Frequency of visits
On your first prenatal visit to Athens Reproduction the presence of an intra uterine pregnancy (a pregnancy that is located in the uterus) will be confirmed with a transvaginal sonogram with the visualization of a gestational sac in the endometrial cavity.
A careful history and physical exam will be performed and pregnancy precautions about nutrition, activities and environmental hazards will be given. Educational pamphlets are handed out and all your questions will be answered.
The required first trimester labs will be explained in detail and ordered electronically by our secretary.
The nuchal translucency NT scan will be scheduled for you between 11-13 weeks. All prenatal visits to our office will be scheduled once a month up until 32 weeks, thereafter the visits will be every 2 weeks. If the pregnancy is a high risk one then the visits may be more frequent.
NIPT (Non-Invasive Prenatal Testing)
NIPT is a screening blood test that traces the cell free fetal DNA in the maternal circulation. Fragments of fetal DNA are out of the cell in the circulating blood of the fetus and some of it crosses the placenta into the maternal circulation. The cell free DNA of fetal origin comprises 3-13% of the total cell free DNA after 10 weeks. Laboratories over the last few years have been able to detect and analyze the cell free DNA enabling them to screen for common trisomies like Trisomy 21 and 18 with a sensitivity that reaches 98-99%. The sensitivity for Trisomy 13 and sex chromosome aneuploidies is somewhat lower at 80-90%.
This test can be done from 9 weeks and onwards and the results are typically available within 7-10days.
The major advantage is its high sensitivity as a test and the fact that it is noninvasive (No risk for miscarriage).
The main disadvantage when compared with invasive tests (like amniocentesis) is that it does not test for all chromosomes and it is still quite expensive.
Amniocentesis is a medical procedure where amniotic fluid is sampled using a sonographically guided needle. The most common reason for amniocentesis is to test for chromosomal defects but it can also be performed in order to test for infection or lung maturity.
In the amniotic fluid sample exfoliated skin cells of the fetus are cultured and karyotype analysis is performed. The accuracy of the test is 99.99 % for all chromosomal defects.
Amniocentesis is usually performed between 17 and 20 weeks of gestation.
The main disadvantage of amniocentesis is a small risk for fetal loss, approx. 3-4/1000.
Another invasive test for chromosomal defects that can be done at an earlier stage and has similar accuracy is the Chorionic Villi Sampling test (CVS).
CVS is performed by sampling placental tissue with a sonographically guided needle.
It is performed earlier between 11 and 13+ weeks but has slightly higher fetal loss risk.
High risk pregnancy
A pregnancy is characterized High Risk when it carries an increased risk for maternal and/or fetal health problems.
Common conditions that make a pregnancy high risk is Hypertension, Diabetes, obesity, multiple gestations, advance maternal age etc.
Women with high risk pregnancies should receive care at more frequent visits, sometimes from a special team of health providers and have more frequent fetal well-being tests.
Usually HR pregnancies are followed more closely after 28 weeks and have more restrictions in order to carry their infant closer to term.
NST (Non Stress Test) is a simple non- invasive test performed usually after 28 weeks of gestation.
Two belts are attached on the mothers’ abdomen. The upper one measures the contractions and the lower one the fetal heart rate over time. It is designed to detect uterine contractility and assess fetal well-being.
When there are at least 2x accelerations of the fetal heart rate of more than 15 beats per minute over 20 minutes, we can be reassured that the fetus is doing well for the next 10-15 days.
Sometimes due to the sleep pattern of the baby, longer observation times might be needed.
BPP (Biophysical Profile) is a test performed with an ultrasound machine and measures your baby’s movement, muscle tone, breathing movements and amniotic fluid.
This test is designed to detect fetal stress. A perfect score means that the baby is having a good time in the uterus.
Sometimes BPP is combined with NST.