SASUOG

South African Society for Ultrasound
in Obstetrics and Gynaecology

For Patients

How do we know if our baby is OK?

Congratulations on your pregnancy! We fully understand that parents-to-be sometimes worry. If you would like to know whether your baby is developing normally or not, we suggest this stepwise approach.

Step 1: Book for antenatal care as soon as possible.

Some tests can only be done very early in the pregnancy. Others may have to be booked many weeks in advance as appointments may be difficult to come by!

Step 2: Read the “Prenatal tests leaflet” on the SASUOG or SASOG website.

It gives a clear overview of all the available tests and of the very important decisions you will need to make. Please take the time to read it carefully. Discuss it with others if you prefer, so you can start forming an opinion on what is important to you. It may also be helpful to find out ahead of time which tests are covered by your medical scheme as some can be quite pricey.

Click here to download the Prenatal tests leaflet

Step 3: Attend the first visit together with your partner or another supportive person, if possible.

At the end of this visit, you will make important and possibly life changing decisions. Having your partner with you or someone who knows you well will help to make sure you really understand the differences between the available tests. You can also use this chance to ask all the questions you need to clarify your thoughts before you decide what to do.

Please take a printed copy of the leaflet along. It can function as a discussion document to help you communicate to your practitioner which test or combination of tests you would prefer, if any.

It is very important that you disclose ANY risk factors that increase the chance that there may be something wrong with your baby. The best choice of test often depends largely on those risk factors.

Step 4: Understand that you will ultimately need to balance two risks against each other.

When you are expecting a baby, there is always risk involved. With screening choices, the risk on the one side is of having a child with health or developmental problems and special needs. This can happen if you opt against the best available test, because then you may only find out there is something wrong after the baby is born. On the other hand, some tests are very expensive or may involve a risk of complications, even miscarriage. You might therefore lose the baby as a result of the test you had to rule out any problems. We know it is unpleasant to have to choose between these two risks. Unfortunately, there is never a no-risk situation once you have fallen pregnant….

As the main concerns are the possibility of a genetic condition (Down syndrome being the most common) and structural defects of the fetal body parts….

What would be a good approach if there were no specific risk factors for your pregnancy?
  1. Book early so your practitioner can do a very early scan to date the pregnancy. All tests can then be scheduled at the right time and be interpreted correctly.
  2. Consider a blood test for Down syndrome screening at 9 weeks (possible up to 13 weeks).
  3. Consider a blood test for Down syndrome and neural tube defects (NTD) at 15-16 weeks (possible up to 20 weeks).
  4. Arrange a scan at 12 weeks and another one at 20 weeks to assess the fetal development.
  5. If the results of any blood test indicates a risk for Down syndrome higher than what you are comfortable with, you can request further tests. These tests include either NIPT (Non-Invasive Prenatal Testing, a test to check the baby’s DNA in a blood sample of you) or referral to an expert for in-depth ultrasound assessment or possible invasive testing.
  6. If the result indicates an increased risk for NTD (open spina bifida), referral to an ultrasound expert is the best way to check whether the baby has any visible physical abnormality or not.
  7. If your regular obstetric practitioner performs your scans and is unhappy with any images during the ultrasound assessment, referral to a fetal medicine expert is recommended for in-depth assessment and counselling.
What if there are risk factors for your pregnancy or you will worry too much unless you have had the best tests possible?

In that case, we suggest the blood test at 9 weeks and NIPT at 10-12 weeks, while arranging both your scans with an expert. This will require booking many weeks in advance as most experts are not available at short notice. It may require significant travel as most experts work in the metropole areas only and will certainly incur significant cost. If you feel you need this to be maximally reassured however, then perhaps this is worth it for you.

Keep in mind that even a series of excellent tests will still not provide a 100% guarantee that your baby will be perfectly healthy and perfectly formed. Many significant conditions (incl. autism, mental disability, most rare genetic diseases and even many structural defects in different body parts) are simply NOT detectable before the baby is born….. Some small risk is therefore always going to remain.

Also, remember that, if you do not have specific risk factors, even without any test, the chances are more than 95% of having a normal baby!

We wish you all the best with your decisions!!!
The SASUOG team