First Trimester Assessment
When is it carried out?
- Between 12+0-13+6 weeks’ gestation, estimated from your last menstrual period (LMP) or a prior ultrasound scan.
What is the purpose of the routine first trimester assessment?
- ·Confirm fetal viability and provide an accurate estimate of the date of delivery (EDD) based on the length of the baby (crown-rump length), except in IVF pregnancies, where the gestation may already be known. Accurate dating of the pregnancy is important in assessing the growth of the baby and ensuring the optimal time of birth. Although at this gestation, the majority of pregnancies are viable, sadly, a small number may result in “silent” early pregnancy loss, which may be apparent at this scan.
- Diagnose multiple pregnancies and determine chorionicity (whether the babies share the placenta). Around 2% of pregnancies are twins or higher order multiples. If the babies are sharing the placenta this has a major impact on the management of the pregnancy.
- Screening for major fetal structural abnormalities. The majority of pregnancies will be developing normally. This scan aims to exclude major fetal structural defects, and although some can be diagnosed at this gestation, we also advise a detailed anatomy scan at 20-weeks.
- Screening for Down's Syndrome. We will discuss the options available to you. If you would like to have NIPT, this will be arranged after the scan.
- Screening for pre-eclampsia. Using a combination of maternal factors and blood pressure, a pregnancy hormone level (PLGF) and an ultrasound assessment of flow through the arteries to the womb, we will be able to provide an individualised estimate of the chance of pre-eclampsia developing in your pregnancy before 37 weeks' gestation. This will enable appropriate treatment to reduce the risk and potential complications and guide appropriate surveillance of your pregnancy.
What will it involve?
- A consultation.
- An ultrasound scan (transabdominal +/- transvaginal ultrasound).
- Blood pressure assessment (two measurements are made in each arm)
- A blood test (for maternal hormone levels (PLGF + PaPPA) +/- NIPT)
Are there any additional costs?
- NIPT (Illumina/SAFE/Panorama basic) costs £295, which is invoiced directly by the OneWelbeck Women’s Health Clinic. Please contact us for prices for extended panel testing for Panorama.
- Multiple pregnancy scans incur an additional tariff of £135 per fetus per scan
- Other specialist scans/tests/consultations if recommended, are not included
Where does this take place and how long does it take?
- The initial consultation, blood pressure assessment and ultrasound scan take place at OneWelbeck Women’s Health and takes approximately 60 minutes for the initial consultation and scan
- The blood tests will be performed at OneWelbeck Women’s Health Clinic and the samples will be sent to the appropriate labs for testing.
When are the results available?
- The results of the scan are available immediately and the significance of any findings will be discussed with you at the time. Dr To will contact your obstetrician directly, should any urgent intervention be required. If more detailed counselling is required, it may be necessary to schedule this at a later date or at the end of the clinic, where possible.
- The results of the Illumina test and screening for pre-eclampsia will usually be available within 5 working days. Panorama results take approximately 14 days.
- The results of the scan and blood tests will provide a recommendation for the most appropriate ultrasound surveillance for the remainder of your pregnancy.
Can I have the NIPT earlier?
- Yes, you can have the Illumina test from 10+0 weeks. The 60-minute First Trimester Assessment between 12+0-13+6 weeks can be replaced by two separate shorter 30-minute scans at firstly, 10+0-11+0 weeks for the early pregnancy scan and NIPT and then secondly at 12+0-13+6 weeks for the remainder of the First Trimester assessment, including pre-eclampsia screening.
- Panorama test can be done from 9+1 weeks but in our experience, this can result in suboptimal analysis for the extended micro deletion panel due to lower levels of fetal DNA at this gestation.