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Early Fetal Scan Explained

Graphic of Early Fetal Anomaly Scan. An illustration of a mother thinking about the normal development of her baby's brain.

Early Fetal Scan Explained

Shaz Khojasteh is an advanced Specialist Sonographer in Fetal Medicine, Gynaecology and Fertility in Central London. Gynae Scans and Follicle Tracking Scans in London.

Miss Shaz Khojasteh on why scanning at 12-16 weeks is important for Mothers.

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The early stages of pregnancy are a time of wonder and crucial development. At London Pregnancy Clinic, we offer a thorough Early Fetal Scan to nurture early prenatal care and provide expectant parents with detailed insights into their baby’s early development.

When I joined the London Pregnancy Clinic, the importance of the Early Fetal Scan became vividly clear through experiences with expectant parents. This critical scan, offering a glimpse of their baby’s developing heartbeat and form, goes beyond just a medical check-up; it’s an early, reassuring window into the baby’s well-being and a vital tool for detecting potential anomalies. At the clinic, we do more than just scans; we provide a journey of reassurance, care, and emotional support, making each early pregnancy scan a crucial, heartwarming step in the beautiful journey of parenthood.

The Basics of Early Fetal Scan

Performed between the crucial 12-16 week mark, the Early Fetal Scan is an essential part of your prenatal care regimen. It provides a detailed look at your baby’s development, including their physical structure, heart rate, and movement. This scan also assesses the health of the placenta, which is vital for your baby’s nourishment and growth. 

Importance of Early Fetal Scan

Early Detection of Anomalies: This scan plays a critical role in the early detection of over 100 different structural abnormalities. These include severe heart defects, early brain anomalies, spina bifida, lethal skeletal dysplasias, and other serious structural conditions. The scan even has the precision to detect minute details such as missing fingers, providing a comprehensive view of the baby’s development.

Beyond Structural Analysis: While this scan is adept at identifying structural abnormalities, it’s important to note that ultrasound alone cannot detect chromosomal conditions. A baby may appear structurally normal but still have chromosomal defects like Down’s syndrome (Trisomy 21). If you haven’t already done this with an earlier pregnancy scan like our 10 Week Scan, we strongly recommend doing a non-invasive prenatal test (NIPT). Complementing our 12-16 week pregnancy scan with NIPT will help identify such chromosomal syndromes and is currently the best screening option available and it is part of our signature Ultrasound plus NIPT Dual Approach.

12-16 week Ultrasound Images of the baby

Here are some of the pictures you can get of your baby at 12 to 16 weeks of pregnancy using our state-of-the-art Voluson ultrasound machine.

  • Ultrasound scan image of a baby at 13 weeks. You can see the amazing definition of the scan, showing the individual fingers of the baby. At this stage the baby is about the size of a plum (7cm).

    13 weeks of pregnancy

    Captured via ultrasound at 13 weeks, this image showcases the incredible clarity of our scanning technology, revealing even the tiny fingers of the baby in amazing detail.

  • 3D ultrasound image of a 14-week-old fetus, showcasing detailed features and development

    14 weeks of pregnancy

    3D ultrasound image of a 14-week-old fetus, showcasing clear features and a serene pose often described by patients as the ‘sucking of the thumb in the womb’.

Your Experience with Early Fetal Scans

We achieve the best results by combining external (transabdominal) and optional internal (transvaginal) scans, adapting to factors like womb position, fetal position, and maternal abdominal wall thickness. While our high-resolution transducers often suffice with transabdominal scans, around 10% of women with a retroflexed uterus may benefit more from a transvaginal scan. We ensure you’re fully informed and comfortable with your scanning choices. You can read more about what to expect during a pregnancy scan here.

Your  frequently asked questions about Early Fetal Scan:

When should I do this early pregnancy scan? 

Schedule Scan at 14-16 Weeks: Post 10 Week Scan and NIPT for a detailed anomaly check, as the baby’s advanced development at this stage allows for more comprehensive screening.

Early Scan at 12-13 Weeks for First-Time Checks: If no early anomaly scan was performed by 10 weeks, opt for this ultrasound scan combined with NIPT for effective Down’s syndrome screening.

Address Unclear NHS 12 week scan Findings with Echocardiography: For inconclusive first trimester results, like increased NT, our Early Baby Heart Scan provides an in-depth heart evaluation and a thorough early baby scan.

Can an early fetal scan detect all fetal anomalies? While no single test can diagnose all fetal anomalies, our early baby scan at London Pregnancy Clinic identifies many, particularly severe abnormalities that might lead to disability or require early intervention. However, certain anomalies, especially those affecting late brain or heart development, may not be detectable at 12-13 weeks. We recommend follow-up scans at 20-22 weeks and 28-29 weeks for comprehensive monitoring, alongside maintaining your NHS scan schedule, to ensure the best care for your pregnancy

  • Promotional graphic from London Pregnancy Clinic on pioneering the Early Fetal Scan and the story behind this groundbreaking scan

    London Pregnancy Clinic Scan Overview

    London Pregnancy Clinic Scan Overview

  • Infographic highlighting the dilemma of scan timing in the first and second trimester for early prenatal care

    Why we need 12 to 16 week private pregnancy scan?

    Why we need 12 to 16 week private pregnancy scan?

  • Educational graphic explaining the 12-16 week ultrasound scan process, screening for over 100 anomalies at 12 weeks of pregnancy.

    What is Early Fetal Scan?

    What is Early Fetal Scan?

  • Informative diagram showcasing the reasons for early fetal scanning at 12 weeks and its importance in detecting fetal anomalies.

    Why do Early Fetal Scan?

    Why do Early Fetal Scan?

  • Timeline showing the optimal period for the EF Scan in the first trimester, aligning with developmental milestones

    Best time for EF Scan?

    Best time for EF Scan?

  • Closing graphic from London Pregnancy Clinic thanking readers and inviting dialogue about the importance of early fetal scans.

    Get in touch

    Get in touch

Conclusion

The Early Fetal Scan is a pivotal part of your pregnancy journey, offering invaluable insights for peace of mind and informed decision-making. At London Pregnancy Clinic, we’re committed to providing detailed, compassionate care during this vital phase of your pregnancy.

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Innovations in Pregnancy Care

An illustration for a blog post about a London Pregnancy Clinic event, depicting a serene winter scene with a doctor holding a snowflake wand beside a giant, glowing snow globe. Inside the globe, a peaceful foetus is curled up, akin to a budding flower on a tree branch, symbolising the clinic's nurturing approach to prenatal care.

Innovations in Pregnancy Care

An evening dedicated to LPC’s commitment towards “Innovative Pregnancy Care”

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London Pregnancy Clinic’s recent “Innovative Pregnancy Care” event was a confluence of expertise and insight, shaping the future of prenatal care. Leading professionals gathered to discuss breakthroughs in early diagnostics and patient education, emphasising LPC’s forward-thinking approach.

A December evening at Spitalfields Market was transformed into a hub of medical expertise during the London Pregnancy Clinic’s event. The focus was on pioneering approaches in prenatal care, particularly the 10 Week Scan,  Non-invasive prenatal testing (NIPT), and pre-eclampsia diagnosis.

Advancing the 10 Week Scan

The evening began with Ms. Shaz Khojasteh, LPC’s clinical lead, greeting each attendee with a warmth that matched her expertise. Her introduction was not just an opening speech but a heartfelt welcome to LPC’s family. She shared with the audience our signature 10 Week Scan, which isn’t just a routine check. It’s a comprehensive examination of the baby’s anatomy, providing vital developmental insights at a crucial early stage, thereby enriching the information gathered before conducting NIPT.

Demystifying NIPT – Dr Fred Ushakov’s Perspective

The spotlight then shifted to Dr. Fred Ushakov, whose speech was not only insightful but also visionary. He spoke passionately about his mission, in collaboration with the London School of Ultrasound and UCLH, to train the next generation of doctors and sonographers. His goal is to equip them with the skills and knowledge necessary to leverage early pregnancy scans to their full potential, enhancing patient care and pregnancy outcomes. This mission, he explained, is vital in ensuring that every pregnancy is approached with the utmost care and precision.

Dr Ushakov then addressed a common misunderstanding about NIPT. He emphasised that while NIPT is effective, it’s not all-encompassing. Patients may misinterpret it as a guarantee against all prenatal issues, not realising that conditions more severe than Down’s syndrome can occur and cannot be detected by NIPT. He further highlighted the importance of the dual approach (watch the explainer video here) that he instilled at LPC. Dr. Ushakov’s call for broader education and comprehensive scanning techniques underscored the need for a more informed approach to prenatal care.

Advocacy for Pre-eclampsia Awareness

Next, we were captivated by Dr. Daniel Stott, whose talk about pre-eclampsia was as enlightening as it was heartfelt. It was clear from his words and the energy in his voice just how dedicated he is to this topic. Dr. Stott walked us through the workings of a groundbreaking blood test for pre-eclampsia. With an approachable manner, he explained how this test isn’t just for identifying pre-eclampsia; it’s a crucial tool in carefully guiding expectant mothers through the rest of their pregnancy. 

Conclusion

As the expert talks wrapped up, the event naturally transitioned into festive networking. It was a perfect opportunity for attendees to connect, exchange experiences, and build professional ties in a holiday atmosphere. The evening emerged as a crucible of innovative ideas and shared goals for advancing prenatal care. Leaving the market, we carried with us the night’s insights and a renewed hope for the future of prenatal health. The event proved to be not just a confluence of minds but a beacon of hope for prenatal care’s future.

A special thank you to our sponsors Eurofins.

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Week 5 of Pregnancy

Graphic of Week 5 of pregnancy. An illustration of a baby in the ultrasound machine.

Week 5 of your Pregnancy

Discovering your baby’s progress since week 4

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Having journeyed through the early whispers of Week 4, we now step into the heart of your pregnancy story: Week 5. It’s a chapter filled with vibrant growth and transformation. Imagine your little one, still as tiny as an apple seed, beginning a significant journey into the embryonic period.

Week 5 of pregnancy, it’s all about growth and transformation. Your little one is busy developing, cell by cell, quickly growing from the size of a poppy seed in week 4 (watch video here) to an apple seed. We’ll explore these changes together, learn how to take care of yourself during this time and get a peek into your baby’s development with early ultrasounds. So, let’s dive into Week 5, where every day brings something new and amazing in your pregnancy journey. So let’s navigate the changes unfolding, how to care for yourself, and what to expect from medical check-ups.

Key Concepts: embryonic period

During Week 5 of your pregnancy, a crucial phase begins as your baby, the size of an apple seed, enters the embryonic period. This week marks the foundation for major organs and systems. Hormonal changes, especially increases in progesterone and human chorionic gonadotropin (hCG), are vital in supporting this stage. These hormones maintain the uterine lining and ensure the continuation of progesterone production, crucial for pregnancy health. As a result, you might notice early symptoms like fatigue and nausea. Understanding these changes is key to navigating the early stages of your pregnancy journey.

Pregnancy Checklist at 5 Weeks

While it’s still early in your pregnancy, there are some important steps you can take:

  • Confirm your pregnancy with a test if you haven’t already.
  • Schedule your first prenatal appointment to discuss your health and pregnancy. At London Pregnancy Clinic it’s called the Viability/Dating Scan. Use our pregnancy calculator to work out the best time for your scan.
  • Begin focusing on a pregnancy-safe diet and lifestyle, emphasising foods rich in folic acid and essential nutrients.

Developmental Milestones: Week 5

Growth of the Gestational Sac: This week, the gestational sac, housing your developing baby, continues to grow. It’s a clear sign of your pregnancy’s progression, providing a protective and nourishing environment for the embryo.

Yolk Sac Development: The yolk sac plays a crucial role at this stage, providing essential nutrients before the placenta is fully operational. It also contributes to the early stages of the circulatory system by producing blood cells, supporting the developing embryo’s needs. This process is essential for supporting the growing needs of your embryo and is closely tied to the growth of the gestational sac.

Heart Development: Now your baby’s heart begins its incredible journey. Initially emerging as a simple tube-like structure, it’s preparing to pulsate and evolve into a sophisticated four-chambered heart in the coming weeks. Although it’s not beating just yet, this early stage sets the stage for one of life’s most vital rhythms.

Brain and Spinal Cord Formation: Alongside the heart, the neural tube, which will become the brain and spinal cord, starts to take shape. This tube forms the bedrock of the entire nervous system, integral for everything from physical movements to cognitive functions. It’s a complex process that lays the foundation for your baby’s future mental and physical capabilities.

Emergence of Other Organs: Week 5 also marks the beginning of other organ formations. Organs like the kidneys and liver start to form, albeit in their very preliminary stages much like the heart.

What is seen on the Ultrasound: Week 5?

During the Week 5 ultrasound, expect to see the gestational sac (which has dramatically increased in size since Week 4), the first structure visible on an ultrasound, indicating your pregnancy is progressing well. This small, fluid-filled sac is where your baby will develop. Inside it, the yolk sac may also be visible, which is crucial for providing nutrients to the developing embryo and for blood cell production in these early stages. However, it’s important to remember that at this stage, the embryo itself and its heartbeat are usually not yet detectable.

It’s common not to see the embryo or hear a heartbeat during a Week 5 ultrasound. The embryo is still very small, and the heartbeat typically becomes detectable around the 6th or 7th week of pregnancy. While we know it’s tempting to have an early ultrasound, we at London Pregnancy Clinic recommend waiting until at least week 6 for your first scan. This crucial ultrasound provides a tangible glimpse into your pregnancy, offering reassurance and joy as you embark on this extraordinary journey.

  • Gestational sac at 4 weeks of pregnancy as seen on ultrasound scan.

    Gestational sac at 4 weeks of pregnancy as seen on ultrasound scan.

  • Image showing what would an ultrasound show at 5 weeks of pregnancy. It shows an Ultrasound image by London Pregnancy Clinic that shows the gestational sac and the newly developed yolk sac - for educational purpose.

    Gestational sac and yolk sac at 5 weeks of pregnancy as seen on ultrasound scan.

Thinking ahead: Week 6?

Looking forward to Week 6, expect continued development of your baby’s facial features. You may also start experiencing more pronounced pregnancy symptoms like nausea and fatigue. It’s a time to start preparing both mentally and physically for these changes.

Week 5 of Pregnancy FAQs


  • How common is it for my baby to have a heartbeat at 5 weeks?

    Your baby is an embryo (not a fetus just yet) and can have a heartbeat at 5 weeks of pregnancy, but it is not very common. The fetal heartbeat usually starts to beat between 5 and 6 weeks gestation, and it may be detectable via ultrasound around this time.

    Here are some reasons why the heartbeat might not be detected on an ultrasound at 5 weeks:

    • The embryo is too small.
    • The heartbeat is too faint.
  • What if there is no yolk sac at 5 weeks?

    Patients have asked us why is there no sac seen when 5 weeks pregnant. The yolk sac is usually visible on an ultrasound between 5 and 6 weeks gestation. If there is no yolk sac visible on an ultrasound at 5 weeks, it could be a sign of a miscarriage. 

    However, it could be a sign that the estimated gestational age is wrong. This could happen if your last menstrual period was inaccurate or if you were ovulating later than you thought.

    In this case, we may recommend a follow-up ultrasound in a week or two to see if the yolk sac has developed.


Conclusion

Week 5 of your pregnancy is a time of rapid and incredible changes. While you might start feeling different physically and emotionally, remember, these are signs of your baby’s healthy development. Stay informed, take care of yourself, and prepare for the exciting journey ahead. If you have any concerns, our team at London Pregnancy Clinic is always here to guide you.

Stay tuned on what your baby’s week-by-week growth will look like on our blog.


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Diane Nzelu Prenatal Expert

Meet Diane Nzelu, our prenatal expert, committed to providing expectant mothers with exceptional care, tailored scans, and informed counselling for a healthy pregnancy journey.

Welcoming Ms Diane Nzelu

London Pregnancy Clinic portrait of Ms Diane Nzelu is a Consultant in Maternal – Fetal medicine.

Our newest Expert Team member at London Pregnancy Clinic

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Discover the newest addition to our London Pregnancy Clinic team, Ms Diane Nzelu: Prenatal Expert. Learn about her expertise in prenatal care and how she’s set to enhance your pregnancy journey with compassionate, professional support.

At London Pregnancy Clinic, we’re thrilled to welcome Ms Diane Nzelu, a seasoned expert in prenatal care. Diane joins our team with a remarkable 13 years of expertise in fetal medicine. Her experience spans across extensive fetal scanning and handling medically intricate pregnancies. She’s always prioritised bespoke care, ensuring her advice and support are tailored to each expectant mother, actively involving them in their care journey.

Her academic pursuits are notable, with a keen focus on researching pregnancy-induced hypertension. This has led to numerous published works and presentations at both national and international fora. Beyond her UK-based work, Diane is actively engaged in global health projects, dedicated to advancing maternal health in various parts of the world.

Meet Ms Diane Nzelu: A Passion for Prenatal Care

Joining us with a wealth of knowledge and years of experience, Diane Nzelu: Prenatal Expert. She is a highly qualified prenatal specialist and her background in providing comprehensive care during pregnancy sets her apart. Diane’s passion for prenatal care stems from a deep commitment to ensuring the well-being of both mother and baby during this crucial time.

Enhancing Your Pregnancy Journey

Diane’s approach to prenatal care is both personal and professional. She understands that each pregnancy is unique and offers tailored advice and support to meet your individual needs. Whether it’s your first pregnancy or you’re adding to your family, Diane’s guidance will be invaluable in helping you navigate this special time with confidence and peace of mind.

A Commitment to Compassionate Care

At the heart of Diane’s practice is a strong commitment to compassionate care. She believes in creating a supportive and understanding environment for all her patients, ensuring that they feel heard, respected, and well cared for. Her empathetic approach not only enhances the quality of care but also strengthens the trust and relationship between practitioner and patient.

Conclusion

Join us in welcoming Diane Nzelu, Prenatal Expert, to our exceptional team at London Pregnancy Clinic. Ms. Nzelu brings a wealth of expertise and a heartfelt commitment to providing the best prenatal care. Whether you’re seeking a comprehensive 3rd Trimester Anomaly Scan, a detailed Week 20-25 Anomaly Scan, or a reassuring Wellbeing Scan, Diane is here to guide you with professional care and support. Don’t miss the opportunity to experience her unique approach to prenatal health. Schedule your appointment with Diane Nzelu today and embark on a pregnancy journey that’s not only medically sound but also emotionally supportive and enriching.

Publications

(1) “Validation of the BPro radial pulse waveform acquisition device in pregnancy and gestational hypertensive disorders” – Jakes, A.Wade, J.Vowles, Z.Seed, P. T.Shennan, A. H.Chappell, L. C. & Nzelu, D.14 Jun 2021, (E-pub ahead of print) In: BLOOD PRESSURE MONITORING. p. 380-384 5 p.

(2) Chronic hypertension: first-trimester blood pressure control and likelihood of severe hypertension, preeclampsia and small for gestational age – Nzelu, D.Dumitrascu-Biris, D.Nicolaides, K. H. & kametas, N. A.2 Jan 2018, (E-pub ahead of print) In: American Journal of Obstetrics and Gynecology.

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Follicle Tracking Scan Explained

Graphic of Follicle Tracking Scan. An illustration of an egg in the uterus with sperm coming towards it.

Follicle tracking scan explained

Shaz Khojasteh is an advanced Specialist Sonographer in Fetal Medicine, Gynaecology and Fertility in Central London. Gynae Scans and Follicle Tracking Scans in London.

Miss Shaz Khojasteh Explains Essential Insights for Expectant Mothers.

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Embark on a journey of understanding with our focused insight into Follicle Tracking Scans. This blog post explores three frequently asked questions, shedding light on the significance, process, and benefits of Follicle Tracking Scans. Ideal for expectant mothers seeking early reassurance in their pregnancy, these insights aim to demystify the process and enhance your prenatal experience. Join us as we delve into the world of Follicle Tracking Scans, explained by Shaz.

Pregnancy is a time of joy and anticipation, but it also brings a plethora of questions and concerns, especially for first-time mothers. A key component of early pregnancy monitoring is the follicle tracking scan. In this blog, we explain follicle tracking scans, addressing three common questions to help expectant mothers gain clarity and confidence in their early prenatal journey.

The Basics of Follicle Tracking

Follicle tracking scans are a type of ultrasound scan used primarily in the early stages of pregnancy and fertility treatments. These scans monitor the development of ovarian follicles, which are small sacs containing eggs. Understanding follicle development is crucial for determining the best time for conception and ensuring the health of the pregnancy in its initial stages.

Importance of Follicle Tracking in Early Pregnancy

Follicle tracking is essential for those undergoing fertility treatments or trying to conceive naturally. It helps in pinpointing the ovulation period, ensuring that the timing for conception is optimal. For early pregnancy, it reassures the health and development of the embryo, offering peace of mind to expectant mothers.

Your Experience with Follicle Tracking Scans

During a follicle tracking scan, you can expect a non-invasive and painless experience. The procedure involves an ultrasound, where a small probe is used to visualise the ovaries and the developing follicles. The scan provides real-time images, allowing the healthcare professional to assess and monitor follicle growth and health. You will be asked to use our facilities and have an empty bladder for your transvaginal ultrasound scan. During your appointment, you will be provided with a skirt cover to change into. There will be a private and separate area for you to get changed. If you have specific requirements, please ask, and our team will do their best to accommodate.

Your  frequently asked questions about Follicle Tracking Scan:

What is a Follicle? A follicle is a small, fluid-filled sac located in the ovaries of the female. It plays a critical role in female fertility and the reproductive process. Each follicle contains an immature egg, or oocyte, which matures within the follicle.

Is the Follicle Tracking Scan painful? The procedure involves a qualified sonographer gently inserting a slender transvaginal ultrasound probe to obtain clear images of your ovaries. While some women might feel a slight sensation of pressure or mild discomfort, it is generally not painful.

Occasionally, mild cramping or a sense of discomfort may occur during the scan, often related to having a full bladder. This is because the bladder, when full, may exert pressure on the uterus. Rest assured, any discomfort is usually brief and tends to ease off promptly after the completion of the scan.

What affects the number of follicles? The number of ovarian follicles in women is influenced by genetics, age, medical conditions, and lifestyle factors. Genetics play a key role, as women are born with a finite number of follicles that diminish over time. Age further reduces this number, especially after the mid-30s. Medical conditions like PCOS can alter follicle count, often increasing it, which impacts ovulation and fertility. Additionally, lifestyle choices such as smoking and obesity, along with environmental toxin exposure, can negatively affect follicle numbers, potentially leading to decreased ovarian reserves and earlier menopause.

  • Graphic by London Pregnancy Clinic featuring the text 'Expert Fertility Assessment' and 'Follicle Tracking - All you need to know...' against a soft, abstract background representing fertility.

    London Pregnancy Clinic Follicle Tracking Overview

    London Pregnancy Clinic Follicle Tracking Overview

  • Informative illustration by London Pregnancy Clinic explaining follicle tracking scans with labeled diagram of the ovary showcasing different stages from the follicle phase to the luteal phase.

    What is Follicle Tracking?

    What is Follicle Tracking?

  • Detailed explanation by London Pregnancy Clinic of what sonographers look for during a follicle tracking ultrasound scan, including the number, size, and maturity of follicles.

    Follicle Tracking Details

    Follicle Tracking Details

  • Educational content by London Pregnancy Clinic indicating the optimal timing for follicle tracking scans during the menstrual cycle and for IVF treatments, with a circular diagram of the menstrual cycle phases.

    Best Time for Follicle Tracking

    Best Time for Follicle Tracking

  • Graphic by London Pregnancy Clinic outlining the reasons for follicle tracking, noting its non-invasive nature and its role in identifying the best times for fertility treatments and natural conception.

    Purpose of Follicle Tracking

    Purpose of Follicle Tracking

  • Next steps guide by London Pregnancy Clinic after a follicle tracking scan, advising patients on discussing results with their clinicians and offering additional consultation services for a fee.

    Next Steps After Follicle Tracking

    Next Steps After Follicle Tracking

  • Ms. Shahrzad Khojasteh, Clinical Lead and Specialist Sonographer at London Pregnancy Clinic, smiling in professional attire with text highlighting services in fertility screening, including follicle tracking, endometrial lining, and pregnancy scans.

    Specialist Sonographer

    Specialist Sonographer

Conclusion

Understanding the role and process of Follicle Tracking Scans is a vital part of your pregnancy journey. These scans offer invaluable insights into the early stages of pregnancy, aiding in conception and providing reassurance. If you have more questions or need personalised advice, we invite you to contact the London Pregnancy Clinic for more information.

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Week 4 of Pregnancy

Graphic of Week 4 of pregnancy. An illustration of a zygote in the uterus.

Week 4 of your Pregnancy

Your Baby’s Remarkable Beginning

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This blog post is part of a series that breaks down early pregnancy week by week. Today we will be talking about Week 4 of your pregnancy journey! Within this article, we’ll delve into the astonishing advancements occurring during this initial phase of pregnancy. Although your baby remains incredibly minuscule, measuring at no more than 1 millimeter (similar to a poppy seed), a realm of growth and transformation is already well underway.

Key Concepts: Gestational Weeks vs. Post-Conception Weeks

Understanding the difference between gestational weeks and post-conception weeks is crucial for accurately tracking the progress of your pregnancy.

Gestational Weeks: Gestational age refers to the age of the pregnancy and is measured from the first day of the mother’s last menstrual period (LMP). This is the standard method used by healthcare providers to track pregnancy. For example, at 4 weeks gestation, the embryo is about 2 weeks post-conception. Gestational age is crucial for determining the due date and monitoring the baby’s development.

Post-Conception Weeks: Post-conception age, also known as embryonic age, is measured from the time of conception. It provides a more precise timeline of the baby’s development. For instance, at 4 weeks post-conception, the embryo is undergoing significant developments, such as the formation of the placenta and the beginning of the amniotic sac.

Pregnancy Checklist at 4 Weeks

While it’s still early in your pregnancy, there are some important steps you can take:

  • During the initial 4 weeks of pregnancy, you may not experience noticeable symptoms. To verify your pregnancy, consider taking a pregnancy test.
  • Once you’ve confirmed your pregnancy you may think about your first prenatal visit with your doctor, even though it may not occur for another couple of weeks. With us, this would be our Viability/Dating Scan. During this visit, our specialists, like Miss Shaz Khojasteh, will check for single/multiple pregnancies, date the pregnancy and check the main structures of the gestational sac. We believe early pregnancy scans are essential for peace of mind and early reassurance for parents. 
  • Focus on adopting healthy diet and lifestyle habits. Say goodbye to smoking and alcohol, opt for nutritious foods, and stay well-hydrated.
  • The NHS provides valuable recommendations for expectant mothers, including considering the importance of taking supplements during pregnancy. Additionally, it’s essential to recognise how emotional changes that often accompany pregnancy can impact your relationships.

Developmental Milestones: Week 4

By Week 4, your baby develops from being a single-cell zygote to a blastocyst. Rapid cell division shapes the future. At this stage, your embryo completes its journey from the fallopian tube to the uterus, burrowing into the uterine lining. Half becomes your future child, and the other forms the placenta—a vital nutrient carrier.

The amniotic sac, often called the “bag of waters,” forms around the embryo, along with the yolk sac, important for your baby’s digestive system.

Your embryo now consists of three unique cell layers:

  • The endoderm—nurturing your baby’s digestive system, liver, and lungs.
  • The mesoderm—laying the foundation for your baby’s heart, sex organs, bones, kidneys, and muscles.
  • The ectoderm—shaping your baby’s nervous system, hair, eyes, and outer skin layer.

What is seen on the Ultrasound: Week 4?

One of the common queries we receive at the London Pregnancy Clinic is whether having an ultrasound at 4 weeks gestation is a requirement. At this stage, around the fourth week of pregnancy, significant developments are occurring. The blastocyst is in the process of dividing into an embryo and placenta. However, it’s crucial to understand that an ultrasound of your uterus during this early stage will typically reveal what appears to be a minuscule dot known as the gestational sac, and it’s important to note that a heartbeat is not typically detectable at this early point of development. Detecting a more advanced pregnancy may require waiting until a later stage.

Thinking ahead: Week 5?

The next steps in your pregnancy journey involve preparing for your first ultrasound appointment. It’s completely normal to eagerly anticipate your first ultrasound, but it’s essential to be aware that at 4 and 5 weeks of gestation, the gestational sac is typically too small to be easily visible on the scan. For a clearer image of your pregnancy, it is generally advisable to wait until around 6 weeks or later, when the development progresses. However, it’s worth noting that in certain cases, skilled sonographers with extensive experience may be able to discern subtle indications of pregnancy by closely observing changes in the uterine lining. You can use our Pregnancy Calculator to work out your optimal scan date range by entering your Last Menstrual Period(LMP).

Week 4 of Pregnancy FAQS?


  • Is 4 weeks pregnant too early to test

    At 4 weeks, it’s not too early to take a pregnancy test. Most home pregnancy tests are designed to be sensitive enough to detect the pregnancy hormone, human chorionic gonadotropin (hCG), in your urine by this time. This is typically around the time your period is due, which is when hCG levels are sufficiently high to indicate pregnancy.

    While you can confirm pregnancy with a test and even start calculating your due date, it’s indeed too early for an ultrasound scan. At 4 weeks, the baby is very small, and significant developmental milestones like the heartbeat, which typically becomes detectable around 6 weeks of gestation, have not yet occurred. Therefore, while a home pregnancy test can provide early confirmation, an ultrasound scan at this stage wouldn’t offer much information. For more detailed and visual insights into your baby’s development, waiting until at least the 6th week or later is advisable when the heartbeat and other embryonic structures start to become visible.

  • What to do when you’re 4 weeks pregnant?

    • Confirm Your Pregnancy: A home pregnancy test can confirm your suspicion of being pregnant. It’s best to take the test after you’ve missed your period for the most accurate result.

    • Schedule a Doctor’s Appointment: Even though it’s early, getting in touch with a healthcare provider is a good idea. They can confirm your pregnancy through a blood test and start guiding you through prenatal care.

    • Document Your Journey: Consider starting a pregnancy journal or diary to record your experiences, thoughts, and feelings. This can be a wonderful keepsake for the future.

    • Rest and Relax: Early pregnancy can bring fatigue and other symptoms. Ensure you’re getting enough rest and practising stress-relief techniques.

  • What does 4 weeks pregnancy look like?

    At 4 weeks of pregnancy, external changes to your body are typically minimal and not yet noticeable to others. However, internally, a remarkable series of events is unfolding. Your embryo, though only about the size of a poppy seed, is rapidly developing. This tiny cluster of cells is already beginning the incredible process of forming what will become vital organs and structures.


Conclusion

Week 4 of your pregnancy signifies the remarkable commencement of your baby’s journey. While ultrasound visuals may not reveal much at this early stage, rest assured that a realm of development is quietly unfolding within your body. Join us as we look forward to exploring the upcoming stages of your pregnancy journey, complete with the changes and milestones that await.

It’s crucial to remember that every pregnancy is unique. Therefore, we recommend consulting your healthcare provider for tailored guidance and attentive care during this special period. Our team is here to provide support throughout your exciting pregnancy journey!

Once again, heartfelt congratulations on your pregnancy. Stay tuned for further updates as we continue to monitor your baby’s week-by-week growth.


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10 Week Pregnancy Scan Explained

Graphic of 10 week Scan. An illustration of a mother thinking about the normal development of her baby.

The 10-Week Scan

Answering your questions about the Earliest Anomaly Scan At 10 Weeks

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This blog post discusses the benefits of the 10-week scan, how it is done, and frequently asked questions. It also highlights that the 10-week scan is the best scan to combine with Non-invasive prenatal testing (NIPT), which is a blood test that can be done at 10 weeks to screen for common chromosomal abnormalities. At the London Pregnancy Clinic, We have a unique and individual approach in that we do not ‘leave any stone unturned’ – we provide the most comprehensive assessment of the development of your baby possible at each stage of pregnancy.

Understanding the 10-week Scan:

Typically, the 10-week scan is performed using either a transabdominal or transvaginal ultrasound. A skilled sonographer will place a transducer on your abdomen or within your vagina. This transducer emits sound waves into the uterus, bouncing off the fetus to create a real-time image on the ultrasound screen. The entire procedure generally lasts between 15 to 30 minutes.

Comprehensive Screening:  

In the realm of prenatal care, knowledge is power. The 10-week pregnancy scan, often regarded as the earliest anomaly scan, holds a special place in the hearts of expecting parents. It’s an opportunity to unveil critical insights into your baby’s development, offering early detection of potential fetal anomalies and precise pregnancy dating. This pivotal examination, conducted through either a transabdominal or transvaginal ultrasound, is an indispensable tool in ensuring a smooth and informed journey towards parenthood.

Benefits of the 10-week Scan:  

The advantages of the 10-week scan are numerous and profound:

Early Detection of Fetal Abnormalities: At the 10-week mark, this scan can identify up to 10 major fetal anomalies, providing parents with vital information to make informed choices about their pregnancy.

Accurate Pregnancy Dating: Precise dating of the pregnancy aids parents in planning for their baby’s arrival and arranging future prenatal appointments with confidence.

Reassurance for Parents: Pregnancy is a time of great joy but can also bring anxiety. The 10-week scan offers peace of mind, assuring parents that their pregnancy is progressing as expected.

Optimal Pairing with NIPT: When combined with NIPT, the 10-week scan offers the most accurate information on the baby’s health. NIPT, a blood test conducted at 10 weeks, screens for common chromosomal abnormalities, such as Down syndrome, trisomy 13, and trisomy 18, complementing the 10-week scan perfectly.

IS THE 10-WEEK SCAN FOR ME?

Many pregnant women in the UK are anxious about the health of their babies in the early weeks of pregnancy. This may be due to a number of factors, including:

  • Previous miscarriage
  • IVF pregnancy
  • Unintentional alcohol consumption
  • Missed doses of folic acid
  • Use of certain medications
  • Severe morning sickness
  • Bleeding
  • Unhealthy diet
  • Sudden loss of pregnancy symptoms

If you are concerned about any of these issues or others, our 10-week scan is the perfect solution for you. It is designed to provide early reassurance for expectant parents.

The 10-week scan is also ideal for any pregnant woman who wishes to have NIPT at the earliest possible stage. Many parents choose to screen for the risk of Down syndrome in the first trimester. This is now possible with a non-invasive blood test at 10 weeks. However, the majority of fetal abnormalities are structural (physical), and some of these may be more severe than Down syndrome.

Unfortunately, NIPT will miss all structural abnormalities. That is why we take the opportunity to conduct an early screening of the baby’s structures to rule out 10 major structural abnormalities before performing NIPT.

Should I Delay My NIPT until 12-14 Weeks, Post NHS NT Scan?

Opting to delay your NIPT until after your NHS (National Health Service) Nuchal Translucency (NT) scan at 12-14 weeks is an approach that is becoming increasingly outdated. We firmly believe that the most effective method is to perform both the dating scan at 10 weeks and the NIPT at 10-11 weeks. This approach offers several advantages, particularly regarding early testing.

Admittedly, some fetal structures and organs may not be fully visualized at the 10-week mark, and certain structural anomalies may remain undiagnosed due to the fetus’s ongoing development. However, the benefits of conducting both tests as early as technically feasible outweigh these limitations.

  • IVF pregnancy
  • Unintentional alcohol consumption
  • Missed doses of folic acid
  • Use of certain medications
  • Severe morning sickness
  • Bleeding
  • Unhealthy diet
  • Sudden loss of pregnancy symptoms

If you are concerned about any of these issues or others, our 10-week scan is the perfect solution for you. It is designed to provide early reassurance for expectant parents.

The 10-week scan is also ideal for any pregnant woman who wishes to have NIPT at the earliest possible stage. Many parents choose to screen for the risk of Down syndrome in the first trimester. This is now possible with a non-invasive blood test at 10 weeks. However, the majority of fetal abnormalities are structural (physical), and some of these may be more severe than Down syndrome.

Unfortunately, NIPT will miss all structural abnormalities. That is why we take the opportunity to conduct an early screening of the baby’s structures to rule out 10 major structural abnormalities before performing NIPT.

Your Frequently Asked Questions About 10-week Scan

Do I need a full bladder for the 10-week scan? No, a full bladder is not necessary for the 10-week scan.

What sets the 10-week scan apart from the nuchal translucency scan? In comparison to the nuchal translucency scan, the 10-week scan is more comprehensive. While both can measure the fluid at the back of the baby’s neck, the 10-week scan extends its scope to assess various aspects of the baby’s development, including the heart, brain, and spine.

Is the 10-week scan safe? Yes, the 10-week scan is a safe and well-established procedure. Ultrasound technology has been a trusted method for safely imaging babies in the womb for many years.

Conclusion

If you’re considering delaying your first scan or wish to explore further options, the London Pregnancy Clinic provides innovative Early Ultrasound Screenings. These include the Early Fetal Scan, conducted between 12 and 16 weeks, which can exclude more than one hundred serious anomalies. Moreover, our Early Fetal Echocardiography is designed to identify up to 80% of detectable severe fetal heart defects. We highly recommend this scan for all babies with increased nuchal translucency (NT) measurements, fetal anomalies, or other unusual findings detected at the 11-13 week scan.

In conclusion, the 10-week pregnancy scan is an essential early step in ensuring the health and well-being of your growing family. It empowers parents with valuable insights and peace of mind, setting the stage for a smooth journey into parenthood. And remember, at the London Pregnancy Clinic, we offer a range of pioneering early ultrasound screenings to cater to your specific needs, ensuring the best possible care for your precious one.

Book NIPT + Scan from £490

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Understanding NT’s 95th Percentile

Graphic of understanding NT's 95th Percentile. A baby on a timeline with abstract representations of measuring tools.

Understanding NT’s 95th Percentile:

Nuchal Translucency (NT) Thickness Measurements in the 1st Trimester and What to Do if NT is Increased?

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Nuchal Translucency (NT), developed over 30 years ago in the early 1990s, remains a pivotal screening marker for evaluating early fetal well-being. Widely used, it screens for chromosomal and genetic conditions, as well as heart defects and other structural anomalies in the developing fetus. To get an understanding of NT’s 95th percentile we will discuss the importance of NT measurements, variations in cutoff values, and what to do if your baby’s NT measurement falls above the 95th centile but below the 3.5mm threshold.

The Significance of Nuchal Translucency Measurements:

NT refers to measuring the clear fluid space at the back of the baby’s neck during an ultrasound scan. According to NHS guidelines, it is measured between the 11th and 14th weeks of gestation. Presently, it is a cornerstone of the NHS Chromosomal Syndromes Screening Program conducted through Combined Screening Testing (CST). This program relies on the enduring significance of NT to assess the risk of chromosomal syndromes in the first trimester of pregnancy. Elevated NT measurements can indicate potential chromosomal abnormalities such as trisomy 21 (Down syndrome) and genetic conditions like Noonan syndrome, as well as heart defects and other structural anomalies. However, there is a significant level of uncertainty regarding what constitutes an abnormal NT measurement.

Variations in Cutoff Values:

One of the challenges with NT measurements is determining what constitutes an abnormal measurement. There is considerable variation in the cutoff values used by different research papers and guidelines. The majority of research studies and international society guidelines use the 95th centile as the threshold for abnormal NT measurements. This means that if your baby’s NT measurement falls below the 95th centile, it is considered normal. However, the NHS guidelines use a more conservative cutoff of 3.5mm. This 3.5mm cutoff is equivalent to the 99th percentile, representing a higher threshold for what is considered abnormal by NHS.

The Importance of Gestational Age:

It’s crucial to understand that the 95th centile for NT measurements varies with gestational age. Younger fetuses at 11 weeks tend to have naturally smaller NT measurements compared to those closer to 14 weeks. Therefore, determining whether your baby’s NT measurement is normal or not depends on both the absolute measurement and the gestational age.

Understanding NT’s 95th Percentile Measurements:

We understand that expectant parents might find it challenging to locate validated data concerning the 95th centile cutoff for their baby, as such data is not readily accessible online. To provide support, we have developed an NT thickness reference table based on highly esteemed international data from the study conducted by Wright et al in 20081. Additionally, we have cross-referenced data on normal NT measurements for the 10-11-week gestational period from Grande et al.’s publication in 20142, which closely aligns with Wright’s findings. Consequently, we have assembled a table that delineates the limit of an increased NT (95 centile) for each week from the 10th to the 14th week, utilising gestational age data recommended by the British Medical Ultrasound Society (2009)3.


Gestational Weeks 10+0 10+1 10+2 10+3 10+4 10+5 10+6 11+0 11+1 11+2 11+3 11+4 11+5 11+6 12+0 12+1 12+2 12+3 12+4 12+5 12+6 13+0 13+1 13+2 13+3 13+4 13+5 13+6 14+0 14+1
NT 95th centile mm 2.3 2.3 2.4 2.4 2.4 2.4 2.3 2.2 2.2 2.2 2.2 2.2 2.2 2.2 2.3 2.3 2.4 2.4 2.5 2.6 2.6 2.7 2.7 2.7 2.8 2.8 2.8 2.8 2.8 2.8

Our chart represents the distribution of increased NT measurements (> 95th centile) in relation to the gestational age. It’s important to note that, at every stage of gestation, normal NT measurements remain below 2.8 mm. Therefore, any NT measurement equal to or greater than 2.8 mm is considered elevated.

What occurs when there is a significant elevation in NT measurements? 

If NT thickness is 3.5mm or more (>99th centile) you will be referred to the fetal medicine unit (FMU) of your NHS hospital or FMU of a large regional NHS trust, where doctors will scan your baby to exclude structural anomalies associated with increased NT and offer further tests (CVS or NIPT). They will also offer fetal echocardiography at 16-20 weeks to exclude associated CHD.

What to Do if NT Measurement is Above the 95th Centile but Below 3.5mm (99th centile)?

The NHS adopts a conservative approach and does not acknowledge the 95th centile raised NT cutoff. Consequently, additional scans and tests are not scheduled for these babies before the routine 20-week anomaly scan conducted by the NHS. However, when the NT measurement surpasses the 95th percentile, it is advisable to proceed with further testing. In such instances, considering Non-invasive Prenatal Testing (NIPT) and an Early Fetal Anomaly Scan (Early Fetal Scan) are recommended.

SMART TEST – A Comprehensive Screening Option

For babies with elevated NT (between 95-99th centile), we have introduced the SMART TEST, which stands as the most advanced early reassurance package available. It comprises two expert early anomaly scans, Early Fetal Echocardiography, and the most comprehensive state-of-the-art NIPT panel. The SMART TEST can effectively rule out the majority of severe congenital heart defects (CHDs) and other structural anomalies associated with elevated NT, and reduce the probability of your baby being affected by chromosomal, genetic, or structural abnormalities.

While the SMART TEST is expensive, it is the most comprehensive early reassurance package available in the UK. For parents unable to afford the SMART TEST, there is a more affordable option of the Early Fetal Scan and an extended Panorama Test. The Early Fetal Scan screens for CHDs, but does not include a detailed examination of the fetal heart. You can further upgrade the scan and Panorama Test NIPT package to include eECHO.

If you have received concerning news about your baby’s increased nuchal translucency, we strongly recommend discussing the SMART TEST with one of our specialists.

Conclusion

Nuchal translucency measurements play a crucial role in assessing fetal well-being during the first trimester of pregnancy. Understanding the variations in cutoff values, gestational age, and available screening options is essential for making informed decisions if your baby’s NT measurement falls above the 95th centile but below the 3.5mm NHS threshold (99th centile). The SMART TEST, with its comprehensive NIPT panel and early fetal echocardiography, offers a valuable non-invasive screening option for parents seeking more information about their baby’s health. We are committed to offering you the best possible care, and you are always welcome to have a personal consultation with us to decide on the most suitable approach based on your individual circumstances.

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Possibility of Early Spina Bifida Diagnosis from 10 Weeks.

Graphic of Early Spina Bifida Diagnosis. A baby that is getting its spine scanned at 10 weeks.

Spina Bifida Early Diagnosis from 10 Weeks of Pregnancy

DR Fred Ushakov Headshot. London Pregnancy Clinic Medical Director. Specialist in Fetal Medicine & Obstetrical Ultrasound.

An Interview with Dr. Fred Ushakov

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In honour of UK Spina Bifida Awareness Week, Dr. Ushakov, Founder and Managing Director of London Pregnancy Clinic, discusses the possibilities of early diagnosis of spina bifida. He is an internationally renowned expert in fetal medicine, with a primary focus on fetal spina bifida and is also currently affiliated with FMU UCLH. In recognition of UK Spina Bifida Awareness Week, we have had the privilege of asking Dr. Ushakov several vital questions about spina bifida.

Dr. Ushakov was interviewed by, our Specialist Sonographer in Fetal Medicine, Gynaecology & Fertility, Ms Shaz Khojasteh.

What sparked your interest in spina bifida?  

“In 1980, as a young obstetrician heavily involved in attending deliveries and particularly interested in ultrasound technology, I performed a scan on a young pregnant woman. I noticed something unusual about the baby’s brain, although I couldn’t quite discern the exact issue. Subsequently, I was present at her delivery, and to my surprise, the baby was born with spina bifida. This experience was truly shocking. It occurred over 35 years ago during the early stages of ultrasound technology when both knowledge and technology were limited.”

What actions did you take next?

“After that shocking experience, I became genuinely intrigued by effectively detecting spina bifida. I dedicated significant effort to mastering scanning techniques for identifying spina bifida in babies. Over time, I evolved into an expert in this field, with a particular focus on spotting it as early as 10 weeks into the pregnancy. And naturally, I made it a point to share this knowledge with my colleagues, advocating for early spina bifida detection.”

How many babies with spina bifida have you encountered?

“I’ve seen hundreds of fetuses with spina bifida during my career. It’s become a routine part of my work – conducting early scans to detect spina bifida and performing expert scans for babies already diagnosed with this condition. Spina bifida is actually relatively common. In the UK, it’s estimated that around 1 in every 1,000 pregnancies is affected by spina bifida. Even though it might not be as well-known as some other conditions, its effects on those who have it can be quite substantial. This is why early detection and awareness are so important.”

Why is spina bifida so important?

“Open spina bifida holds immense significance due to its prevalence as a major fetal structural defect. It adversely affects essential bodily functions, such as bowel and bladder control. Walking becomes a challenge for most babies born with open spina bifida, and some may also exhibit brain abnormalities. While treatments can enhance outcomes, a complete cure remains elusive. Many babies survive, but their lives are profoundly impacted by long-lasting disabilities. In essence, it’s a severe condition with enduring consequences.”

What do you consider the main issue with spina bifida?

“The primary concern regarding spina bifida, from my perspective, is the alarming lack of awareness. This lack of awareness extends not only to patients but also to primary healthcare providers. From my experience, many pregnant women take folic acid supplements without fully grasping their significance. It’s imperative to raise awareness and educate both the general public and healthcare professionals about this condition, its risk factors, and the crucial role of folic acid supplementation during pregnancy and early first-trimester spina bifida screening. Unlike the widely recognized Down’s syndrome, spina bifida remains relatively obscure. This is a significant concern because, for some babies with spina bifida, the potential outcomes can be even more challenging than those for Down’s syndrome.”

Fred, could you clarify why it’s essential to start taking folic acid immediately upon discovering pregnancy?

“Yes, immediate folic acid supplementation upon discovering pregnancy is of paramount importance. Neural tube formation is an early pregnancy event, usually concluding by the end of the 6th gestational week, approximately 28 days after conception. In babies with spina bifida, the neural tube fails to close correctly, leading to spinal cord and spine bone issues. This anomaly develops extremely early when the baby is less than 1 cm in size and has just initiated its heartbeat.

Folic acid plays a pivotal role during the critical period before and during the first six weeks of pregnancy when the baby’s spine is forming. In practical terms, most people discover their pregnancy around 4 weeks after conception, and by that point, they are already 4 weeks into the pregnancy. This leaves just two weeks during which folic acid can exert its most significant impact. Taking early action is the key to providing essential support for your baby’s neural tube development and minimizing the risk of spina bifida.”

Let’s delve into early Spina Bifida diagnosis during pregnancy. When can you identify this condition?

“With my level of expertise and the use of advanced 3D ultrasound scanners (Fig 1), I can diagnose the majority, probably over 90%, of open spina bifida as early as 10 weeks into the pregnancy. To put it differently, personally missing a diagnosis of spina bifida at that stage would be a great disappointment to me, and I would be highly motivated to conduct a thorough investigation into why such a diagnosis was missed. 

  • 3D Ultrasound GIF of baby at 10 week. Image by London Pregnancy Clinic - for educational purpose.

    Fig 1 – 3D ultrasound image of the baby at 10 weeks: All main structures are visible
  • It’s important to note that achieving a 100% accuracy rate in diagnosing spina bifida through ultrasound is a challenge. There can be significant variations in the presentation of spina bifida, and in some rare cases, the anomaly may go undiagnosed until delivery. While early detection is highly valuable, there are instances where the condition’s subtleties make it difficult to diagnose definitively with ultrasound.”

How can you diagnose spina bifida so early? Are you inspecting the baby’s spine?

“No, actually, it’s quite challenging to directly visualize spinal abnormalities at this early stage. What I’m primarily focused on is the fetal head and brain (Fig 2). In cases of open spina bifida, there’s a distinct phenomenon at play. There is a leakage of fluid from the brain through the hole in the spine, and this leakage creates a very specific brain anomaly known as Chiari 2 malformation. I’m essentially searching for the earliest evidence of this phenomenon in the ultrasound images. It’s a highly specific indicator – when this particular brain anomaly is present, it’s a strong indication that the baby has spina bifida.

Certainly, at 10 weeks, I also examine the fetal spine. The spine is not yet ossified, so it appears as dark lines running along the baby’s back, and often I can even discern individual vertebrae as bright dots (Fig 3). This level of detail means that very severe spinal deformities can be visible. Sometimes, spina bifida can manifest as a small bubble on the baby’s back at this early stage (Fig 4).”

  • Ultrasound GIF of baby's brain at 10 weeks. Image by London Pregnancy Clinic - for educational purpose.

    Fig 2 – Normal brain at 10 weeks: this baby has no spina bifida
  • Ultrasound GIF of baby's spine at 10 weeks. Image by London Pregnancy Clinic - for educational purpose.

    Fig 3 – Baby’s spine at 10 weeks: no deformities
  • Ultrasound GIF of baby with spina bifida at 11 weeks. Spina bifida cystica is seen at the bottom of the spine. Image by London Pregnancy Clinic - for educational purpose.

    Fig 4 – Baby with spina bifida at 10-11 weeks: spina bifida marked by the circle

Can other professionals detect spina bifida early?

“Yes, there are indeed many research studies indicating the possibility of early detection. One of the most significant research efforts comes from King’s College Hospital in London. Sonographers at this hospital have scanned over 100,000 babies at 11-13 weeks of pregnancy and were able to detect more than half of the fetuses with spina bifida. This achievement is truly impressive, although it’s important to note that it may not be applicable to all NHS trusts. King’s College Hospital has a dedicated unit, established protocols, and a comprehensive training program. Only a handful of other hospitals across the UK, including UCLH that I work for, have similar protocols in place.”

What is the situation like in an average NHS hospital?

“In NHS hospitals, there is a screening ultrasound program called the anomaly scan, which is typically conducted at 19-20 weeks into the pregnancy. During this scan, sonographers check for spina bifida among other anomalies.

Unfortunately, there isn’t a routine first-trimester screening for spina bifida, and the majority of cases are detected during the second trimester. In a 2019 survey of ultrasound units performing scans in the first trimester (11-13 weeks) in England, it was found that only 16% of them included a check of the fetal spine in their protocols.”

Tell us about the “crash sign” and its significance.

“Yes, indeed. Many research groups have proposed various methods for detecting spina bifida in the first trimester. In our case, we’ve come up with a marker that represents the ultrasound appearance of Chiari 2 malformation in the early fetal brain. It’s pretty obvious when you have a top-notch ultrasound scanner.

Now, why ‘CRASH’? We actually have a video up on YouTube that demonstrates it, and once you watch it, the name will make perfect sense.”

Any advice for patients seeking early spina bifida ruling out?

“If you’re keen to know early on, I’d suggest considering booking a 10 Week Scan with a professional having a special interest in this area. For those with previous pregnancies affected by spina bifida, arranging a 10 Week Scan at Fetal Medicine Unit at UCLH with a referral from your primary NHS care provider is an excellent choice. Alternatively, you can book a 10 Week Scan privately at London Pregnancy Clinic. At our clinic, we can combine this scan with non-invasive prenatal testing (NIPT). Please inform our admin staff about your worries, and we will arrange a proper scan for your baby.

If you prefer to stick with NHS services, ask your sonographer during the 11-13 weeks scan if they’re actively screening for spina bifida. Some hospitals in London may have established protocols for this. However, if your NHS provider doesn’t routinely check for spina bifida (which is the case for most hospitals), you might want to consider an early anomaly scan (Early Fetal Scan) at 13-16 weeks through a private provider. For those going the private scan route, it’s a good idea to check if the clinic screens for spina bifida at early stages. Advanced private ultrasound clinics are typically well-equipped, and their staff may have special training in fetal medicine.

Please note that the majority of sonographer-run clinics that provide NIPT or perform non-medical gender scans do not screen for spina bifida.”

It seems like you prefer screening for spina bifida at 10 weeks rather than at the time of the standard NHS scan around 12 weeks. Is that accurate, and could you tell us why?

“Yes, you’ve got it right. In the past, I used to advocate for spina bifida screening during the conventional nuchal translucency scan at around 12-13 weeks. But with the introduction of NIPT, which can be done as early as 10 weeks, I’ve started scanning for spina bifida even before the blood test. At 10 weeks, the little ones are really tiny, measuring less than 1.5 inches (around 35 mm).

Interestingly, with the help of state-of-the-art ultrasound technology (and we’re lucky to use the most advanced machines), many fetal structures are surprisingly easier to examine at 10 weeks compared to 12 weeks. The brain and spine, in particular, stand out as more visible structures.

I won’t bore you with all the technical stuff, but it’s somewhat paradoxical that I feel that an early screening at 10 weeks is actually probably more effective. Plus, it’s a relief for parents who are understandably anxious and want reassurance as soon as possible. But it’s essential to recognize that this type of screening demands a high level of expertise and top-notch ultrasound technology to be done effectively.”

Can other professionals detect spina bifida early?

“Yes, indeed. There are internationally renowned groups in Melbourne, Nice, and Berlin, among others, who also have experience in diagnosing spina bifida before the 11th week of pregnancy. At present, our joined expertise is largely based on anecdotal cases. This is because the incidence of spina bifida is relatively rare, occurring at a rate of 1 in 1,000 pregnancies. To establish statistically significant numbers and determine the detection rate of a 10-week scan, one would need to scan thousands and thousands of babies.”

What is the SMART TEST, and does it include screening for spina bifida?

“The SMART TEST is an innovative concept in prenatal care developed and offered by the London Pregnancy Clinic. It combines extended NIPT with expert ultrasound. The SMART TEST is unique in that it covers a wide range of structural anomalies, chromosomal conditions, and genetic diseases, and it can do so as early as 10 weeks into the pregnancy.

A primary target of the SMART TEST is indeed the earliest possible screening for spina bifida. The test incorporates advanced 2D and 3D ultrasound technology to thoroughly examine the fetal brain and spine at a stage when the baby has just transitioned from an embryo to a fetus. This comprehensive approach ensures early detection and peace of mind for expectant parents.”

Why do you believe that early detection of spina bifida is so crucial? After all, the condition can be diagnosed by the NHS anomaly scan at 20 weeks.

“I’m a strong advocate for early detection of spina bifida, and let me explain why. Spina bifida is a highly serious structural anomaly associated with severe disabilities. While we’ve made significant progress with in-utero surgical treatments, it’s important to understand that these treatments don’t cure the condition.

Moreover, it’s essential to highlight the significance of the surgical aspect. At UCLH, I’m part of the Fetal Surgery for Spina Bifida team, which is led by Professor Jan Deprest, an internationally renowned expert in fetal surgery. Our centre is the sole one in the UK commissioned by the NHS to provide this cutting-edge treatment. In my role, I conduct scans on the baby before and after the surgery. I take great care to evaluate the spinal lesion, perform a thorough examination of the baby’s brain, and perform a comprehensive top-to-toe scan of the entire baby. I’ve had the privilege of scanning hundreds of babies with spina bifida before and after surgery, contributing to their care.

Performing surgery on a baby with spina bifida while they’re still in the mother’s womb is an incredible feat. This complex procedure requires a skilled international team of doctors and medical professionals from the UK and Belgium. The delicate balance of providing life-changing treatment for the baby while ensuring the safety of both the baby and the mother is a remarkable achievement in fetal medicine.

However, almost half of mothers are not eligible for this ground-breaking surgical treatment, often due to the severity of the baby’s condition or additional fetal problems. For these parents, making difficult decisions about the pregnancy becomes a reality, often after 20 weeks. Even for parents eligible for surgery, the journey is challenging. They go through numerous tests, counselling, and procedures in a short time, adding to the stress.

All of this can be alleviated with early diagnosis. Early detection provides parents with the time and information they need to make informed decisions. For the most severe cases of spina bifida that are not operable, early detection helps parents understand their options from the start of the pregnancy. That’s why I advocate for screening for spina bifida as early as 10 weeks or at least at 12 weeks.”

Fred, as a conclusion, what advice or suggestions would you like to offer to future parents?

“If you are in the planning stages of pregnancy, consider starting to take folic acid supplements. Folic acid is most effective when taken before conception and during the first few weeks of pregnancy when the baby’s spine is forming. This simple step can contribute to the healthy development of your baby and reduce the risk of spina bifida.

Additionally, I’d like to emphasize the importance of early screening for spina bifida, which can now be done as early as 10 weeks into the pregnancy. This can provide you with valuable information, peace of mind, and ample time to make informed decisions about your baby’s health. If you have concerns or a history of spina bifida in your family, consider the SMART TEST at the London Pregnancy Clinic. It’s a comprehensive approach that combines NIPT and advanced ultrasound technology to screen for a wide range of conditions, including spina bifida.

Remember that knowledge is power. Being informed and seeking early detection can make a significant difference in the journey of your pregnancy. Stay well-informed, ask questions, and don’t hesitate to seek expert guidance. Your baby’s health is our priority, and we are here to help you every step of the way.”

References

(1) Karim, J., Pandya, P., McHugh, A. and Papageorghiou, A.T. (2019). OC23.06: Significant variation in practice for first trimester anatomy assessment: results from a nationwide survey. Ultrasound in Obstetrics & Gynecology, 54(S1), pp.60–61.

(2) Ushakov, F., Sacco, A., Andreeva, E., Tudorache, S., Everett, T., David, A.L. and Pandya, P.P. (2019). Crash sign: new first-trimester sonographic marker of spina bifida. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, [online] 54(6), pp.740–745.

(3) University College London Hospitals NHS Foundation Trust. (n.d.). Management of Fetal Spina Bifida. [online] Available at: https://www.uclh.nhs.uk/patients-and-visitors/patient-information-pages/management-fetal-spina-bifida [Accessed 21 Oct. 2023].

(4) Syngelaki, A., Hammami, A., Bower, S., Zidere, V., Akolekar, R. and Nicolaides, K.H. (2019). Diagnosis of fetal non‐chromosomal abnormalities on routine ultrasound examination at 11–13 weeks’ gestation. Ultrasound in Obstetrics & Gynecology, 54(4), pp.468–476.

(5) Rolnik, D.L., Wertaschnigg, D., Benoit, B. and Meagher, S. (2020). Sonographic detection of fetal abnormalities before 11 weeks of gestation. Ultrasound in Obstetrics & Gynecology, 55(5), pp.565–574.

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Spina Bifida Awareness Week

Graphic of Spina Bifida Awareness Week. A baby that is getting its spine scanned at 10 weeks.

Spina Bifida Awareness Week:

What is it? and how we can screen for it?

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This week is Spina Bifida Awareness Week, a time to shine a light on this important condition. We look at what Spina Bifida is, how it can be detected and charities that spread awareness about it.

Comprehensive Screening:  

From the 16th to the 22nd of October, we shine a light on Spina Bifida Awareness Week. But first, let’s break it down. What exactly is spina bifida? It’s a condition where the spine doesn’t fully develop in the womb. It occurs when the spine and spinal cord fail to develop properly in the womb, resulting in a gap in the spine. This incomplete development can lead to both physical and intellectual challenges.

A surprising fact? As many as 10% of people might have a milder form of spina bifida. Most aren’t even aware of it. On the more severe end of the spectrum, open spina bifida impacts about 700 babies in the UK every year.

Now, here’s the uplifting part. Taking folic acid during the early stages of pregnancy can significantly reduce the risk of a baby developing spina bifida. However, many women still don’t know about this simple preventative measure. It’s essential for healthcare providers to share this knowledge.

Early Detection Makes a Difference! 

At our clinic, we’re proud to offer a specialised Ten-week Anomaly Scan. This scan is designed to detect signs of spina bifida at a very early stage. By identifying it early, families can make informed decisions and medical professionals can provide the best care options. Early detection can dramatically improve outcomes for affected pregnancies. Surgeons from UCLH and GOSH carried out the first procedure on babies in the womb in the UK back in 2018. This international team received their training at UZ Leuven1

While many might be more familiar with conditions like Down Syndrome, it’s vital to bring spina bifida to the forefront as well. Its prevalence is notable, and with the right measures like early detection and folic acid intake, we can make a difference.

Join Our Mission in Boosting Awareness: 

Knowledge is power. By understanding spina bifida, its risks, and the preventive steps, we can safeguard future generations. Let’s raise the bar of awareness together by educating ourselves and supporting charities like Shine. 

Shine Charity is a UK-based charity that supports people with spina bifida and hydrocephalus. The charity’s vision is a society where all those affected by spina bifida and/or hydrocephalus are empowered and enabled. Shine’s mission is to make a positive difference to the lives of people affected by these conditions.

Shine’s goals for 2022-2027 include:

  • Enabling babies and children with spina bifida and/or hydrocephalus to achieve their potential
  • Empowering young people with these conditions
  • Ensuring that adults with these conditions have the choices and opportunities to live healthy and independent lives

Watch the explainer video on the 10 week scan:

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