Obstetrics in Singapore

All expectant mothers wish for nothing more than a safe pregnancy and a smooth delivery of a healthy baby. With technological advancements in prenatal screening, expectant mothers can better monitor their baby’s growth and development closely from conception to birth.

With less-invasive prenatal investigations ranging from high definition ultrasounds to biochemical marker analysis to hormone and blood tests, chromosomal abnormalities and other fetal anomalies can be detected safely and more accurately. These include:

FETAL VIABILITY SCAN and DATING SCAN

This is the first ultrasound that will demonstrate the presence or absence of a viable fetus. It is particularly helpful for those with previous pregnancy losses or who are undergoing assisted reproduction as the anxiety levels are higher. The earliest one can confidently see a fetal pole and presence of fetal heart pulsations is from 6 weeks onwards. The CRL (crown rump length of a fetus at 6 weeks is approximately 3 -5 mm. It should be performed transvaginally to be accurate. This scan helps to exclude ectopic pregnancy by confirming the presence of an intrauterine pregnancy as well as the absence of any abnormality outside of the uterus.

This scan can also help to accurately date the pregnancy if it is performed prior to 10 weeks gestation. It is also particularly important in the case of multiple pregnancies, to determine the type of twins.

NUCHAL TRANSLUCENCY (NT) SCAN

In this method, a special ultrasound scan is used to check the thickness of the nuchal translucency (the fluid present at the back of the baby’s neck) and the presence the nasal bone. An increased amount of the nuchal fluid and the absence of the nasal bone indicates a higher risk of a chromosomal disorder such as Trisomy 21 or Down’s syndrome. The NT scan is typically done during the first trimester between 11-14 weeks of pregnancy. It has an accuracy of around 75%.

FIRST TRIMESTER PREGNANCY SCREEN OR OSCAR

This is a diagnostic tool which uses a combination of the NT scan and a maternal blood test that measures the levels of pregnancy-associated plasma protein-A (PAPP-A) and human chorionic gonadotropin (hCG). It is also performed during 11-14 weeks of pregnancy. When combined with a NT scan, the accuracy rate of detecting Trisomy 21 increases to 85-90%.

NON-INVASIVE PRENATAL TESTING (NIPT)

With 99% accuracy for Trisomy 21, NIPT evaluates the free fetal DNA (which is present in the mother’s blood during pregnancy) to check for the presence of variants in the amount of free Fetal DNA, which would indicate a higher risk of a genetic disorder. This screening test, which can be performed from as early as 9-10 weeks of gestation, is used to indicate whether further diagnostic tests are needed. This is the most sensitive test to date for the common trisomies and is useful for both low and high risk patients.

CHORIONIC VILLUS SAMPLING (CVS)

This method involves taking a sample of the chorionic villi from the placenta either through the abdominal wall. Chorionic villi refer to finger like projections within in the placenta that contain the baby’s genetic makeup. A CVS test is typically done during 11-14 weeks gestation, and is a DIAGNOSTIC test to confirm the high risk result from a screening test or exclude a chromosomal problem in the presence of a structural fetal abnormality.

AMNIOCENTESIS

An amniocentesis is also diagnostic test which involves taking a sample of the amniotic fluid, the liquid that surrounds the fetus in the womb, via an ultrasound-guided needle. It is best performed at 16 weeks of pregnancy. Amniotic fluid contains fetal cells from which the genetic testing is performed. This removes the risk of placental mosaicism as the placenta occasionally has cells which are different from the fetus. Your fetal maternal specialist will advise you with regards to the diagnostic test which would be more suitable for your pregnancy.

FETAL ANOMALY SCREENING SCAN

This is the definitive ultrasound scan which is usually performed anywhere between 18 to 22 weeks. This scan aims to help detect any major fetal structural abnormalities as well as demonstrate the location of the placenta and determine the uterine blood flows in mid pregnancy. Abnormalities which can be detected with high degree of accuracy include anencephaly, bilateral renal agenesis, cleft lip, diaphragmatic hernia, Edward’s syndrome (T18), exomphalos, gastroschisis, lethal skeletal dysplasia, open spina bifida, Patau’s syndrome (T13) and serious cardiac abnormalities.

CERVICAL LENGTH ASSESSMENT

An ultrasound assessment of the cervical length can help determine whether the expectant mother is at risk of preterm labour. It is recommended for this test to be done before the second trimester for the sake of early intervention and treatment if necessary.

ASSESSMENT OF FETAL WELL-BEING

Conducted anytime between 24-41 weeks of pregnancy, this scan monitors the baby’s growth and development, including placental condition. Observe fetal movements and determine amniotic fluid volume. This may be done alongside a Doppler ultrasound test to measure blood flow from the placenta to the baby. This helps to give an idea of the baby’s functional status.

SCANS IN LABOUR AND DELIVERY

Finally when the mother goes into labour or to the operation theatre, the ultrasound can be used to confirm the lie of the baby and assist it the managmenet of the labour. For example, a transverse lie at caesarean is best turn to a breech presentation for ease of delivery. Using the scan to determine how the baby is lying just prior to operation would certainly reduce operative anxiety on the part of the sugeon.

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