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