Ultrasound examinations

This is the most important scan during pregnancy. Most of the child’s internal organs are already fully formed. An assessment of the anatomy and the heart of the foetus allows us to determine the risk of chromosome aberrations and to exclude over half of congenital disorders.

A detailed assessment of the structure of the ovum includes the following elements:

1. Determining the number of embryos in the uterine cavity, determining chorionicity and amnionicity in multiple pregnancies

2. Assessment of fetal heart rate (FHR)

3. Biometric measurements:
   • Crown-rump length (CRL)
   • Biparietal diameter (BPD)

4. Assessment of fetal anatomy:
   • Skull (shape), cerebral falx, choroid plexus of the lateral ventricle
   • Abdominal walls in the abdominal cavity including physiological umbilical hernia in the first weeks of pregnancy
   • Stomach
   • Fetal heart – Position and function
   • Urinary bladder
   • Spine
   • Upper and lower limbs

5. Chorionicity determination

6. Nuchal translucency (NT) and nasal bone (NB) screening

7. Blood flow in the ductus venosus and in the atrioventricular valves of the fetal heart

At this stage of pregnancy, we recommend complementing ultrasound scans with non-invasive diagnostics of chromosomal defects for the following syndromes: Down’s, Edwards’ and Patau’s – based on the double marker test, i.e. testing the levels of the pregnancy hormones hcG and PAPP-A in maternal blood. On request, we offer the non-invasive, antenatal Harmony test to our patients, instead of the double marker test.

Testing the level of the above-mentioned hormones combined with ultrasound imaging enables the risk assessment of potential genetic defects. The vast majority of pregnant women qualify for the low-risk category following the screening. Patients with an increased risk can decide to undergo invasive diagnostic tests. These tests include: amniocentesis, chorionic villus sampling (CVS) and cordocentesis, carried out by a specialist with certificates in Diagnostic Skills and Fetal Intrauterine Therapy.

Ultrasound scans between weeks 11 and 14 of pregnancy, including testing for nuchal translucency (NT) and nasal bone (NB), as well as other markers for genetically conditioned syndromes, are carried out in line with the principles set out by the Fetal Medicine Foundation and can only be performed by doctors with up to date certificates from the Polish Gynaecological Society as well as the Fetal Medicine Foundation.
The optimal timing for antenatal testing: weeks 11+0 – 13+6 of pregnancy; CRL 45 – 84 mm.

In addition, the goal of ultrasound scans in the first trimester is to assess the risk of pre-eclampsia caused by high blood pressure (complications in 2% of pregnancies) as well as risks of intrauterine growth restriction of the child (5% of pregnancies). The assessment is based on blood flow parameters in uterine vessels, the weight and height of the pregnant patient, and smoking status, as well as previous gynaecological conditions, if any.

This ultrasound scan is essential for a detailed assessment of fetal development and anatomy. It includes:

1. Determining the number of foetuses, their position and heart function.

2. Fetal biometry: BPD, HC, AC, FL + optional Estimated Fetal Weight (EFW)

3. Assessment of fetal development:
   • Skull – Continuity, shape
   • Brain – Chambers, the choroid plexus, posterior cranial fossa, cerebellum
   • Face – Profile, eye sockets, nasal bones, optional assessment of the palate and upper lip
   • Spine – Continuity, symmetry
   • Chest, heart – Size, location, normal appearance of the four chambers, frequency and regularity
   • Abdominal cavity – Abdominal wall continuity, stomach (localisation, size, shape), echogenic bowel
   • Urinary bladder
   • Kidneys – Description of potential abnormalities (the width of the pelvicalyceal system)
   • Limbs – Assessing the presence of femurs, humerus, forearm, lower legs, hands and feet, limb mobility

4. Placental assessment:
   • Position
   • Structure – Placental maturity grading according to Grannum’s classification (description of potential placental abnormalities, retroplacental hematomas)

5. Umbilical cord assessment:
   • The number of vessels
   • Description of potential abnormalities

6. Estimating the amniotic fluid volume

7. Where necessary for clinical reasons: examining the cervix – transvaginal scan.

If a fetal congenital disorder is diagnosed, we will refer the patient to a consultation with a paediatric specialist or neonatologist to determine the prognosis and available treatment after birth.

The goal of the ultrasound scan in the third trimester is the assessment of the child’s weight gain and development, its anatomy for the detection of late-appearing anomalies, peripheral circulation for placental efficiency, the volume of amniotic fluid, and the position and maturity of the placenta. Congenital disorders which appear late include amongst others: microcephaly, cerebellar hypoplasia, obstruction of the duodenum and other intestinal defects, some defects of the urinary tract, some limb defects as well as dynamic heart defects. Ultrasound screening in the last trimester makes their detection possible.