"Don't let our looks fool you. We're pretty dangerous..." - babies
That CVS has been shown to be as safe or safer than amniocentesis?
|
| Home : FAQs : Frequently Asked Questions |
  |
Frequently Asked Questions
|
As a physician practicing for over 20 years, I have encountered countless questions and have heard infinite concerns from mothers and their families about everything from smoking during pregnancy to what sort of music may or may not be harmful to the development of a baby’s ears. Hopefully, going through this list will ease some of your worries, or in the least inform you as to what you should and should not be concerned about. - Alexander D. Kofinas, MD
|
What are the risks of nuchal cord to my baby?
|
As many as 30% of all fetuses are born with their umbilical cords wrapped around their necks, and in most cases there is no evidence of any harmful effects. On the other hand, most of the fetuses that sustain damage during labor do so because of cord compression. This is often caused by a variety of reasons, the most common of which have their roots in NuchalNuchal:
Anything, which relates to the back of the neck. cord. In addition, there are many factors, which may exacerbate or alleviate such a condition. Examples are cord length, cord tissue quality (Wharton's jellyWharton's jelly:
The mucous connective tissue of the umbilical cord. ) , quality of the PlacentaPlacenta:
A membranous vascular organ that develops in female mammals during pregnancy, lining the uterine wall and partially enveloping the fetus. as well as the site on which the cord is inserted (site located somewhere on the PlacentaPlacenta:
A membranous vascular organ that develops in female mammals during pregnancy, lining the uterine wall and partially enveloping the fetus. ) . At KOFINAS PERINATAL, we screen all pregnancies for the above-mentioned conditions, and although we recognize that preventing fetal damage in its entirety is impossible, we are proud to report that we have prevented more than 20 fetuses from suffering serious brain damage and even death. In such cases the fetuses were delivered immediately by emergency cesarean section or the patient's obstetrician was warned about the potential problem, thus protecting the fetuses involved. |
|
What is genetic amniocentesis (amnio)?
|
Genetic AmniocentesisAmniocentesis:
A procedure in which a sample of amniotic fluid is drawn out of the uterus through a needle inserted in the abdomen, used to detect genetic abnormalities or the baby's sex. is the procedure used to obtain AmnioticAmniotic:
Of or related to the amnion or characterized by developing an amnion; "amniotic membrane" fluid, which contains fetal skin cells. These cells are then used to check the baby's ChromosomeChromosome:
A threadlike linear strand of DNA and associated proteins in the nucleus of cells that carries the genes of hereditary information. for Down syndrome and other ChromosomalChromosomal:
Of or relating to a chromosome;"chromosomal defect" anomalies. AmniocentesisAmniocentesis:
A procedure in which a sample of amniotic fluid is drawn out of the uterus through a needle inserted in the abdomen, used to detect genetic abnormalities or the baby's sex. is performed at 16 weeks or later and has a risk for pregnancy loss of 1 in 300. When AmniocentesisAmniocentesis:
A procedure in which a sample of amniotic fluid is drawn out of the uterus through a needle inserted in the abdomen, used to detect genetic abnormalities or the baby's sex. is done before 16 weeks, the risk of pregnancy loss can be as high as 3.4 %. CVS is done at 12 weeks and is as safe as AmniocentesisAmniocentesis:
A procedure in which a sample of amniotic fluid is drawn out of the uterus through a needle inserted in the abdomen, used to detect genetic abnormalities or the baby's sex. . At KOFINAS PERINATAL we offer both procedures but we prefer CVS, because in our experience the benefits of CVS outweigh those of AmniocentesisAmniocentesis:
A procedure in which a sample of amniotic fluid is drawn out of the uterus through a needle inserted in the abdomen, used to detect genetic abnormalities or the baby's sex. . We do not use AmniocentesisAmniocentesis:
A procedure in which a sample of amniotic fluid is drawn out of the uterus through a needle inserted in the abdomen, used to detect genetic abnormalities or the baby's sex. for the prenatal diagnosis of spina bifida. This condition can be reliably diagnosed only with ultrasound. After the ultrasound, an AmniocentesisAmniocentesis:
A procedure in which a sample of amniotic fluid is drawn out of the uterus through a needle inserted in the abdomen, used to detect genetic abnormalities or the baby's sex. is then performed to check the ChromosomeChromosome:
A threadlike linear strand of DNA and associated proteins in the nucleus of cells that carries the genes of hereditary information. since such fetuses may suffer from ChromosomalChromosomal:
Of or relating to a chromosome;"chromosomal defect" anomalies as well. |
|
What is the nuchal translucency (NT)?
|
Nuchal translucency is the thickening of a baby’s neck, specifically in the back. This is usually noted between the 11th and 14th week of pregnancy and is the result of water accumulation under the baby's skin. The degree of thickness, or water accumulation, correlates directly with the probability of Down syndrome in the NeonateNeonate:
A newborn infant, especially one less than four weeks old. . Therefore, as the volume of water in the neck increases, so too does the probability that the baby has Down syndrome. When the baby’s ChromosomeChromosome:
A threadlike linear strand of DNA and associated proteins in the nucleus of cells that carries the genes of hereditary information. are normal (test results indicate that baby does not have Down syndrome) and NuchalNuchal:
Anything, which relates to the back of the neck. translucency is still present, the risk for fetal CardiacCardiac:
Of, near, or relating to the heart. defects increases substantially. |
|
What is non-stress test (NST)?
|
An NST is done to evaluate fetal well-being. The test is performed by means of weekly electronic fetal heart monitoring and contemporarily is usually combined with a Biophysical ProfileBiophysical Profile:
An ultrasound test which evaluates fetal behavior (breathing, tone, movement)and amniotic fluid volume. . NST is falsely positive (abnormal) as often as 80% of the time, and results in a great deal of unnecessary additional testing and maternal anxiety. Sometimes this leads to unwarranted precautionary measures, which may in turn harm the fetus. When NST is conducted weekly and shows normal results, the ensuing risk of fetal death in the next 7 days is approximately 3 in 1000. This risk can be reduced further with the addition of a Biophysical ProfileBiophysical Profile:
An ultrasound test which evaluates fetal behavior (breathing, tone, movement)and amniotic fluid volume. or by increasing the frequency of testing to twice a week. However, the problem with NST, and this is a serious problem, is that when a test comes back as abnormal, the fetus is at high risk to have already sustained some degree of brain damage. For the above reasons, at KOFINAS PERINATAL we rarely use electronic fetal monitoring and only for specific indications other than fetal well-being. |
|
How is Nuchal Translucency (NT) used to identify fetuses at increased risk for Down syndrome?
|
|
NT in combination with pregnancy associated plasma protein (P-APP) and the free beta subunit of human chorionic gonadotropin (ß-hCG) constitutes the Ultra-screen test, which is used to detect fetuses with Down syndrome. The accuracy of the test is 90% and is the most effective test available for the first trimester. Performed between 11 and 14 weeks gestation, the Ultra-screen test involves an ultrasound assessment, which includes measurements of the NT as well as a blood test obtained from the mother. The results take about a week and when negative, reduce the risk for Down syndrome to an acceptable level. The ultra-screen test is available only for singleton and twin gestations. If a patient is carrying 3 or more fetuses she can still use NT by itself, which reduces the risk of Down syndrome by about 80%. |
|
What is selective reduction?
|
|
Selective reduction is a surgical procedure by which multiple gestations with more than 3 fetuses are transformed into twin gestations (2 viable fetuses). This procedure is performed only after thorough assessment of the pregnancy in combination with extensive counseling of the parents. This procedure runs the risk of total pregnancy loss, and is performed only when it is expected to benefit the majority of fetuses involved. |
|
What is home uterine monitoring (HUM)?
|
|
HUM involves the use of a special monitoring device, which monitors pregnant women while they remain at home. The monitoring device is used to record contractions, and if there are more than 4 contractions per hour, the patient goes to the emergency room for further assessment. HUM has not been shown to prevent prematurity in randomized clinical trials; in fact it is extremely expensive at a direct cost of $800 per day. Furthermore, HUM has increased the number of patient visits to the emergency room, while at the same time failing to reduce prematurity all together. A visit to the emergency room for such a reason may cost more than $2,000 raising the total cost of the procedure significantly. In addition to the direct costs incurred by this method, one has to also consider the inconvenience and loss of productive time for all involved. At KOFINAS PERINATAL, we do not use HUM and our results have proven superior to any service that does. |
|
What is fetal cardiac echo?
|
|
CardiacCardiac:
Of, near, or relating to the heart. echo is the examination of the fetal heart using ultrasound imaging. This involves different ModalityModality:
A diagnostic method, such as ultrasound, Doppler, or X-ray that is used to visualize the human body and diagnose various diseases. including 2D gray scale, color DopplerDoppler:
Often used as a non-invasive method of measuring blood flow in humans. , pulsed wave DopplerDoppler:
Often used as a non-invasive method of measuring blood flow in humans. and M-mode imaging. Fetal echo can detect up to 90% of major CardiacCardiac:
Of, near, or relating to the heart. defects if done by an experienced physician. However, there are certain CardiacCardiac:
Of, near, or relating to the heart. defects, which cannot be detected prenatally, and therefore a negative test does not preclude entirely the possibility of their existence. |
|
What is a contraction stress test?
|
A contraction stress test is conducted in order to evaluate the amount of placental reserve available to the fetus. The placental reserve signifies the placenta’s “back-up” capacity in case it is put under heavy strain by the fetus or mother. By putting the PlacentaPlacenta:
A membranous vascular organ that develops in female mammals during pregnancy, lining the uterine wall and partially enveloping the fetus. under artificial strain through this test, we are able to observe how it would react if such conditions were actually to occur naturally, and therefore work to prevent possible complications. The problem with this test however, is that it is time consuming as well as potentially dangerous to the mother and the fetus, and as such is advised against in many high-risk conditions. With today's knowledge and advanced technologies, the contraction stress test has become obsolete. |
|
 |
