The document provides information about various tests and scans performed during pregnancy, including: - Ultrasound scans which use sound waves to visualize the fetus and are done routinely to check fetal growth and development. - 4D ultrasounds which show clear, moving 3D images of the fetus. - Amniocentesis which tests amniotic fluid for genetic disorders by inserting a needle into the uterus under ultrasound guidance. - Anomaly scans done in the second trimester to check for major fetal abnormalities by examining organs and structures. - Marker tests which analyze maternal blood for protein levels that can indicate chromosomal issues like Down syndrome. - The importance of reporting any vaginal

1. TESTS & SCANS
DOUBLE MARKER
SCREENING
AMNIOCENTESIS
4D
ULTRASOUND
SCAN
VAGINAL
BLEEDING
ANOMOLY
SCAN
During Pregnancy

3. Pregnancy Ultrasound
WHY YOU
NEED IT?
When pregnant, all expectant mothers would like to know about the
well-being of their babies. It is necessary to go for routine health check-ups
during pregnancy to learn about the baby’s movements and health. Ultra-
sound scan is one such routine medical check-up performed on pregnant
women to ensure the baby’s health. Here is all about ultrasound scan and its
importance during pregnancy:
What is Ultrasound Scan?
The practice of examining pregnant women using ultrasound is known as
obstetric sonography. The ultrasound scan is a standard painless procedure
used to visualize the fetus inside the uterus using sound waves to create
images of the organs, bones and structures. The sound waves usually
bounce off the baby as echoes which are turned into images on the moni-
tor.
As bones and other hard tissues reflect more echoes, they appear white in
the image while soft tissues appear grey. The sound waves pass through
fluids like amniotic fluid and appear dark due to absence of echoes.

4. Why is it required?
The pregnancy ultrasound scan is required for various purposes such as:
• To detect any abnormality in the growth of the fetus
• To check the heartbeat of the baby
• Detect if you are pregnant with one baby, twins or more
• Check out the cause of any bleeding during pregnancy
• Find out the date of pregnancy by measuring the size of the baby
• To check if the embryo is implanted in a normal position or outside the
uterus (fallopian tube)
• To ensure that all the baby organs are normal
• Diagnose any developmental abnormality in the baby such as Spina
bifida
• Assess the baby’s growth rate by comparing over several scan results
• Check the amount of amniotic fluid and the position of the placenta
• To detect the gender of the baby
• To assess the risk of Down syndrome and other abnormalities during
pregnancy.
When is it performed?
• The first pregnancy ultrasound scan is performed around 8-13 weeks to
confirm the pregnancy and to arrive at the due date.
• The second ultrasound scan is performed between week 18 and week 21
to see if the baby is normal and without any structural abnormality.
• The doctor might recommend for a growth scan in the third trimester
between week 28 and week 40.

5. 4DUltrasound Scans:
A New Trend in Pregnancy Care
Having an ultrasound scan during pregnancy is a part of prenatal
care to check the growth and normal development of the baby
inside the womb. These scans can detect any developmental ab-
normality in the baby so that necessary actions can be performed.
Apart from diagnosis, ultrasound scans are also used the see the
baby before its official arrival. 4D ultrasound scan shows a clear
video of the baby moving inside the uterus which can be made
into a DVD.

6. What is 4D Ultrasound Scan?
A 4D ultrasound scan is the moving 3D images of the baby inside the
uterus, having time as the fourth dimension. It clearly shows the
movements and the facial features of the baby in real time like a
video.
How is 4D scan different from 2D & 3D?
The difference between 2D, 3D and 4D scan lies mostly in the com-
puter software advancement rather than the scanning mechanism.
The 2D scan can show the baby’s internal organ while the 3D and 4D
scan shows only the external features. The 2D scan has grey blurry
lines that show the baby’s movement while 3D scan shows clear
images of the baby like a photo. The 4D scan on the other hand
shows clear movements of the baby where one can see the facial ex-
pressions, body movements, shape of the nose, mouth, eyes etc.
When is the right time to have a 4D scan?
It is advisable to wait for 28 to 32 weeks in order to have a clear 4D
scan result. However, it is important to consult your doctor about the
scan, its advantages and disadvantages before making a decision.

7. AMNIOCENTESIS
Why is it needed during
pregnancy?
Amniocentesis also called as Amniotic fluid test is a prenatal test to
detect various medical conditions in the fetus. Amniotic fluid is a
watery substance surrounding the fetus which provides protection
and information about the baby’s health inside the uterus. During the
test, a fine thin needle is inserted into the abdomen and a sample of
amniotic fluid is drawn from the uterus under ultrasound guidance
without hurting the baby. This sample will be sent to lab for testing on
various genetic disorders.

8. Why is it performed?
Amniocentesis is performed to test the presence of birth defects
such as Down syndrome (chromosomal disorder), sickle cell anemia,
muscular dystrophy, cystic fibrosis, spina bifida, Tay-Sachs etc.
It is usually performed if the expectant mother shows the following
signs:
• Family history of above mentioned birth defects
• Pregnancy after 35 years of age
• Previous child with birth defects
• Abnormal ultrasound
When is it performed?
It is usually performed between week 16 and week 18 to ensure the
absence of birth defects in baby. Sometimes, the test is also per-
formed in the last trimester to check the growth and maturity of the
fetal lung. The test results might take up to 12 -15 days for processing.
The amniocentesis results are 99.4% accurate and it is completely
harmless for the mother and the baby inside the womb.
How is it performed?
During the test, a small area of the abdomen is cleansed to avoid
infection and local anesthesia will be given to ease the pain if re-
quired. Through ultrasound, the doctor will locate the position of the
fetus and the placenta and then safely insert a long thin needle in to
the uterus through abdomen without disturbing the baby. With ultra-
sound guidance, the doctor can insert the needle in to the uterus far
away from the baby. A small amount of amniotic fluid will be drawn
and sent to the lab for testing. You may feel the amniocentesis pain
like a minor menstrual cramp during the procedure and it may last for
few more hours. If the pain prolongs or if you experience any other
symptom like bleeding or vaginal discharge, consult your gynecolo-
gist.

9. Wellbeing of the baby is a constant thought in the minds of expect-
ant mothers. Doctors recommend an ultrasound scan to ensure the
healthy development and normal growth of the baby. In the second
trimester, you can expect level II ultrasound scan prescribed by your
doctor.
What Is Anomaly Scan?
This a detailed scan usually carried out in the second trimester to
check for major abnormalities. It is also called as Level II ultrasound
scan. By the 20th week, the individual organs of the baby are clearly
seen so this scan will show the growth rate, safe development of
internal organs and external features like face, legs, arms etc.
When is it performed?
The Anomaly scan is usually performed in the second trimester be-
tween 18 and 22 weeks. Doctors may ask for more scans in the
second trimester if the anomaly scan reveals any problem in pregnan-
cy.
ANOMALY SCAN
Level II Ultrasound Scan

10. WHY IS IT PERFORMED?
The scan is mainly performed to ensure that the baby’s growth is
normal without any abnormality. The Level II anomaly scan helps to
detect the following:
1. The scan measures the baby to see if the growth pattern is as
expected.
2. The number of babies inside the womb. In most cases, twins are
not detected untill week 20.
3. The shape and structure of the head are examined to rule out
severe brain problems.
4. The length and cross section of the spine is checked to see if the
bones are aligned and covered by skin at the back.
5. All 4 chambers of the heart, valves connected to it, heart beat
and major arteries & veins are examined.
6. The stomach is observed to see if the baby could swallow and
process the amniotic fluid (seen as a small black bubble).
7. Both the kidneys and the urinary bladder of the baby were
checked.
8. Check if the baby’s abdominal wall covers the internal organs in
the front.
9. Baby’s face is checked for cleft lip and other facial abnormalities.
10. The arms, hands, legs and feet were also checked to see if they
have developed normally.
The scan takes about 30 minutes and you are allowed to see while it
is performed. If you would like to know about the Level II anomaly
scan, talk to your gynecologist and have it done if your doctor recom-
mends it.

11. Pregnant women have to undergo various tests during all the three
trimesters to ensure normal development of the baby and to avoid
complications during labour. Based on health condition, previous his-
tory of pregnancy and age of the expectant mother, gynaecologists
will recommend double, triple and quad marker screening tests.
How Is The Test Performed?
Initially, pregnant women undergo ultrasound scan and if there are
any anomalies detected, the doctor would suggest for a double, triple
or multiple marker tests. In these tests, a small amount of mother’s
blood sample is taken and tested for the presence of marker sub-
stances originated from the foetus, placental tissue or combination of
both. The test result will indicate if the growing child is normal or have
any chromosomal abnormality by measuring the level of the sub-
stances.
Importance Of
PROTEIN
MARKER TESTS

12. DOUBLE
MARKER TEST
TRIPLE
MARKER TEST
• Beta hCG – Human Chorionic Gonadotropin marker
• PAPP – A – Pregnancy Associated Plasma Protein marker
• UE3 – Unconjugated protein
MULTIPLE
MARKER TEST
(QUAD SCREENING)
This test measure 2 sub-
stances in blood - beta
hCG and PAPP - A
Performed between
10-13 weeks
This test measure 3 sub-
stances in blood - beta
hCG, Alpha feto-protein
and UE3
Performed
between 14-20 weeks
To check for Down
syndrome, Trisomy 18 and
neural tube defects
(spina bifida)
Beta hCG - High levels
indicate Down syndrome
& low levels indicate
Edward's syndrome
Alpha Feto-protein - Low
level indicates Down
syndrome and Edward's
syndrome & high levels
indicate neural tube
defects
UE3 - Low levels indicate
Down
syndrome and
Edward's syndrome
This test measure 3
substances in
blood - beta hCG, Alpha
feto-protein and UE3
Performed between 15-19
weeks
To check for Down syn-
drome and neural tube
defects (spina bifida)
Beta hCG - High levels
indicate Down syndrome
& low levels indicate
Edward's syndrome
Alpha Feto-protein - Low
level indicates Down
syndrome and Edward's
syndrome & high levels
indicate neural tube
defects
UE3 - Low levels indicate
Down syndrome and
Edward's syndrome
Inhibin A - high level
indicates Down syndrome
To check for Down
syndrome, Trisomy 18
(Edward's
syndrome) and
chromosomal
abnormalities
Beta hCG-High levels
indicate Down
syndrome & low levels
indicate Edward's
syndrome
PAPP-A-Low levels
indicate Down
syndrome and
Edward's syndrome
DOUBLE/TRIPLE/MULTIPLE MARKER TESTS

13. Importance Of
VAGINAL
BLEEDING IN
EARLY
PREGNANCY:
Vaginal bleeding is a common symptom experienced by many
moms-to-be during the first trimester of pregnancy. Pregnancy bleeding
occurs in 2 out of 10 women during the early stages and in most cases it
is not associated with miscarriage or ectopic pregnancy. Generally, first
time pregnant mothers confuse the symptoms of spotting with bleeding,
so it is necessary to check with your medical practitioner.
How spotting is different from bleeding?
Spotting is when you see a few drops of blood now and then which may
not enough to cover a panty liner whereas bleeding is a heavy flow of
blood which requires a sanitary pad or panty liner to avoid staining of the
clothes. Spotting occurs when the fertilized egg implants itself to the
uterus wall which occurs between 6- 12 days after you got conceived. Se-
rious bleeding in early pregnancy needs to be checked immediately so if
you spot heavy flow of blood, contact your gynecologist or visit the near-
est hospital to get treatment

14. Does spotting causes any harm?
Light bleeding during early pregnancy may occur due to various
reasons so it is advisable to let your gynecologist know about your
health condition. If you have a normal pregnancy confirmed through
ultrasound, inform your doctor during the next visit. If you have not
had an ultrasound scan and sense spotting, it is crucial to consult
your doctor as early as possible. Sometimes spotting occurs if the
fetus grows outside the uterus (ectopic pregnancy) which is not
safe for the mother.

15. Causes of vaginal bleeding
It is possible to experience bleeding in pregnancy due to the
following reasons:
• Implantation of fertilized egg in the uterus
• Infection in the vagina
• Sexual intercourse
• Hormonal changes etc.
Apart from these, there are other reasons for early vaginal
bleeding which are as follows:
Infection - Any kind of infection in the vagina and cervix due to
sexually transmitted diseases may cause bleeding in the first
trimester. It is important to use protection while having sex in all the
three trimesters.
Change in the cervix – During intercourse, there is possibility of
change in the cervix which may result in bleeding. However, this
type of bleeding is nothing to worry about.
However, if there is heavy bleeding then it might be a sign for
miscarriage, ectopic pregnancy or molar pregnancy (pregnancy not
formed properly). It is necessary to visit the hospital if you
experience heavy bleeding in pregnancy, bleeding with pain and
dizziness or abnormal pain in the belly and pelvis region.

16. WHAT TO EXPECT ON
FIRST TRIMESTER
ULTRASOUND SCAN?
Being pregnant for the first time is
exciting and hectic at the same time,
like going on a roller coaster ride.
Pregnant women may have million
questions on their mind about the
growth and well being of the baby along
with the symptoms of pregnancy. This
article will help you understand the
importance of ultrasound scan performed
in the first trimester.
Ultrasound scan is one of the routine tests
in pregnancy which determines the
normal development of the baby and
helps to identify any abnormalities, if
present. This is a painless procedure
which doesn’t have any known side
effects to the mother and the baby.
How is it performed?
During ultrasound scan, a small
amount of gel will be applied on
your abdomen and the physician
will run the transducer over it.
This will send high frequency
dure normally takes around 25-30
minutes and the image can be
printed or copied as a video.

17. Why is it performed?
1. To arrive at the pregnancy due date and confirm it by
measuring the size of the fetus. This will help pregnant women
who have irregular menstrual cycle or who can’t recollect the
date of their last period.
2. To check the heart beat of the baby and confirm the normal
development.
3. To check the number of babies in the uterus and if there are
twins, the scan will help to identify whether they are identical or
not.
4. To detect if there are any fetal abnormalities.