Perinatal Office Services

                                                              CONSULTATION

                                                               Consultations are available for fetal conditions affecting development including birth defects such as cardiac defect, facial abnormalities, neural tube defects, and Down syndrome. In addition, consultations are available those pregnancies complicated by hypertension, diabetes, pre-term labor, pre-term delivery, recurrent pregnancy loss, blood abnormalities, and autoimmune diseases (e.g. Lupus) as well as gynological concerns, addressed using ultrasound. Telephone consultations and collaborative management are also available.


OB ULTRASOUND

Our OB ultrasound examinations provide reassurance and detailed information regarding the condition of your pregnancy. The most common way to image the baby is with 2D diagnostic ultrasound. Our facility also provides 3D/4D ultrasound giving a “special” look at the baby, as an option. This is the basis of our practice also allows it to be a site for innovative development in the field; training and education for physicians, technologists and nurses. We offer only state of the art technology and have always had early access to new advances participating in application and development. See Baby steadfastly collaborates with MindRay ultrasound technology and MedStreaming image archiving system to bring a cutting edge evaluation to pregnancy and care of the patient. Thereby allowing the patient to “Experience Excellence”.

 GYN ULTRASOUND

 Our GYN ultrasound examinations are performed to provide detailed information regarding the reproductive organs.  This includes, but is not limited to the uterus, ovaries and fallopian tubes.  Pelvic pain, pelvic masses, fibroids and ovarian cysts are just a few of the many areas of concern, that GYN ultrasound can address.  GYN ultrasounds are performed both trasnabdominally and transvaginally. 

Perinatal Procedures & What You Need to Know

NON-STRESS TEST (NST)

This procedure is performed in our office using a fetal monitor to listen to and evaluate your baby’s heart activity. An NST observes the baby’s heart rate while the baby moves. Fetal activity with a rise in the baby’s heart rate is a good indication of fetal well being. This test usually takes 30 minutes to complete. Two monitors are placed on your abdomen. One will record the baby’s movements and/or uterine contractions, while the other records the baby’s heart rate. The medical team at See Baby will interpret the test and let you know if further testing is needed.


GENETIC AMNIOCENTESIS

This procedure is often performed between 14 – 22 weeks, to identify or exclude chromosomal abnormalities. Amniocentesis is often offered as an optional test when risks or concerns are suspected for genetic problems. This procedure is brief and usually requires 10 minutes to complete.

This is a simple medical procedure used to obtain a small amount of the amniotic fluid surrounding the fetus. An ultrasound is performed with the amniocentesis to check the position of your baby and to locate pockets of fluid. The doctor will insert a needle through the abdominal wall into the amniotic sac to remove a ~ 4 teaspoons (20 cc) of fluid for testing. The test usually takes ~ 1 minute, and most patients experience very little discomfort. The fluid that is withdrawn typically reaccumulates within 12 - 24 hours. Amniotic fluid contains cells from the fetus that can be tested to yield a diagnostic result.

AMNIOCENTESIS FOR FETAL LUNG MATURITY (LS/PG)

This procedure is performed to rule out or identify fetal lung maturity. The information obtained from these results will help aid your doctors in deciding the best time to deliver your baby. An amniocentesis is performed to obtain a small amount of the amniotic fluid surrounding the fetus. An ultrasound is performed during the amniocentesis to check the position of your baby and to locate pockets of fluid. The doctor will insert a needle into the amniotic sac to remove a small amount of fluid for testing. After your amniocentesis, you may be placed on a fetal monitor for a non-stress test.

CHORIONIC VILLUS SAMPLING (CVS)

CVS can be performed earlier in pregnancy than a genetic amniocentesis. It is usually performed at 11 – 13 weeks gestation. This allows for earlier detection of chromosomal abnormalities.

When CVS is performed, a small sample of cells is taken from the placenta where it attaches to the wall of the uterus. Chorionic villi are tiny parts of the placenta, formed from the fertilized egg. Therefore, they have the same genes as the fetus. An ultrasound is also performed with CVS to facilitate appropriate sampling and safety.

There are 2 approaches or techniques used to collect the sample:

1) Transabdominal, which is similar to amniocentesis

2) Transcervical, which is perform using a speculum as it would be for a Pap test. Then, a very thin, plastic tube is inserted through the vagina and into the cervix. With ultrasound, the tube is guided to the placenta and a small sample is removed. The sample is then sent to the lab for genetic testing.

This decision regarding which approach to use is typically made at the time of your appointment after ultrasound assessment of the placental location. This will be discussed with you before any procedure is performed. This procedure usually takes 20 minutes to complete.


What is an Amniocentesis and CVS?

Amniocentesis is a procedure used to draw a sample of the amniotic fluid that surrounds the baby in the womb. This fluid contains cells that have been sloughed off of the developing fetus.

Amniocentesis is most often used to detect genetic abnormalities, though the results can also reveal the baby's sex, gauge lung maturity (if done close to term), detect amniotic fluid infections, or diagnose other pregnancy related problems.

Amniocentesis can diagnose or rule out many possible fetal abnormalities. Most often, it's used to spot common genetic defects (such as Down syndrome) and neural tube defects (such as spina bifida). Amniocentesis is usually performed between 16 to 22 weeks gestation, although it can be done as early as 13 - 14 weeks and beyond 22 weeks gestation.

Chorionic villas sampling (CVS), a similar test is sometimes used to detect many of the same abnormalities. Instead of amniotic fluid, CVS examines placental cells, which are genetically identical to the fetus. Since CVS can be done earlier in the pregnancy (~ 11 – 12 weeks), and since results are available within 48 hours, it may be preferable for women who need earlier answers about their baby's health. CVS carries a higher risk of miscarriage than amniocentesis, and may increase the risk of limb deformities if performed too early.


What Are the Risks?

About one woman in every 200-400 women can have a miscarriage as a result of amniocentesis, although recent studies suggest that the rate of miscarriage may be as low as one in 1,000 (0.1%). Amniocentesis done during the first trimester carries a greater risk for miscarriage than amniocentesis done after the 15th week. The risk of miscarriage can be similar to that caused by CVS, which is ~ 1:100. Less than one woman in every 1,000 women develop a uterine infection after amniocentesis.


How Can I Prepare?

Amniocentesis provides diagnostic information about the baby. It not a form of treatment, however can provide information to the mother to make certain decisions about treatment. So before you have the test done, think about how you might use the information it provides. Some birth defects are incompatible with life, others are easily correctable, and still others fall somewhere in between.

Weigh the benefits and risks. If the information provided from either CVS or amniocentesis doesn’t impact on your decision about the pregnancy, the test may add more anxiety than it's worth. On the other hand, knowing your baby has a problem may allow you to prepare better for his or her birth. One study of mothers who continued pregnancies after learning their babies had Down syndrome showed they were much better able to cope than women who discovered at birth that their babies were affected.

If you decide to proceed with the amniocentesis or CVS, there is no specific preparation needed, except to maintain a relaxed & calm disposition leading up to the day of the procedure and thereafter. After either procedure, patients are typically advised to maintain reduced activities and no heavy lifting for 12 – 24 hours. Prolonged bed rest or absence from work is not necessary.


What Will Happen?

First, an ultrasound is done to visualize the position of the fetus and placenta. This allows your doctor to determine the safest place to insert the needle. Guided by ultrasound, the doctor carefully inserts a hollow needle through your abdomen, into the amniotic sac, and draws out about four teaspoons (~20 cc) of amniotic fluid. Your baby quickly replaces any fluid that is lost within 12 - 24 hours. During the course of the procedure the patient can observe her baby’s activity before, during and after for reassurance.


If a local anesthetic is used, you may feel a stinging sensation for a few seconds. You may also feel slight pain or cramping when the doctor inserts the needle and pressure in your lower abdomen when the fluid is withdrawn. Some women report no pain or discomfort, and find the “anticipation” of the procedure the biggest obstacle.
After the fluid is removed, the fetal cells are grown in a laboratory and then analyzed. Your doctor will get the complete results within 7 -10 days. On occasion a rapid preliminary test result can be obtained in ~ 24 -48 hours.

Additionally the level of alpha-fetoprotein in the amniotic fluid is measured, which may confer certain risk if abnormally elevated (e.g. risk of neural tube defect). Since alpha-fetoprotein does not need to be cultured in the lab, these results are available right away -- although a potential problem must be confirmed by subsequent genetic analysis of the amniotic fluid.


Who Should Have Amniocentesis?

Amniocentesis is typically offered only to women at increased risk for bearing a child with birth defects. This includes women who:

• Will be 35 or older when they give birth
• Have a screening test or exam result that indicates a possible birth defect or other problem
• Have had birth defects in previous pregnancies
• Have a family history of genetic disorders

If birth defects run in your family, seek genetic counseling before you have amniocentesis - and if possible, before you get pregnant. You and your partner can have certain blood tests to determine your chances of having a baby with a birth defect. Commonly parental carrier testing for such defects such as Cystic Fibrosis or Sickle Cell anemia may preclude the patient from having an amniocentesis or CVS, pending the results.

FIRST TRIMESTER GENETIC SCREEN

First-Trimester screening is a normal, reliable test used for early pregnancy evaluation. It consists of two parts:

1) A blood test, drawn from either your arm or your finger
2) A detailed ultrasound examination of your baby

The First Trimester Screen allows an early risk assessment for Down syndrome (Trisomy 21), Trisomy 18, & Trisomy 13.

By having your blood drawn between 11.3 – 13.3 weeks couple with a limited fetal ultrasound assessment (nuchal translucency NT) a genetic risk result can be obtained with ~ 85% accuracy.

The Perinatologist will conduct and interpret your ultrasound examination to provide you with a final calculation of your risk for Down syndrome, Trisomy 18 and Trisomy 13. In the event of an “at risk” result, we will provide you with additional consultation, genetic counseling and testing options as clinically indicated and per your desire.


Frequently Asked Questions:

Q: Do normal amniocentesis results mean I will have a healthy baby?

A: A normal amniocentesis shows that your baby’s genetics are normal. But even with a normal pattern of chromosomes, your baby can have other types of birth defects. Minor genetic abnormalities may not be detected. About 1 – 3% of all pregnancies are associated with a structural or genetic abnormality.


Q: Can doctors treat any defects diagnosed by amniocentesis?

A: Scientists have been working on possible cures and treatments for a variety of fetal conditions. Many conditions can be treated after birth, and a few can be corrected while the baby is still in the womb, although this type of surgery is still considered experimental. Knowing about a condition ahead of time allows parents and physicians to prepare for the child's special needs, even if his condition can't be treated. Discovering if your baby has a genetic problem such as Down syndrome provides for you information to actively plan for any challenges with the pregnancy and beyond.


Q: I have a relative with Down syndrome. Should I have an amniocentesis?

A: Down syndrome occurs when the cells of a fertilized egg divide abnormally, creating an extra 21st chromosome. Maternal age -- not family history -- seems to be the most important risk factor. A 20-year-old mother, for example, has a 1/2000 chance of delivering a baby with Down syndrome. For a 45-year-old, the chances are significantly higher, ~ 1/40. Very rarely is Down syndrome is inherited when a father or mother carries an egg or sperm with a defective 21st chromosome. If you think you have an increased risk, discuss the benefit and risk of genetic testing with your doctor or a genetic counselor.


Q: Are there alternatives to amniocentesis?

A: There are a number of screening tests that can help assess your risk of having a baby with a chromosomal problem. These tests are routinely offered to women of all ages. Such tests include ultrasound and maternal serum screenings such as: 1) First trimester screen (Free beta-HCG, PAPP-A, NT), 2) Second trimester screen (Triple and Quadruple marker). These tests are non-invasive, carry no risk of miscarriage or other problems, and can correctly identify 65 - 85% of chromosomal problems. However, none of these tests can confirm that your baby has a problem. To make an accurate or more certain diagnosis (>99%) an amniocentesis or CVS would need to be performed.