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Luxury City Hotel & Towers Room

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200 Seat Capacity Conference Hall

Should pregnant women go for scan? (Part II) by Dr. Chin Akano.

In part 1 Isaid that in normal pregnancies women are expected to undertake only 2 scan sessions being

;

• dating or booking scan at between 6 to 15 weeks 
and 
anomaly scan at 20-22 weeks



In this part I shall be talking about reasons why a pregnant woman may be asked to undertake more than 2 scan sessions.

 Like I said when there are problems in the pregnancy, the woman may undergo further ultrasound scans. Some of the possible reasons for this are as follows:



• Suspected ectopic pregnancy



Ectopic pregnancy is any pregnancy growing outside the uterus (womb).
 Without ultrasound there is no way it can be diagnosed with precision. If a woman is pregnant confirmed with a urine and blood test and then suddenly develops a low abdominal pain, bleeding through the vagina or feeling faint among other symptoms, they are referred for scan to rule out ectopic pregnancy. It is a very serious condition that needs to be diagnosed promptly and with precision.



• Miscarriages
 

It is only with a scan that a Doctor can tell a woman with absoluteness that she has miscarried. Your doctor may suspect that a you are miscarrying based on symptoms but confirmation must be through an ultrasound scan. It is even more crucial for those women who suffer missed miscarriage where there baby has died in the womb. There is no other way of confirming this except with an ultrasound scan.



• Any case of bleeding and severe abdominal pain in pregnancy


 It is through scan that a doctor can confirm if the bleeding or pain in pregnancy is related to the pregnancy or not



• Elderly pregnant women to check for downs syndrome and other genetic abnormalities in their babies


We already know that the older a woman is, the more likely she is to give birth to children with downs syndrome and other genetic disorders. In good centres, a scan known as Nuchal Translucency is done around 15 weeks to check if the baby is likely to have these disorders.

• 
Growth scan


If the baby seems not be to growing well or bigger than expected, a growth scan is done to confirm the growth of the foetus (baby). There is no need to undertake this in normally progressing pregnancy



• Placental localisation

I am sure most of us know about placenta often referred to as the after birth. This organ is for the nourishment of the baby while in the womb. Sometimes it lies in a position that obstructs the birth canal and prevent normal vaginal delivery. This is known as placenta praevia. So a scan is done to check the location of the placenta .If the placenta is found to be this low lying, the woman will be planned for a routine Caesarian Section (CS) . If this diagnosis is not known before the woman goes in labour, of course the labour will be obstructed, the baby can't come out through the vagina and an emergency CS is called for. This obviously may affect the well-being of both the mother and baby



• Foetal (fetal) distress


This is when the baby is in distress in the womb and in serious danger. In addition to other tests, an ultrasound scan with a doppler facility can correctly diagnose the cause of the distress



• The presentation and lie of the baby


The obstetrician and midwife need to know the presentation and lie of the baby in the womb. Presentation means how the baby is coming towards the birth canal. If the baby is coming with the head, this is normal and it is known as cephalic presentation. Sometimes the baby comes with the buttocks,this is known as breech presentation. Women are unable to deliver a baby with breech presentation through the vagina without help or intervention. In some cases the baby even presents with the legs etc .
So knowing how the baby is presenting is crucial in planning how the woman will deliver her baby.
The lie on the other hand is how the baby is lying in the womb. The normal lie is what we call longitudinal lie where the long axis of baby is longitudinal and parallel to that of the mother.Sometimes babies lie in awkward positions like obliquely, transversely etc. The obstetrician and midwife need this information to plan the delivery for the woman



• Fetal well being scan for women with serious medical problems


Women who suffer from serious medical conditions that can affect their babies and impact on planning of their delivery eg diabetes, hypertension in pregnancy, Pre- ecclampsia etc would need to have regular scans as prescribed by their obstetrician to assess the well being and growth of the baby



• What of the gender of the baby?

Ideally this is not a reason for a scan since there is no difference in the outcome of the pregnancy and planning for delivery for different sexes.However some women want to know the gender of their baby(babies) for whatever reason. It is often possible to confirm this from about 15 weeks of pregnancy and beyond. It must be emphasized that it is not always possible to see the gender of the baby and it is therefore subject to errors at times. 




Dr Chin Akano

Should pregnant women go for scan? Find out in this well written article titled Ultrasound by Dr. Chin Akano.

ULTRASOUND

Today's topic is about ultrasound scan for pregnant women. I want to explain what ultrasound is, how it works, the safety, why and when it should be done and also to possibly correct some myths about it.



WHAT DOES ULTRASOUND MEAN?



Ultrasound is a sound of high frequency that one cannot hear and is emitted and received by the special machine known as ultrasound machine.These sound waves create images of organs and structures inside your body which the scan machine picks up. Ultrasound is used for both diagnosis and treatment.In diagnosis, it is used in various spheres of medicine including obstetrics, gynaecology, surgical, medical, foetal (new born babies), musculo-skeletal, cardiac, neurological etc etc.
Today i shall focus on obstetric scans which applies to pregnant women only.


WHAT IS REQUIRED FOR THE PROCEDURE:


* an air conditioned room to reduce heating from the machine
* an ultrasound machine
* a couch where the woman will lie
* a gel 
* a light dimmer to dim the light before the procedure takes place
* Paper towels to clean the woman after the procedure and also to protect her clothings from being soiled by the gel



WHAT IS THE USE OF ULTRASOUND IN PREGNANCY?



Ultrasound is used in pregnancy to monitor the baby for well being and to plan the pregnancy . It is not used for diagnosing pregnancy . Diagnosis of pregnancy is by either urine or blood test. It is only when one has confirmed that they are pregnant that they go for scan to check out their babies.



WHEN WAS ULTRASOUND FIRST USED IN PREGNANCY MONITORING?


Early 1960s and since then it has been improved and remodelled.

IS IT SAFE?
Yes ultrasound scan is largely safe for the mother and baby. However there may be a little rise in temperature known as heating effect to the baby especially when the mother is running a temperature or when doppler scan is being used. Therefore it is advisable for pregnant women as much as possible to avoid ultrasound scan when running a temperature (fever) or for the operator not to use the doppler for a very long time on the baby.

TYPES OF SCANS IN PREGNANCY

In pregnancy a woman can be scanned in two ways as follows:
* Transabdominal scan where the procedure is done on the abdomen . This is shortened as TA
* Trans-vaginal scan where it is done through the vagina shortened as TV

Does one type have an advantage over another?
Yes TV has some advantage over TA in early pregnancies. In TV, the ultrasound probe is inserted into the vagina to release and receive ultrasound beams. So since the vagina is close to the womb and other reproductive organs, the images produced are clearer than a TA where the beam has to pass through skin, fat, muscles etc before getting to the reproductive organs. So the image seen via a TV scan is more optimum and clearer than one seen via a TA scan.
TV is therefore better than TA in early pregnancies for dating (booking) the pregnancy, in diagnosing miscarriages, ectopic pregnancies and other early pregnancy problems. It is also better in non pregnant women for gynaecological diagnosis.
However TV is not advised in virgins for obvious reasons and some women do find it unpleasant.



DOES A WOMAN NEED TO DRINK WATER BEFORE A SCAN?


In the first instance, let us understand why pregnant women are sometimes asked to drink water before being scanned. It is not to fill up her stomach but to fill up her bladder with urine.
Why does the bladder need to be filled up?
A full bladder is necessary to push the womb out of the pelvis to prevent shadows from pelvic bones. If not these shadows will prevent the visualisation of images. A full bladder also acts a window for proper visualisation of the ultrasound images
Do all pregnant women going for a scan need a full bladder?
Answer is capital NO
For a TV scan, the bladder must be completely empty. So the woman needs to empty her bladder before being scanned because urine in the bladder will affect the image quality.
For an abdominal scan in pregnancy (TA), a full bladder is not necessary in most of the cases.
A full bladder is only necessary:
1) if the pregnancy is still quite early or young. I mean pregnancies younger than about 13 weeks. After that the woman does not need a full bladder to be scanned.
2) If the reason for the scan is to check the location or position of the placenta (after birth)
In all other cases, the woman does not need to drink water or have a full bladder before being scanned.



IS ULTRASOUND SCANNING A MUST IN PREGNANCY?


Absolute yes. Sometimes i wonder how obstetricians and midwifes coped before the advent of ultrasound in diagnosis.



WHAT ARE THE REASONS FOR ULTRASOUND SCANNING IN PREGNANCY?


In normal pregnancies, the woman is expected to be scanned only twice.
When?
1) when dating or booking the pregnancy
This means assigning an age to the pregnancy known as gestational age and also estimating date of delivery known as expected date of delivery (EDD). This is known as a dating or booking scan
When should this be done?
Between 6 weeks and 15 weeks of pregnancy. Beyond 15 weeks, the dating becomes unreliable.
2) when checking the baby for anomalies or abnormalities. This is known as anomaly scan. This is a very important scan because this is when any physical abnormality in the baby can be diagnosed.
When should this be done?
This scan is done only when the baby is fully formed and the organs and parts are fully developed. This is between 20-22 weeks
. In essence for every pregnant woman, only two scans are necessary if pregnancy is normal. That is
* dating (booking)
* anomaly scan

. Dr Chin Akano

Dr Chin Akano

Dr Chin Akano is from Nkwerre Town in Nkwerre LGA of Imo state. He bagged a bachelors degree of medicine and surgery (MBBS) from the University of Benin, Benin City Nigeria.
He did his one year housemanship at the University of Port Harcourt Teaching Hospital Port Harcourt.

Subsequently he worked at the Ponyx Hospital, Port Harcourt as a resident doctor for several years before he relocated to the United Kingdom for further training.

He joined the Mid Glamorgan Psychiatry  Rotation training and also enrolled at the Cardiff University for an MSc in Psychiatry.

Subsequently he had post graduate training in General Practice ( family medicine) and  qualified in 2005.


He also undertook training as a medico-legal medicine and after qualification acted as a an expert witness and prepared several reports for the Royal Court of Justice for several years.


He is currently undertaking a MSc programme in Ultrasound diagnostics ( O&G) at the Cardiff University, UK.


He has attended about a hundred courses/seminars and conferences, made several presentations and written several articles and publications
He is a member of the Royal College of GP (RCGP) and British Medical Association (BMA)
In his spare time, he gets involved with humanitarian, charity and philantropic services
 

Dr. Chin is our in-house doctor & will be available Tuesdays to attend to our health matters. Please feel free to direct your questions/comments to abiapost@gmail.com and be rest assured he will answer them all professionally.