Diabetes Screening In Pregnancy

Diabetes Screening in Pregnancy - Newborn BabyGestational Diabetes Mellitus (GDM) is diagnosed when a woman has higher than normal blood glucose levels during pregnancy.

Why does GDM happen?

Certain pregnancy hormones made by the placenta work to help prevent the mother from developing low blood sugar, which is dangerous for her unborn baby. They do this by resisting the actions of insulin, the hormone responsible for getting sugar from the blood into the tissues. As a consequence, there is a progressive increase in blood sugar levels (impaired glucose intolerance) during pregnancy. To counteract this and try to decrease blood sugar levels, the mother’s pancreas makes more insulin. Usually, the mother’s pancreas is able to produce enough insulin to overcome the effect of the pregnancy hormones. A pregnant woman needs two or three times more insulin than normal. If her pancreas gland is unable to produce this much insulin, her blood sugar level rises and GDM develops.

GDM is an increasing risk as pregnancy advances. This is why screening is done at 26 to 28 weeks unless the pregnant woman is at high risk of gestational diabetes (when it is done earlier). For the same reason, screening may need to be repeated

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Down Syndrome Screening

Down syndrome ScreeningThis is a topic of conversation early in every pregnancy. It is important to consider this and work out what you want to do.

There are three ‘screening’ options available:

1. No checking. Many patients opt for this as they would not do anything with an abnormal result. A karyotype abnormality (as with Down syndrome) cannot be corrected. So there is only one thing that can be done if someone wants to be proactive with the result. If a couple tells me they would not consider termination of pregnancy even if they knew the baby had Down syndrome then I recommend no testing. Why potentially subject your baby to the risk of miscarriage (as is the potential with the NTS screening with an abnormal result) and why pay extra money (more so with the NIPT) if you would not act on an abnormal result? Some say: “It will prepare me”. My experience is an abnormal result causes more worrying. I have patients who have had abnormal NTS and serum result but did not have an amniocentesis because of the risk of miscarriage. They are more stressed than if they had not had the NTS test. As well, Down syndrome has a spectrum of severity and a variety of other associated health conditions. ‘Knowing’ does not prepare you for the outcome

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Growth and Well Being Scan

This externally sourced scan will occasionally be requested help verify your baby’s:Growth and Wellbeing Scan

  • Size - Your baby’s estimated weight especially if I find it significantly outside the normal range.
  • Wellbeing (biophysical profile) - Whether or not there are signs of your baby’s well being is compromised by lack of oxygen and so labour will be more dangerous for your baby.
  • Abnormalities – Your baby will be rechecked for abnormalities and any previously noted abnormal findings will be checked again.

This scan will also help verify the:

  • Placental site – whether it is too low (covering the cervix) or morbidly adherent to uterine wall (called "placenta accreta") which is more common after a previous Caesarean section delivery.
  • Amniotic fluid volume - Too much and too little liquor both have implications for delivery and also raises the need for further checking to try to establish why.
  • Uterine wall - Thickness and defects of
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Morphology scan of the foetus

What is the foetal morphology scan for?

This morphology ultrasound is suggested at 18-20 weeks gestation to check for abnormalities in your baby. The word "morphology" means the “form, structure and configuration” of your baby.

3D Morphology Scan
Besides checking for abnormalities in your baby this morphology scan checks:

  • Your baby's heart is beating
  • Multiple pregnancies
  • Size of your baby
  • Position of the placenta
  • Volume of amniotic fluid around your baby
Why is the morphology scan done at 18 – 20 weeks?

At 18-20 weeks gestation there are usually good views of limbs as well as internal organs. It is sometimes called an "anomaly scan" because fetal abnormalities are looked for at this time.

Why do I need a full bladder for this scan?

Fluid in the bladder provides a clear "window" to the pregnancy. It also makes the uterus rise up from behind your pubic bone. Your bladder does not need to be

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Non-Invasive Prenatal Test (NIPT)

This is a new non-invasive way of checking your baby’s chromosomes and so excluding the most common chromosome disorders with a very degree of accuracy.

Amongst my patients, the Non-Invasive Prenatal Test (NIPT) is now far more popular than the Nuchal Translucency Scan (NTS) and serum as a screening test for foetal chromosome disorders.

The cost has reduced considerably from what it was when NIPT screening was introduced and now through Sonic Genetics (Douglass Hanly Moir Pathology (DHM)), the NIPT testing is done in Australia. The cost of the Harmony NIPT through Sonic Genetics (DHM) has been reduced to $420.

The NTS looks at the skin fold on the back of the baby’s neck at about 12 weeks. This has been further refined by looking at the nose bone of the baby. In addition, there is a checking of the levels of two pregnancy hormones to increase accuracy. This is the combined test (ultrasound scan and serum) has a considered predictive value of about 92%. In contrast, the NIPT has >99.9% accuracy in checking for the three commonest chromosome disorders and as well can check for sex chromosome disorders and so the sex of your

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Nuchal Translucency Scan (NTS)

What is a Nuchal Translucency Scan?

nuchal tranlucency scanA Nuchal Translucency Scan ( NTS) is a screening test to check for Trisomy 21 (Down syndrome), Trisomy 18 (Edwards’s Syndrome), Trisomy 13 (Palau’s Syndrome).

An ultrasound scan is done between 11.5 and 13.5 weeks of pregnancy where there is measurement of the amount of fluid in the skin at the back of the baby's neck. It is usually performed through the abdominal wall but sometimes it is necessary to do an internal (vaginal) scan. The ultrasound has no known harmful effects on the mother or the baby.

All babies at this stage in pregnancy have some fluid in this area, but a baby with Trisomy 21 (Down syndrome), Trisomy 18 (Edward’s Syndrome), Trisomy 13 (Palau’s Syndrome) will have more fluid than normal.

This ultrasound also checks for the presence of your baby’s heartbeat, single or twin pregnancy, dates, exclusion of some other abnormalities such as exomphalos, holoprosencephaly, some heart abnormalities and megacysis.

Is a Nuchal Translucency scan accurate?


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Tests during pregnancy

What tests are needed In my pregnancy?

Pathology Tests

Tests During Pregnancy

In early pregnancy (usually following the first visit) tests are arranged to check for anaemia (full blood count and iron studies), thyroid function, blood group, red cell antibodies, blood sugar check (for diabetes screening) Rubella (German measles) immunity, Hepatitis B, Hepatitis C, syphilis, HIV, Chicken pox immunity and urine infection. If these tests have already been done by your general practitioner can you please bring a copy of the results. I will give you a referral to Douglass Hanly Moir Pathology for these tests. Douglass Hanly Moir Pathology has collection rooms all over Sydney. You may need a Pap smear also.

Blood tests in later pregnancy (at 26 to 28 weeks) are taken to check for anaemia, red cell antibodies (if your blood group is Rhesus negative) and diabetes. There is also a swab check for Group B Streptococcus if a vaginal delivery is planned.

If you have Rh negative blood group and if you have no red cell antibodies as shown by your result you will be offered a

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