Your test was positive! And so the ninth month wait begins, along with its share of pregnancy check-ups. What examinations will you have to undergo?
Ultrasounds
Written by Dr. Pelletier, Gynaecologist-Obstetrician, Polyclinique du Parc (Saint-Saulve)
The antenatal ultrasound scan is the first precious contact the couple has with their child and is essential for achieving certain major objectives in antenatal care.
These objectives are to identify in those who do not present any particular risk, any diseases whose diagnosis is likely to change how the pregnancy is monitored and have an impact on the health of the mother and the foetus.
Recognising certain foetal malformations, chromosomal anomalies, growth disorders, multiple pregnancies, errors of term or abnormal placenta cord insertion are all objectives of ultrasound screening.
“The ultrasound scan also enables practitioners to assess foetal wellbeing, and contributes to evaluating the risk of premature birth.”
However, considering the ultrasound as confirmation of “normality” is a misrepresentation, since it cannot detect each and every abnormality. A normal ultrasound cannot therefore exclude a serious child pathology.
During a normal pregnancy, three antenatal ultrasound scans are offered: in the first, second and third trimesters (11-13, 22-24, 32-34 weeks of amenorrhea). Stretch mark cream should not be applied in the days preceding the examination. A 2D ultrasound is perfectly sufficient in the majority of cases. 3D or 4D imaging is only useful in case of poor 2D visibility and/or suspicion of an abnormality.
It is recommended that ultrasound scans only be carried out for medical reasons, thereby limiting the frequency and duration of these examinations to that which is necessary for diagnosis only. These scans are completely painless and do not harm the foetus, under normal conditions of use.
First trimester ultrasound or dating ultrasound (11-13 weeks of amenorrhea, or about 3 months of gestation)
The purpose of the dating ultrasound is to detect any major early deformities and to orient towards the detection of chromosomal anomalies or malformations that may express themselves at a later stage. The dating scan also checks the date of fertilisation and the expected delivery date, especially if the menstrual cycle is irregular. Lastly, it detects multiple pregnancies that require specific antenatal care.
During the dating scan, the different organs of the foetus are examined to ensure that it is healthy and growing properly. Craniocaudal length is measured, i.e. the distance between the top of the head and the bottom of the buttocks, in order to date the beginning of the pregnancy to within three to four days. Nuchal translucency (thickness of the foetus’ neck) is also measured to detect any potential chromosomal anomalies, and maternal serum marker screening may also be carried out in combination to detect trisomy 21 (Down’s syndrome).
The dating scan is also an opportunity to examine the mother’s ovaries and uterus to check for any anomalies that could have an impact on the smooth running of the pregnancy.
Second trimester ultrasound or morphology scan (22-24 weeks of amenorrhea, or about 5 months of gestation)
During this examination, various measurements are taken to verify foetal growth by checking it against reference curves (head diameter, abdomen diameter, femur length).
The whole of the foetus’ body is examined in detail. The morphology scan can detect about 60% of the most serious abnormalities.
It is during the second ultrasound that the sex of the baby will be known. Note that you must specify before the examination whether you want to find out or not!
Third trimester ultrasound scan (32-34 weeks of amenorrhea, or around the 8th month of pregnancy)
During the third ultrasound, foetal growth is assessed (head diameter, abdomen diameter, femur length). An estimate of the baby's weight at term is calculated (plus or minus 15%). The placenta position, the amount of amniotic fluid and the foetal position are also noted.
The entire foetus is again examined, thus completing the fifth month morphology scan. The third trimester ultrasound is as thorough as the second trimester scan, since some abnormalities can only be detected at this stage.
Amniocentesis
Written by Nathalie DAURELLE, Referring midwife at the maternity word of the Claude-Bernard clinic (Albi)
Amniocentesis is routinely offered to pregnant women over 38 years of age and is performed according to the patient's choice.
Why should an amniocentesis be performed?
An amniocentesis is routinely offered to pregnant women over 38 years of age and is performed in accordance with the patient’s choice. It is also proposed if the ultrasound has shown any suspected abnormality, if there is a family history of hereditary or chromosomal disorders or if there are signs of Down’s syndrome.
This examination is entirely reimbursed by the French social security system and can be carried out from 15 weeks of amenorrhea up until the end of the pregnancy. The risks of miscarriage and infection are very low but still present.
How is an amniocentesis performed?
Performed on an outpatient basis, in a sterilised operating room and using ultrasound, the examination consists of removing a small quantity of amniotic fluid which will renew itself very quickly.
The exam is painless for the patient and the baby. Resting for 24 to 48 hours is recommended afterwards. The risk of miscarriage is low – about 0.5% to 1%. However, if signs such as contractions, bleeding or loss of fluid appear after the examination, the mother-to-be should see a doctor immediately.
What analyses are performed?
Various analyses are carried out on the amniotic fluid sample.
Biologists look for signs of chromosomal or genetic disorders by determining the karyotype of the foetus.
Results of the trisomy 21 (Down’s syndrome) test, the most common chromosomal disease, are obtained within 15 days to three weeks.
What is a karyotype?
- It is an individual’s collection of chromosomes.
- Every human being has 23 pairs of chromosomes.
- The sex is determined by the 23rd pair: XX for females and XY for males.
- There are two kinds of anomalies: in the structure or number.
What about the psychological side of things?
Painless for the future mother and her baby, an amniocentesis is, nevertheless, often very stressful since it entails the potential revelation of an abnormality, or even a decision to terminate the pregnancy.
It is not uncommon for parents to unconsciously “detach” themselves from their child whilst waiting for the results, as a self-protective measure.
Noninvasive screening for Down’s syndrome
Written by the maternity ward of the Jean-Villar clinic (Bruges)
An effective and innovative method for screening for trisomy 21 (Down’s syndrome) and other aneuploidies (anomalies in the number of chromosomes) exists.
Taking a sample of blood from the mother, foetal DNA is analysed to reliably detect the three main trisomies (chromosomes 13, 21 and 18) and sex chromosome abnormalities.
The test is carried out after a combined prenatal diagnosis which assesses the risk of foetal anomalies on the basis of the first trimester ultrasound and the determination of maternal serum markers (free B HCG and P APP A).
Given the accuracy of the results, this test makes it possible to reassure high-risk patients and to limit the number of trophoblast biopsies (placenta sampling) or amniocentesis (amniotic fluid sampling), where the risk of miscarriage, although very rare, cannot be entirely eliminated. Amniocentesis is an invasive operation that is not entirely harmless for the child and the mother since it carries a risk of miscarriage in 0.5% to 1% of cases.
“Moreover, only 5% of amniocenteses lead to a confirmed diagnosis of Down’s syndrome. In other words, amniocentesis is performed 95 times out of 100 for nothing and leads to the loss of nearly 100 unaffected foetuses per year in France,” explains one of Elsan’s gynaecologist-obstetricians.
“Only 5% of amniocenteses lead to the confirmation of a diagnosis of Down’s syndrome.”
If the mother is expecting twins, this test is particularly useful since the determination of maternal serum markers is not feasible. Until now, screening for Down’s syndrome was therefore based solely on ultrasound monitoring.
Five percent of pregnant women benefit from the Noninvasive prenatal screening test. This test “can be carried out throughout pregnancy but should not be performed before the 10th week of amenorrhea and is recommended after the first trimester screening (ultrasound + serum markers) if the risk is high”, specifies one of Elsan’s gynaecologists.
A specialised appointment must be made for organising the sampling. During this appointment, the reasons for performing the test will be given, as well as all the necessary information for the patient.
The blood sample is sent to and analysed in a reliable lab. “The doctor receives the results within seven days. A positive test indicates a strong suspicion that the foetus is affected by one of the anomalies being investigated. The mother will then usually be offered an amniocentesis to confirm the result. However, for all those who test negative, an amniocentesis is avoided.”
A fully-reimbursed dental examination
Written by MOLLET E, Pregnancy and Oral Health: A prospective study of knowledge, oral hygiene habits and frequency of consultation with the dental surgeon of pregnant women. Dissertation: Midwife: Université du droit et de la santé Lille II, 2015.
During pregnancy, the body undergoes a host of physical and psychological changes.
Hormonal changes have an influence on oral and dental health and can, in the absence of strict dental hygiene, lead to certain oral pathologies such as an increased risk of cavities, bad breath or gum problems such as gingivitis (inflammation, pain and bleeding of the gums when brushing teeth).
Equally, oral pathologies can also have repercussions on the smooth running of the pregnancy and increase the risk of premature birth, the birth of a low birth weight baby, pre-eclampsia (high blood pressure and protein in the urine), etc. This is why it is essential to have your teeth checked before and during pregnancy.
Time for prevention
You can make an appointment that is fully reimbursed by the French social security system from the fourth month of your pregnancy. To do so, visit your dentist, taking with you the pre-prepared form downloadable on the ameli.fr website. Routine and preventive dental care is possible throughout pregnancy (and fully covered the French social security system from the sixth month of pregnancy up until 12 days after the birth).
Regardless of what stage of pregnancy you’re at, all emergency treatment to eliminate pain or oral infections must be carried out, which is why it is essential to see a dentist during your pregnancy. The prescription of certain medications (pain killers, antibiotics, etc.) and local anaesthesia are possible during pregnancy. If necessary, your dentist can also perform dental X-rays, which do not increase the risk of foetal malformation or growth retardation.
To get the best possible care, remember to tell your dentist that you’re pregnant!
Vous êtes:
Futurs parents ?
Télécharger dès maintenant l'application Materniteam
