Pregnancy is often a time of great anticipation mixed with doubts and anxiety particularly about the health of the baby. There is a 2 % chance of a abnormalities and there are various tests available to detect fetal abnormalities and these include blood tests, ultrasound and amniocentesis.  While amniocentesis provides 100% accuracy, it has its risk (1%) of miscarriage as it is invasive. Both ultrasound and existing blood tests have their limitations.
 
Hence what was really awaited was a test that can be non invasive and yet highly accurate. This is now possible with the NEW blood test called the Non Invasive Prenatal Test (NIPT)
 
Non Invasive Prenatal Test (NIPT)
 
This a blood test taken from the pregnant mum which detects the fetal DNA present in the blood. During pregnancy traces of the baby’s cells from the placenta cross into the mum’s blood. The baby’s blood then break up and release fetal DNA ( cell free DNA). This DNA is from the fetus and can be measured to diagnose various abnormalities. This test can be done anytime after 10 weeks and the results are available in 10 days
 
This test has an accuracy of 99% as it detects the fetal DNA directly making it highly accurate. In view of this it can reduce the number of invasive procedures, like amniocentesis. This test will detect : Trisomy 13, Trisomy 18, Trisomy 21 (Down Syndrome) ,sex chromosome abnormalities (X and Y chromosomes) and microdeletions ( These are small chromosomal deletion involving several genes that is not typically detected on routine chromosome analysis)
The advantages of this new test is that it is safe, simple accurate, high quality and fast
If the test is positive i.e. reported as high risk, then it is still recommended that an amniocentesis is performed to confirm the results.
 
Various tests are available and they all have their limitations. Some abnormalities can go undetected. The NIPT however seems the most accurate and will soon replace all the other non invasive tests. You should discuss with your doctor on what is best for you and resolve with your partner on the options in event that a birth defect is discovered
 
 
Keyhole surgery refers to laparoscopic surgery.  It is also called minimal access surgery and often falsely called 'laser surgery'
It has gained tremendous popularity over the years and most gynecological surgery nowadays are done via laparoscope. The instruments used are smaller, more advanced and it is a lot safer than the early days. If you are considering one, you may a few questions as below:
 
Which conditions are ideal for keyhole surgery?
 They include uterine fibroids, endometriosis, ovarian cysts, ectopic pregnancy, 'and sterilization. It also used for assessment of infertility.
 
Under which circumstances are keyhole unsuitable?
It may not be suitable if the growth to be removed is very large, there have been several previous abdominal surgeries and there are preexisting medical conditions. (e.g.; heart disease, uncontrolled diabetes)
 
Is it safe?
It has become increasing safe with the use of smaller and safer instruments and energy sources. Most hospitals also have stringent credentialing processes where consultant are credential with the necessary skills before they can perform such surgery.
Accidental injures to the bowel. bladder, ureters and blood vessels can occur but is rare.
 
What are the advantages?
There are several advantages as compared to open abdominal/pelvic surgery. The recovery time is faster, the pain is less, the hospital stay is shorter, the scars are smaller and heal better. It is also cosmetically more acceptable,
 
What happens during the surgery?
The surgery is done under general anesthesia. During the surgery a 0.5 to 1cm incision is made just below the navel and the laparoscope (telescope with camera) is inserted. Gas is also introduced to help visualise the organs better. This is to view the pelvic organs and the images are projected on to a high definition screen. 2 or 3 more incisions about the same size is then made at the lower half of the abdomen to introduce the thin operating instruments. The surgery is then done and can last between half an hour to 3 hours depending on the complexity of the surgery involved.
 
What happens after the surgery?
For a minor operation, you can go back the same day while the more major cases will stay for 3-4 days. Immediate post operation you may feel bloated and some nausea. Feeling of shoulder discomfort is common due to the stimulation from the remaining gas under the diaphragm. This will disappear within a few hours
 
When should I be concerned after going home?
You should consult the doctor if you have pain in the abdomen, bleeding from the vagina, fever, bladder symptoms and swelling around the wound sites.
 
When can I resume my normal activities?
For a simple day care surgery you can resume normal activity in 3-4 days. For a more major surgery like a hysterectomy, it usually takes 2-4 weeks. You can drive by that time and start minimal activity, house chores, and slow walks at 2-4 weeks. Resuming sexual activity and more strenuous activity will be in 4- 6 weeks.
 
SUMMARY
 
Most benign pelvic conditions can now be safely operated laparoscopically with faster recovery and less pain. You should consider this mode of surgery as a good alternative to conventional surgery. Explore this with your doctors 
It is a simple test to detect cancer of the cervix. Now improved by Liquid Based Cytology (LBC) method of detection.

Recommended

  1. Annual Pap smear tests, until 65 years.
  2. Include HPV DNA test as virus linked to Cancer of cervix.

What is it?

Ultrasound in pregnancy is an examination of the baby using safe sound waves. 

The Early Scan

The early scan will confirm that you are pregnancy. It is also important to confirm if it is a multiple pregnancy or an ectopic pregnancy (pregnancy outside the womb which is serious).Miscarriages are also diagnosed at this time. This scan is important to establish accurately the age of the fetus and the expected date of delivery

The Detail Scan

This scan is done at 20 weeks. At this time the doctor will check thoroughly for abnormalities and a large number of abnormalities can be detected from the brain to the feet. The accuracy is as high as 90% and of course there will be a few abnormalities that are not possible to diagnose. All doctors here are specially trained in this field. Other information that can be obtained are the position of the placenta, the adequacy of the amniotic fluid, the umbilical cord and the sex of the baby. Sometimes due to the position of the fetus it may not be possible to see all of the features in which case you will be asked to return for a repeat scan.

    • Colour Doppler is done for smaller vessels eg assessment of the brain as well as for the Heart.
    • Biophysical to assess the health of the fetus.
    • Vaginal ultrasound to assess miscarriages, ectopics and the placenta.
This is a special scan which uses a special computer technology to give you a 3 dimensional view of the fetus and its features. This is also dependent of the position and the activity of the fetus.
4d Colour Scan
This is 3D scan that is live as in you will see the fetus in 3D that is actually mobile on the monitor.
Is scanning safe?
Ultrasound have been around for almost 30 years and there has been no reports of risks to the mother and/or fetus

Triple Test

This is a screening test which is offered to all pregnant women between 16 and 20 weeks of pregnancy. A sample of blood is taken and the levels of alphafetoprotein (AFP), and Estriol (E3) Human Chorionic Gonadotrophin (HCG) are measured. Hence the name triple test and the results will normally be available in 10 days.
Measurement of the levels of AFP determines the risk of your baby having an abnormality such as Spina Bifida.
Also by measuring the levels of AFP, Estriol and HCG it is possible to estimate the risk of your baby being born with a chromosomal abnormality such as Down’s Syndrome.

Occasionally the test results are inconclusive, and we may ask you to have the test repeated. Do not worry about this since most tests would then fall within the normal range.

It is important to remember that a screening test only gives us an indication of the risks. The majority of women will have perfectly normal results. If the AFP/HCG/E3 levels are abnormal in any way, further more decisive tests such as a detailed ultrasound scan or amniocentesis may be suggested. If an abnormality of any kind is found following these further tests you may need to consider a termination of the pregnancy. You might wish to discuss such possibilities with your partner before deciding to have the antenatal screening tests.

A Normal Result

Most pregnancies will have a normal test result and a report will be conveyed to you. If you have not heard from the doctor within about 10 days you may assume the test is normal.

The test cannot identify every abnormality and a normal AFP/HCG/E3 result is not a guarantee that your baby will be healthy. However, if your test result is normal, it will reduce the chance of an abnormality being present.

A High Afp Result

This may indicate that the baby is at risk of having a defect such as Spina Bifida.

If your result is high you will be advised to have a detailed ultrasound scan. Following the scan you will have the opportunity to discuss the significance of the raised AFP and should any abnormality be found, this would be fully discussed with you at the time. About 9 out of 10 of Spina Bifida babies will be detected by a raised AFP.

If the AFP level is raised and no abnormally has been found, you will receive extra antenatal care, because it has been shown that there may be a slightly increased risk of these babies being smaller than average.

The Afp/Hcg/E3 Result (Triple Test)

By measuring the AFP/HCG/E3 levels, and considering your age and stage of pregnancy, it is possible to estimate the risk of your baby being born with a chromosomal abnormally such as Down’s Syndrome. Risk is often quoted in terms such as 1 in 280 or 1:280. What this means is that out of 280 pregnancies, then 1 of them will be affected and 279 will be normal.

If your risk is shown to be more than 1 in 400 of having a baby affected by Down’s Syndrome (for example 1 in 50), you will be set an appointment to discuss this. After discussion you may choose to have an amniocentesis which will confirm whether or not the baby is affected. Most women will have a normal amniocentesis result, but if an abnormality of any kind is found it will be fully explained to you and you will have ample time to discuss this.

Overall, about 6 out of 140 Down’s Syndrome babies will be detected by the Triple test. The rate of detection has been shown to vary according to the age of pregnant mother as shown.

What is it?

This is a test in which a small amount of fluid which surrounds the baby in the womb is taken off and sent to the laboratory for genetic analysis. It can be performed as early as 14 weeks onwards.

Why Is The Test Done?

This test is advisable for those who are over 35 years of age, in view of the increased risk of the baby having a chromosomal abnormality such as Down’s Syndrome. Women with a family history and abnormal blood tests results are also at higher risk.

25
1 in 1,500   38 1 in 170
30
1 in 800   39 1 in 140
35
1 in 350   40 1 in 100
36
1 in 300   45 1 in 25
37
1 in 200      


What Will The Test Show?

The fluid is tested for chromosomal disorders, of which Down’s Syndrome is the most important. If there is a family history of certain inherited diseases it may be possible to test for these also. Amniocentesis will not necessarily exclude subtle chromosomal abnormalities or mosaicism.

How Is It Done?

The test takes place in the Ultrasound room. You will have the opportunity to ask questions or discuss any problem with the staff. One relative may stay with you during the procedure if you wish.

You will have a short ultrasound scan before and after the test. No anesthetic is required and meals may be taken as normal before hand. The doctor will clean the skin with antiseptic fluid and then pass a very thin needle through the skin of the abdomen into the uterus. A small amount of amniotic fluid will be drawn off. During this time the ultrasound is done to avoid injuries to the fetus and placenta. The whole procedure will take about 10-15 minutes.

The test is done in the 14th and 18th week of pregnancy and results take several weeks. Risks include possible miscarriage (1%), infection, vaginal bleeding, leaking from the place where the needle went in, isoimmunization if mother is Rh+ and fetus is Rh-, and harm to the baby from the needle. These are rare, but they do occur.

Most women say that the test is uncomfortable but not painful and in most cases the thought if it is much worse than the actual test.

You may go home as soon as the procedure is finished.

It is advisable to rest at least for one day and you will be given two days off work. You should avoid any heavy lifting or strenuous exercise.

The results will be available in two weeks. Rapid results can be available in 2 days with newest techniques.

If an abnormality of any kind is discovered, your doctor will tell you what it is and how it will affect your baby. You will have the opportunity to discuss the matter carefully.

What is it?

This is a test in which a few cells are taken from the developing placenta (chorion) and tested for chromosomal abnormalities in the baby. It can be performed as early as 10 weeks onwards.

The main advantage of the CVS test is that results are normally ready during the early weeks of pregnancy.

Why Is The Test Done?

This test is advisable for those who are over 35 years of age, in view of the increased risk of the baby having a chromosomal abnormality such as Down’s Syndrome. Women with a family history and abnormal blood tests results are also at higher risk. It is particularly done for the diagnosis of Thalassemia.

What Will The Test Show?

The cells are tested for chromosomal disorders, of which Down’s Syndrome is the most important. If there is a family history of certain inherited diseases it may be possible to test for these also especially Thalassemia. CVS will not necessarily exclude subtle chromosomal abnormalities or mosaicism.

25
1 in 1,500   38 1 in 170
30
1 in 800   39 1 in 140
35
1 in 350   40 1 in 100
36
1 in 300   45 1 in 25
37
1 in 200      


How Is It Done?

The test takes place in the Ultrasound room. You will have the opportunity to ask questions or discuss any problem with the staff. One relative may stay with you during the procedure if you wish.

You will have a ultrasound scan before to locate the position of the placenta. A local anesthetic will be injected into the skin. Under ultrasound guidance a fine needle will be passed through the skin and into the placenta. A tiny piece of tissue is gently sucked up through the needle. Occasionally it is necessary to repeat the procedure once more in order to obtain more tissue. During this time the ultrasound is done to avoid injuries to the fetus and placenta. The whole procedure will take about 20 minutes.

Results take one to two weeks. Risks include infection, bleeding, harm to the fetus, and miscarriage. Long-term risks of this procedure are unknown.

Amniocentesis has been done for many years and it is suggested that perhaps one woman in every 150 many miscarry, over and above the normal incidence of miscarriage.

A Brief Guide To Prenatal Tests

These days, a pregnant woman receiving prenatal care will find that having a baby can involve complex technology and testing. This booklet presents the most common prenatal test and procedures and discusses what they test, how accurately they test, and what risks or side effects there are. As these questions are answered, it will be easier for you as a pregnant woman or expectant couple to decide which tests are appropriate for you.

Prenatal tests can be divided into two categories: those which give information about the status of the mother and baby (such as urine samples, blood counts, glucose tolerance test, fetal heart tones, and ultrasound), and those which information about the genetic makeup and possible congenital abnormalities of the baby (such as Alpha-Fetoprotein
[ AFP ], Chorionic Villus Sampling [ CVS ], amniocentesis, and ultrasound).

Test For Maternal And Fetal Well-Being

Urine samples can give healthcare providers important information about how you and your baby are doing. They are first used to determine pregnancy; then you will probably be asked to give urine samples at each prenatal visit. You or your practitioner will insert a small paper stick into your urine to measure the amounts of protein, sugar, and sometimes ketones. Usually, none or only a trace of these will be found. Too much protein in your urine is one of three symptoms of pre-eclampsia (also known as toxemia or pregnancy-induced hypertension). All three symptoms (protein in the urine, high blood pressure, and usual swelling) must be present for toxemia.

Too much sugar may be an indication of gestation diabetes, a form of diabetes which is found only5 in pregnant women and usually disaqppears soon after birth.

Ketones in the urine, particulary a problem in early pregnancy, may indicate actual weight loss for the mother, which can be unhealthy for the fetus.

All of these test are indicators and further testing would be necessary to determine if there is a problem and how serious it is. These are conditions which can be controlled diet, exercise, and rest.

Urine test are also used to screen for drugs, such as cocaine, marijuana, and alcohol. Results take two to three days. Such testing sometimes requires informed consent, meaning you must understand the purpose of the test and give your permission to have it administered.

Urine tests are done in the practitioner’s office and results are given immediately, with no risk or side effects. Your informed consent is not required. The results are most accurate when you give a “ clean sample, “ meaning that you clean your vulva well with soap and some antiseptic and give urine from the middle of your flow, although such accuracy is usually not required each time you go in. Urinary tract infections, not uncommon for pregnant women, are detected in urine samples. These results take one to two days.

Blood tests are taken several times throughout pregnancy. Your blood contains a wealth of information about you and the fetus. It can be used to confirm pregnancy and / or duration if there is reason to think that the urine test was not accurate. It is most often used to measure the amount of iron in the blood. It is normal for pregnant women to have lower iron (in proportion to their blood volume) than non-pregnant women, but it is important to make sure there is enough iron to support mother and fetus. Results are given immediately or within a day or so depending on which type of blood test is done and whether or not there is equipment to run the test in your practitioner’s office. Most blood test do not require informed consent, and accuracy depends on what you are checking.

Alpha-fetoprotein (AFP) is a blood test for indication of congenital and chromosomal anomalies (deviations from normal) in the baby.

HIV/AIDS testing is also a blood test. The results take about three weeks, and accuracy depends on when the test is done in relation to when you may have been exposed to the virus. If you have shared IV needles or been otherwise exposed to the AIDS virus in the last eight to twelve years, then you are at risk for HIV/AIDS. If exposure was more than six months before the test, then the results are considered very accurate. Scientists and practitioners do not yet understand how HIV is transmitted from mother to fetus. It is important to have some kind of counseling before and after the test to learn the implications of this test for you and your baby.

Glucose tolerance testing is used to test for gestational diabetes. Some doctors do this test routinely, and others do so only when there is some other indication of a possible problem either from symptoms or a urine test.

The test involves drinking a very sweet substance (sometimes on empty stomach) and testing your blood an hour later. If this test indicates problems, then a more accurate test is done in which you drink the sweet substance and then have blood drawn one, two, and they are considered to be accurate, particularly the three-hour test. Risks of drinking such a sweet substance are unknown. Side effects can include nausea or headache for a few hours after the test.

Weight gain is another indication of the baby’s growth and your general health in pregnancy. You will probably be weighed at each prenatal visit. There should be consistent, even weight gain throughout the pregnancy, and you should gain 25 to 45 pounds altogether. Sudden gain or loss of weight may indicate problems which need to be investigated further.

Measurement of fundal height is used to assess growth of the fetus. You will be asked to lie on your back, and the practitioner will use a tape measure or special fundal height ruler to measure the distance from the top of your uterus to your pubic bone. This is done at each prenatal visit from about 20 weeks on, with no risks but possible discomfort from having to lie on your back for those few moments.
Sometimes ultrasound scans are used to determine size and position of fetus or placenta. They can also be used to determine certain congenital anomalies. Be sure you know what the practitioner hopes to learn from an ultrasound scan before you agree to have one. Details of the test are discussed under Fetal heart tones.

Blood pressure is another indication of maternal and fetal well-being which will be measured at each visit. It is normal for blood adjusts to the increased volume of blood in your system, but a sharp rise in blood pressure could indicate a serious problem. Often weight gain and blood pressure problems are solved by changes in diet, exercise, and rest.

Fetal heart tones will be checked at each prenatal visit after the first 12 or 17 weeks, depending on what type of equipment is used. The Doppler, a handheld device which magnifies the sound of the heartbeat, uses ultrasound technology to pick up the baby’s heartbeat. Long-term effects of ultrasound exposure are not known.

It is possible to hear the heartbeat earlier in the pregnancy with a Doppler than with a fetoscope (a stethoscope designed to measure fetal heart tones), but the value of this is not clear. Fetal heart rate should be about twice as fast as that of an adult. A slow or irregular heartbeat many indicate that the fetus is or has been in some distress.

Amniocentesis is a surgical test in which a needle is inserted through the abdomen into the womb to withdraw a sample of amniotic fluid. This fluid contains urine and skin cells from the baby which can be analyzed to discover its chromosomal or genetic makeup.

Today it is possible to detect about 200 chromosomal disorders, most of which are very unusual. This test may be useful if you know that such a disorder runs in your family. It is most commonly used to detect neural tube disorders and Down’s syndrome.

The test is done in the 14th to 18th week of pregnancy and results take several weeks. Risks include possible miscarriage (1 %), infection, vaginal bleeding, leaking from the place where the needle went in, isoimmunization if mother is Rh+ and fetus is Rh-, and harm to the baby from the needle. These are rare, but they do occur.

The test is sometimes performed in the practitioner’s office, but most often in a hospital or genetic testing center, It is preceded by an ultrasound to determine the location of the fetus. A local anesthetic is injected into the area where the needle will be inserted. Results are considered to be very accurate, although factors such as maternal cell contamination, cell culture failure, and artifacts (in which the cells in the lab do not reproduce themselves exactly) can affect accuracy of results. The test is sometimes uncomfortable and can produce considerable anxiety in the two to four weeks between taking the test and receiving the result.

Results take one to two weeks. Risks include infection, bleeding, harm to the fetus, and miscarriage. Long-term risks of this procedure are unknown.

Women should go for regular medical screening from the age of 20 or the time of first sexual activity whichever is earlier, to well past the menopause. You should check as a routine and not wait for symptoms. A family practitioner or a gynaecologist will be able to advise you on the appropriate screening tests. The tests include :
 
A:GYNAECOLOGICAL
 
 1. Cervical smear
     Here the doctor does a vaginal examination and uses a thin  
     spatula or brush to gently ‘scrape’ the cervix for its cells
    and sends to a cytopathologist to examine them under the
    microscope for abnormal cells.  This test should be  
    conducted yearly from your first onset of sexual activity
    until at least 60 years. If there are abnormalities then you
   will be subjected to another test called colposcopy.
 
2. HPV DNA screening
  A specific area in the cervix known as the transformation
  zone is prone to changes to abnormal cells (cervical
   Intraepithelial neoplasia) or even cancer. HPV (Human   
   Pappilloma Virus) is the main risk factor for these changes
   and this can be screened at the same time as the cervical
   smear.
 
3. Vaginal examination
    Here the doctor conducts a vaginal examination  
  (sometimes called an internal examination) and will be able
   to pick up abnormalities in the pelvis including the uterus,
    tubes and ovaries
 
4. Pelvic ultrasound
     Here an ultrasound is done to visualise the uterus, ovaries,
    fallopian tubes and the surrounding structures known as
    adnexa. Ultrasound is not irradiation and is therefore safe.
   This test is good for identifying fibroids, ovarian tumuors
    ectopic pregnancy and pelvic inflammatory disease.
   Gynaecologist often use vaginal ultrasounds as the images
    are a lot clearer and well defined. This mode of ultrasound
   is especially useful for screening of ovarian tumuors. This
   particular ultrasound causes nothing more than a slight
   discomfort.
 
5. Breast examination
   The doctor by examining your breast will be able to pick up
    growths that you may have missed.
 
6. Mammogram
   This is an X-ray test that involves very small amounts of
   irradiation and is more sensitive than a manual
    examination. It is highly accurate but by no means
   perfect as it can, rarely, miss lesions. You should do this
    3 yearly from the age of 40 or sooner annually if there is a
   risk factor such as breast cancer in your family.
 
7. Breast Ultrasound
    This is an alternative to a mammogram and is usually
     done in the intervening years between a mammogram.
     As it is only an ultrasound it is very safe.
 
8. Bone Mineral Density
    This is done 3 yearly from the age of 65 and it an Xray
     based test of the hips and spine.
 
 
B) GENERAL CHECK
  This is usually incorporated as part of a routine check when
   you see a gynaecologist
 
 1. Physical examination
    You will be examined for anaemia by looking under your
   conjunctiva for paleness. Your pulse and Blood pressure will
   be recorded together with your height and weight.
   Examination will include the heart, lungs, breasts and
    abdomen.
 
2. Urine tests
  This is done to detect infections and abnormal glucose and
   protein levels
 
3. Blood tests
    Blood tests are not necessary as a routine but may be ordered
    if the doctor feels there is a certain need. However it is
    increasingly common for women to request for a ‘full and
    thorough blood test’. Here the blood test will look for
   abnormalities in your liver, kidneys, bone, cholesterol,
    glucose, thyroid, white and red cells, platelets. Cancer
    markers are usually included but they have their limitations  
    in detection of cancers
 
4. Heart Assessment
    This is a routine after 50 years and you should consult
    a physician. The benefit of Routine ECG (Electrocardiogram)
   and a stress ECG using the Treadmill is controversial
 
5.  Colonoscope
    This is useful to do after the age of 50 and 5 yearly thereafter
 
SUMMARY OF CHECK
Age 20-39   Yearly Pap smear/breast/pelvic ultrasound
Age 40-70   Yearly as above
Yearly blood for cholesterol/liver/kidney
Yearly breast ultrasound
3 yearly mammogram
Yearly cancer markers
5 yearly colonoscopy
3 yearly Bone Mineral Density