Consultations

Although there are a large number of genetic tests that are now available they would not be regarded as routine tests due to the rarity of the conditions.

Clearly, in some cases, for example couples with a family history of genetic disorder then further investigation sometimes in conjunction with genetic counselling needs to be considered.

Genetic screening may also be indicated in couples with certain backgrounds (eg those with an Ashkenazi background may wish to have screening for Tay-Sacks and other associated genetic problems).

Most of these tests are screening tests (ie they are not definitive but allow identification of high risk or low risk of a problem) and all have implications so if you think that they may be appropriate for you please discuss this with Mr Fernando at your appointment.

These are usually done at The Doctors Laboratory (76 Wimpole Street); you will be given a form to take to the lab. You do not need an appointment; it is a drop in system. Opening hours and directions are on the form.

Results will normally be discussed at your next appointment unless urgent action is required.

Usually immediately before your appointment with Mr Fernando you will have a formal ultrasound scan for measurement of the nuchal translucency (NT – fluid at the back of the baby’s neck) which also screens for chromosomal and cardiac problems as well as potentially identifying other problems

NT measurement in combination with measurement of early pregnancy hormones and maternal age is an alternative method of screening for chromosomal problems but has a slightly higher false positive rate (ie the screening test says high risk when in fact the baby is normal) and poorer detection rate when compared with NIPT testing.

We typically arrange NIPT and NT testing with the Fetal Medicine Centre (link) or UDS (Link) in Harley Street. Scanning can take up to 40 minutes. You will have already received your NIPT test results directly from the scanning unit.

If you have chosen not to do NIPT testing then combined testing takes up to 24 hours for a result to be available. As well as discussing your chromosomal screening results, Mr Fernando will go through the first trimester blood tests, answer questions and plan the next steps.

Around 16 weeks, you will have a routine check with Mr Fernando. This is a good opportunity to discuss any challenging pregnancy symptoms you have been experiencing and to ask questions about the coming months.

Although the majority of babies are normal, up to 1% may have a serious congenital abnormality.

Ultrasound assessment at about 20 weeks of pregnancy would be expected to pick up 70% of these babies by careful examination of structures such as the heart, face, brain, kidneys and skeleton. In addition ultrasound assessment of the blood flow pattern in the uterine arteries (which supply the placenta) can assess the risk of pre-eclampsia or fetal growth problems in later pregnancy.

Measurement of the length of the cervix (neck of the womb) can potentially identify women at risk of pre-term delivery when other risk factors are present (such as previous surgical treatment to the cervix).

At this scan the position of the placenta is noted and where requested the sex of your baby can usually be determined.

Anomaly scan will be done at the Fetal Medicine Centre (www.fetalmedicine.com) or UDS (www.uds.uk.com). You will be given the ultrasound report to bring to your 20 week appointment which would normally be immediately after the scan. If a MAT B1 form is needed in order to claim Statutory Maternity Pay from your employer please ask for one. It is valid after 20 weeks.

Around 24 weeks, you will have another routine check with Mr Fernando. You can discuss how any bothersome symptoms have developed or abated since your last appointment. It is also another opportunity to ask questions about the coming months.

Diabetes that develops during pregnancy is called gestational diabetes and does not normally have symptoms. It may be associated with increased birthweight of your baby and a number of other problems

As a result all women are offered screening. This involves drinking a set amount of a sugary drink at the laboratory (which provides a sugar ‘load’) and taking blood to measure sugar levels an hour later.

Women with a higher than expected result will be asked to do a more formal ‘glucose tolerance test’ to establish whether they actually have gestational diabetes.

.If possible please have this test a few days prior to your 28 week appointment to enable Mr Fernando to discuss the results with you.

We recommend that all women have a formal scan at 32-34 weeks of pregnancy to objectively assess fetal growth and wellbeing. This will be done at the Fetal Medicine Centre (www.fetalmedicine.com) or UDS (www.uds.uk.com)

Routine check with Mr Fernando.

All women are offered a swab test to check for the presence of group B streptococcus (GBS). GBS is just one of the many bacteria that can be present in our bodies. Up to 1 in 5 pregnant women carry GBS and in the majority of cases this does not cause disease.

During childbirth babies become colonised by GBS, but most do not suffer any ill effects. However, although only a small number of babies develop infection (about 1 in 2000), it can be life-threatening. In view of this, we recommend that women carrying GBS should be offered intravenous antibiotics in labour to prevent infection.

Mr Fernando will see you around 6 weeks after the delivery of your baby for a postnatal checkup. However if you have any problems or questions before this appointment you can contact Mr Fernando through his secretary Abe or through the Lindo Wing postnatal ward (Tel: 020 3312 1624).

During the postnatal visit Mr Fernando will answer your questions and examine the perineum / caesarean section wound. He will also discuss about getting back to normality, exercises and contraception.