Fetal Medicine Foundation First Trimester Screening
Fetal Medicine Foundation First Trimester Screening
Fetal Medicine Foundation First Trimester Screening
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The <strong>Fetal</strong> <strong>Medicine</strong> <strong>Foundation</strong><br />
Nuchal cord<br />
A nuchal cord is present in about 5% of pregnancies. The cord has often moved if the patient is<br />
scanned later and it does not obviously cause the poor fetal outcome associated with cord accidents.<br />
However, it may make the NT difficult to interpret and in this situation the NT must be measured above<br />
and below the cord and the average used in the risk calculation. The new software will make this<br />
calculation of the mean for you as long as the NT max and NT min are correctly entered when<br />
prompted.<br />
Nasal bone<br />
At 11 – 13 +6 weeks the nasal bone (NB) is not visible by ultrasonography in about 65% of fetuses with<br />
T21 and in about 2% of chromosomally normal fetuses. Therefore, the presence of the fetal nasal bone<br />
will reduce the risk for T21. There is some ethnic variation in the appearance of the fetal nasal bone, so<br />
it is important to correctly attribute maternal ethnic group (see ethnic group section). The software will<br />
not use the fetal nasal bone in the risk calculation if the ethnic group is not entered using the grouping<br />
provided.<br />
It is essential that the FMF guidelines for the measurement of NB are followed correctly (see appendix<br />
2) and the findings on NB will only be taken into account in the risk assessment if you hold the FMF<br />
certificate of competence in NB have the NB included in your license.<br />
When the nasal bone appears to be absent in a patient who otherwise has a low risk result from all<br />
other ultrasound markers (with or without serum biochemistry), the FMF advice is that the patient is rescanned<br />
in one week and the risk is only increased at that point if there is persistence of the absence<br />
of the nasal bone.<br />
Tricuspid regurgitation<br />
Tricuspid regurgitation (TR) is observed in about 55% of fetuses with T21 and in 1% of chromosomally<br />
normal fetuses.<br />
It is essential that the FMF guidelines for assessment of TR are followed correctly (see appendix 3) and<br />
the presence or absence of TR will only be taken into account in the risk assessment if you hold the<br />
FMF certificate of competence in TR assessment and have the TR included in your license.<br />
TR is associated with cardiac defects and therefore when TR is noted at the 11 – 13 +6 weeks scan, it is<br />
important to carry out a good fetal cardiac examination at 20 – 23 weeks.<br />
Ductus venosus<br />
Blood flow in the ductus venosus (DV) has a characteristic waveform with high velocity during<br />
ventricular systole (S-wave) and diastole (a-wave). At 11 – 13 +6 weeks reversed a-wave in the DV is<br />
observed in about 65% of fetuses with T21 and in 3% of chromosomally normal fetuses.<br />
It is essential that the FMF guidelines for the assessment of the DV are followed correctly (see<br />
appendix 4) and the DV assessment will only be taken into account in the risk assessment if you hold<br />
the FMF certificate of competence in DV assessment and have the DV included in your license.<br />
Reversed a-wave in the DV is associated with cardiac defects and therefore when this pattern is noted<br />
at the 11 – 13 +6 weeks scan, it is important to carry out a good fetal cardiac examination at 20 – 23<br />
weeks.<br />
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