20 week scans

Monday morning and its time for the first of the 20 weeks anomaly scans. No need to drink loads this time which is a relief. The first scan is the standard anomaly scan that even woman is given at 20 weeks pregnant. This is where the whole of the baby is examined under ultrasound to check for physical abnormalities and you can normally ask to find out the sex of the baby at this point, but we already know he is a boy so there is no need for that. Many things are checked but a few involve checking that measurements and growth are on target, checking the presence and blood flow in the major organs. Looking for extra fluid around the brain, gastrointestinal abnormalities such as duodenal atresia, holes in the heart and checking heart function.

The list is quite extensive. There are two main things that are checked for in a baby with confirmed Down’s syndrome. The first is that 50% of these babies have a hole somewhere in their heart that requires surgery when they are born. The other is duodenal atresia. This is where the stomach and the small intestines are not joined together. This requires surgery immediately after birth. Naturally I have been googling again and read a lot about both of these and I have looked up what you might see on an ultrasound if the baby had either of these. I feel prepared but also very worried as I think I had convinced myself that there was going to be something else wrong with the baby. The difference with my 20 week scan is that it was performed by the consultant rather than your standard ultrasonographer. We arrived, checked in and sat down in the waiting area. It wasn’t long before we were called through. The consultant got me laid down on the bed and went through what she was going to do and the things she was going to check for. Then comes the chilly gel, on goes the probe and up comes the baby on the screen. I can feel him kicking a bit when she is poking him with the probe and I can see him kicking on the screen. The consultant spent about half an hour going over various bits of the baby and doing various measurements. She then put the probe down and said all together baby seems pretty healthy and normal. The only things she can see are things that she would expect in a baby with Down’s syndrome. These are the things they look for called soft markers that can show if a baby has trisomy 21 and it has not been already detected. Firstly he has shorter femurs (thigh bone) than normal, He has a flatter face and although his nasal bone is present it is not as obvious as it should be and he has some increased size to one of the ventricles (fluid filled spaces) in his brain. None of these are problems. She says she is happy that he is growing well and his heart function looks good although she has not looked at the heart in detail as I am seeing her colleague who specialises in cardiology, and she will be able to assess his heart to a higher degree than she can. I am so relieved a huge weight has been lifted. I was so convinced there was going to be something else majorly wrong. The consultant is happy and doesn’t want to see me again until I am 28 weeks when she will repeat the scan and do a growth check. I wiped myself off, thanked her and we make our way home.

On to Wednesday and our first trip to the John Radcliffe hospital in Oxford. This is a much larger hospital and one that is a lot easier to get lost in. We take the lift up to the top floor, check in and sit down and wait. We are then called in by the cardiology consultant who is the loveliest doctor I have met so far. She has an amazing bedside manner and is full of compassion which is hugely reassuring. She went through what she was going to do and then said that she scans in silence and makes notes and to not be worried by her quietness its just how she does things. So I lay there quietly and watch the screen as she meticulously scans all parts and measures different bits of his heart, she looks at the blood flow and listens to the sound the flow makes. I can see the screen clearly and I can make out that there are four defined chambers and I can’t see any gaping holes which is good. When she is finished she turns to me and tells me all she has seen.

  1. There is a slight offset of the atrial ventricular valves, not a problem in itself but is a soft marker for down’s syndrome.

  2. There is a prominent echogenic focus in the mitral valve again not a problem but a soft marker.

  3. The aortic arch is left sided with an aberrant origin of the right subclavian artery. This means the major artery coming from the heart is the opposite way to how it should be and this makes the other artery come out in a different direction. This again has no significant affect on the function of the heart but is considered a red flag for down’s syndrome.

But she could also see no obvious holes anywhere which was great news. She again wanted to do a re-scan at 28 weeks but otherwise felt his heart was healthy. So home we go to celebrate and relax in the knowledge that so far so good no need for any surgery after birth.