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Examinations during pregnancy

The early symptoms of pregnancy are: loss or delay of menstrual bleedings, breast tenderness, fatigue and nausea. A pregnancy test (urine) is positive very early in pregnancy. The urinary pregnancy test result is extremely seldom falsely positive, but it may be negative if taken too early. The duration of pregnancy is expressed as the number of weeks of pregnancy. The first day of pregnancy is set as the first day of the last menstruation. When menstruation stops, the fifth week of pregnancy is usually ongoing. The pregnancy test is may be positive also in the rare case when the pregnancy is not normal; it is positive also when the embryo is located outside the uterine cavity, e.g., in the Fallopian tube, or if the development of the embryo stops (called blighted ovum or anembryonic pregnancy, as there is no embryo).

Early pregnancy ultrasound 

An ultrasound examination in early pregnancy will confirm where in the uterus the growing fetus is located, the pulse of the fetus, the number of fetuses and the duration of the pregnancy. The best time for an early pregnancy ultrasound is during pregnancy weeks 7–10. The examination is performed through the vagina. The examination will confirm if the fetus is situated and growing within the uterus and that the fetus is alive, as shown by the presence of a heartbeat (pulse). The crown-rump length of the fetus is measured to verify the duration of the pregnancy. If there have been pregnancy-related problems during previous pregnancies, such as miscarriages or pregnancy outside the uterus (extrauterine pregnancy), the ultrasound may be performed already during pregnancy weeks 6–7. All physicians at Aura Klinikka perform early pregnancy ultrasound examinations.

All pregnant women have a statutory right – i.e., it is not compulsory – to have fetal screening at the public healthcare system. The screenings are 1) combined (blood test + ultrasound) early pregnancy screening and 2) midpregnancy screening by ultrasound for structural changes of the fetus.

Fetal screening

Combined early pregnancy screening includes an ultrasound examination of the thickness of the nuchal fold and a general view of the body structures of the fetus.  The blood test shows if there is an increased risk for certain chromosomal aberrations. The most common chromosomal aberration is trisomy 21 which causes Down syndrome. The blood test included in combined screening is taken during pregnancy week 9+0–12+6 and the ultrasound included in the combined screening shows if the fetus has an exceptional nuchal fold and if the fetal structures are as expected. The ultrasound discloses the number of fetuses and allows a reliable estimation of the duration of pregnancy. The ultrasound examination is carried out during pregnancy weeks 11+0–13+6. If you decide not to participate in the combined pregnancy screening, you have the statutory right to a general ultrasound examination at pregnancy weeks 10–13, where the number of fetuses, the duration of pregnancy and significant structural anomalies can be ascertained. This ultrasound is performed with the ultrasound sensor either on the abdomen or intravaginally.

Aura Klinikka provides also the NIPT blood test regardless of whether you have attended at early pregnancy screening and got a normal result and you would like to have the result checked. NIPT stands for Non-Invasive Prenatal Testing. The blood sample from the pregnant woman contains some DNA that originates from the fetus. The fetus is not touched at all, and testing does not pose any risk to the pregnancy. The NIPT test may be performed as of pregnancy week 10 and it is essential that the duration of the pregnancy has been checked by ultrasound before the blood sample is taken.

The basic NIPT test screens effectively for trisomy 21, 13 and 18 and for aberrant sex chromosomes. The extensive NIPT test screens, in addition to the ones mentioned, also for the six most common microdeletion syndromes (CATCH/Di George, 1p36, Angelman, Prader-Willi, Cri-du-Chat;and Wolf-Hirschhorn). Both tests will disclose the gender of the fetus, and if the pregnant woman wants to know if it is a boy or a girl, this information is available.

If the pregnancy is a twin pregnancy, the NIPT test will only work for screening of trisomy 13, 18 and 21 and for the Y sex chromosome. The test does not tell the gender of the twins except if both fetuses are girls (in which case there is no Y chromosome). In the case of a twin pregnancy, an abnormal test result cannot identify which of the twins the abnormal result refers to. In this situation the result can be confirmed by a placental biopsy (chorionic villous sampling) or by examining a sample of amniotic fluid.

Since the NIPT test will give a statistical likelihood for the presence of a chromosomal aberration, it is not a diagnostic test. If the result of the NIPT test is unexpected, the condition of the fetus needs to be confirmed by a chromosomal study of a placental biopsy (chorionic villous sampling) or a sample of amniotic fluid. If the result is normal, you will get this information by email. Otherwise, a physician will discuss with you what the abnormal result means.

If you are above 40 years of age or if a chromosomal aberration has been found in a previous pregnancy, you may have the NIPT test in place of the combined fetal screening without cost at the public healthcare system.

Midpregnancy ultrasound is performed to check the structures of the fetus. This ultrasound examination is preferably made during pregnancy weeks 20–22. The ultrasound sensor is moved on your abdomen in this study. The ultrasound looks carefully at the organs and structures of the fetus and checks for structural aberrations. The reliability of the ultrasound depends on the position of the fetus, the amount of amniotic fluid, the experience of the investigator, the quality of the ultrasound device and the thickness of the abdomen of the pregnant woman. Obesity and dense tissues may impair the quality of the study result. If you decide not to have the midpregnancy screening ultrasound, it is possible for you to have a regular ultrasound after the 24th pregnancy week. If structural aberrations are found, it will be easier to plan for the care of the newborn; pregnancy termination because of structural abnormalities is not possible after pregnancy week 24.

4D ultrasound

The most recent development in the field of ultrasound during pregnancy is three-dimensional imaging. Improved resolution and improved device technology have made it possible to examine the condition of the fetus and the fetal structures in detail throughout the entire pregnancy.

The two-dimensional (2D) ultrasound image is a thin slice of the object, and the overall picture of the object is created in the mind of the investigator based on consecutive 2D slices. Technological advances have made it possible to generate rapid ultrasound images over bigger areas and the number of slices used to create such images exceeds one hundred. The result is a three-dimensional still image (3D) or three-dimensional mobile images (4D).

Three-dimensional images provide information on structure and motion

3D/4D ultrasound has made it possible to examine in greater detail than ever many of the problems of pregnancy: The most obvious benefit from this new technique is a superior view of the surface structures of the fetus. This is the case for the whole fetus during early pregnancy and for the face, abdomen, spine and extremities in midpregnancy and late pregnancy. 4D images do not only produce a superior overall image – the 4D technique clearly shows the fetal movements and other fetal activity, e.g., swallowing, position and movements of the extremities. Pregnancy weeks 24–28 are optimal for these 3D/4D ultrasound studies.

More information about the fetal skeleton and blood circulation

3D/4D ultrasound shows the skeletal structures of the fetus very clearly. When this capability is combined with 3D-visualization from several points of reference, diagnosis of any skeletal aberrations, e.g., of the skull or spine, becomes more reliable than before. Visualization of the blood vessels and blood flow using colors has been possible for many years (color Doppler ultrasound).  When this technique is combined with 3D ultrasound of the fetus, the detailed structures of the heart and blood vessels and flow becomes visible.

The examination is safe, painless and easily repeatable.

The ultrasound examination results in images and video clips which you may take with you home. If required, these images may be uploaded for you on a flash drive. You may also make your own video recording on your smart phone. Here is a 4D video for you to watch.

NOTE! For 4D ultrasound studies your need to book a time. The phone number is 02-2334418.

Late pregnancy follow-up 

Usually, the follow-up toward the end of pregnancy takes place in the municipal maternity health clinic and, if needed, at the maternity outpatient clinic of a hospital. If you prefer, you may also visit our clinic for a physician’s examination of late pregnancy. Ultrasound is used to follow the growth, development, wellbeing and presentation of the fetus. Although research shows that ultrasound examinations are safe for the fetus, performing an ultrasound should always be medically indicated. If indicated, the physician will also examine the cervical os (orifice) and the pelvis in connection with a late pregnancy check-up.

Late pregnancy ultrasound examinations are performed by the physicians familiar with obstetrics at Aura Klinikka. Please book an appointment by telephone if you wish to attend for a late pregnancy examination (after pregnancy week 20).

If you need a physician’s certificate for traveling, you may book a time to any one of the gynecologists at the Aura Klinikka. In that case, please take with you the form issued by the airline for this purpose. The physician enters the required information on the form.