the uterus)
• Number of babies
• Presence of heart motion
• Age of pregnancy (from the first day of menstrual period)

The ultrasound appearance will depend on the age of the pregnancy. At 5 weeks gestation only a gestation sac will be seen. After this a yolk sac will be visible, then a small fetus.

The size of the fetus has to be over 5mm (6½ weeks) to see a heart beat.

Dating the pregnancy by measuring from the head to the bottom (crown-rump length) is very accurate (+ /- 3 days).

Most miscarriages are due to chromosomal abnormalities. Occasionally a pregnancy may occur outside of the uterus, which is known as an ectopic pregnancy.

An assessment of the baby's structure is difficult before 12 weeks, when a Nuchal Translucency scan can be performed to assess for the risk of Down Syndrome and other related conditions.

Fetus in profile

 

Twins Sometimes more than one baby will be seen (twins or triplets) or the pregnancy may not be viable (miscarriage).

 

 

 

 

 

 

 

 

Nuchal Translucency Testing

A New Early Pregnancy Test for Fetal Wellbeing NT-plus is a simple, straightforward and non-invasive test undertaken at 11-14 weeks in pregnancy. It combines maternal age with high-resolution ultrasound assessment of fetal nuchal translucency (NT) and the levels of two proteins (free-BhCG and PAPP-A) in a pregnant woman's blood. Chromosome abnormality All our genetic information is packed into strands of DNA called chromosomes. Normally there are 46 chromosomes in every cell. Sometimes the number or arrangement of chromosomes is abnormal - the commonest problem being Down syndrome. Any woman who falls pregnant can have a child with a chromosome problem, but the risk increases with age. What is Nuchal Translucency? Normal fetuses accumulate fluid under the skin behind the head and neck between 9 and 14 weeks of pregnancy. If there is excess fluid it has been associated with chromosome abnormalities such as Down syndrome. A simple ultrasound performed between 11 and 13 weeks can measure this fluid (Nuchal Translucency). The gestational age of the fetus can be established by measuring from head to bottom - crown rump length ( CRL ). The NT tends to be larger in a fetus affected by a chromosome abnormality and it can be compared with what is expected for a fetus of the same size. Not all cases of Down syndrome will be detected by this test but 80-90% will be.

Normal male chromosomes 12 week fetus showing the Nuchal Translucency

PAPP-A and BhCG

PAPP-A (Pregnancy associated plasma protein-A) and BhCG (Beta human chorionic gonadotrophin) levels can be assessed from a simple blood test taken from the mother either before or on the same day as the Nuchal Translucency ultrasound is performed. The level in the mother's blood can be compared to the level expected in a pregnancy at the same gestational age. The PAPP-A level tends to be lower and the BhCG level tends to be higher in pregnancies affected by Down syndrome.
Our practice is directly linked to the laboratory. This enables the blood test to be taken and the Nuchal Translucency assessed, then the combined results are available that same day. The addition of this blood test increases the detection rate from 80% up to 90%.

Women whose result falls into the increased risk zone will be offered further prenatal testing (by CVS or amniocentesis).

When this information is combined with the mother's age and the Nuchal Translucency measurement, an increased risk group can be established, which has been shown to contain 90% of the Down syndrome affected pregnancies. We call this "NT-Plus".

Other benefits of an 11 - 13 week scan Accurate dating of the pregnancy Diagnosis of multiple pregnancy Detection of early pregnancy failure Assessment of early fetal structures (such as the brain, limbs and abdominal wall) and detection of some of the more severe structural abnormalities

A cross section through the fetal head at 12 weeks