Early warning of baby’s health

Prenatal screening helps detect abnormalities and enables early treatment, writes Olivia Miwil

FOR expectant mothers, getting printouts of ultrasound images is no just about having an idea of how their unborn baby would look like. It is to help detect abnormalities in the foetus.

Chong Yi Phing, who is pregnant with her third child, was referred to the Sabah Care Specialist clinic in Kota Kinabalu after a scan at a private hospital revealed that her baby’s skin appeared to be swollen.

She was told that the condition required consultation with an expert. Chong, who has two sons, was referred to obstetrician and gynaecologist, Dr Vijayan Valayatham.

“Before I met him, the uncertainty had caused sleepless nights. But his expertise in diagnosing the cause of the condition via ultrasound and blood tests helped me calm down. We now know that an infection was the probable cause of the baby’s condition,” she said.

Chong said her baby was suffering from a condition known as hydrops fetalis. It is caused by an abnormal accumulation of fluid in a baby’s tissues and organs around the skin, heart, lung or the peritoneal cavity or in all of them. Causes include heart failure, congenital heart disease, genetic conditions and severe anaemia (low red blood cells). Viral infections can also cause hydrops fetalis.

She said the initial scan revealed reduced blood flow to the baby’s heart and throughout the whole system. Chong was recommended for an in-utero foetal blood transfusion. The procedure was performed by Dr Vijayan at the local tertiary hospital during the 32nd week of gestation.

“A needle was inserted into the womb and into the baby’s blood vessel. After paralysing the baby, a blood transfusion was done to top up its red blood cells. It was not painful but scary as it was a first-time for me,” said Chong, 31.

“The latest scan indicates improvement although the actual situation would only be known when the baby is born,” she added.

DIMENSIONAL ULTRASOUND

Dr Vijayan said ultrasonography can be done as early as 11 to 13 weeks of pregnancy for preliminary analysis. “Around this time, the foetus measures between 45 and 84mm and a preliminary assessment of the brain, heart, chest, abdomen and limbs can be performed.

“The thickness of the neck, presence of nasal bone and the visual of blood flow to vital organs give insight into the baby’s genetic makeup.” He said any abnormality would be further detected with other tests such as chorionic villus sampling and amniocentesis, where the placenta and amniotic fluid are sampled.

Additional screening can be performed during this period, such as a blood test for genetic risk analysis, preeclampsia risk (risk of developing severe hypertension in pregnancy) and hormone profiles.

Prenatal genetic screening tests can rule out common genetic diseases such as Down, Patau and Edwards syndrome. The trio account for 70 per cent of genetic anomalies.

Further scans are recommended on the 20th week when a detailed analysis of foetal structures can be performed. All vital organs will be examined and any abnormality recorded.

“As the baby grows, the face, eyes and shape of the head become more prominent. So the ultrasound scan can detect further problems based on the images.

“Prenatal scans have an 80 per cent detection rate. The final assessment will be completed with a systematic examination of the baby at birth,” said Dr Vijayan.

He advised mothers with a history of illnesses or who are on medication to go for detailed screening as they face higher risks in pregnancy.

“Parents’ psychological preparedness is also essential in dealing with problems. When breaking bad news, doctors must use simple words to explain the condition to parents,” he said.

TYPES OF SCANS

Dr Vijayan said that while there are new technologies in ultrasound images such as 3D and 4D, the 2D images are adequate to assess the feotus’ condition. The higher resolution gives better pictures but limited medical information.

“It is a misconception that higher dimensional ultrasound such as 3D and 4D are better than the basic 2D images. While they are able to give nicer images of the face and external contours, they are merely technology that capture volume rather than a slice of the foetal body.

“The sliced image, which usually refers to 2D technology, is the standard technique that foetal medicine consultants and obstetricians in general utilise to assess the foetus.”

The 4D foetal imaging is similar to 3D scans, with the difference being time: 4D allows a 3D streaming in real time, like video streaming. The 3D and 4D scans are increasingly used by experts when analysing the foetus.

The Sabah Care Specialist clinic also has the prenatal risk calculation software that can help early intervention of treatment and planning for complicated pregnancies. It allows for early collaboration with midwives and paediatricians in future.

Dr Vijay explaining fetus condition while scanning client.

Chong Yi Phing's printup 4D picture of her fetus