Usually immediately before your appointment with Mr Miskry you will have a formal ultrasound scan for measurement of the nuchal translucency (NT – fluid at the back of the baby’s neck) which also screens for chromosomal and cardiac problems as well as potentially identifying other problems. NT measurement in combination with measurement of early pregnancy hormones and maternal age is an alternative method of screening for chromosomal problems but has a slightly higher false positive rate (ie the screening test says high risk when in fact the baby is normal) and poorer detection rate when compared with NIPT testing.
When noninvasive testing has identified a baby as being at high risk of a chromosomal problem many couples will wish to consider an invasive test such as amniocentesis or chorionic villus sample (CVS) despite the small risk of miscarriage in order to have a definitive result.
For more information about Down’s syndrome screening and the tests available visit Ultrasound Diagnostic Services (www.uds.uk.com) or the Royal College of Obstetricians and Gynaecologists website (www.rcog.org.uk).
We typically arrange NIPT and NT testing with UDS or the Fetal Medicine Centre in Harley Street. Scanning can take up to 40 minutes. You will have already received your NIPT test results directly from the scanning unit. If you have chosen not to do NIPT testing then combined testing takes up to 24 hours for a result to be available.
As well as discussing your chromosomal screening results, Mr Miskry will go through the first trimester blood tests, answer questions and plan the next steps.
16 week Appointment
Routine check with Mr Miskry
20 week Fetal Anomaly scan + appointment
Although the majority of babies are normal, up to 1% may have a serious congenital abnormality. Ultrasound assessment at about 20 weeks of pregnancy would be expected to pick up 70% of these babies by careful examination of structures such as the heart, face, brain, kidneys and skeleton. In addition ultrasound assessment of the blood flow pattern in the uterine arteries (which supply the placenta) can assess the risk of pre-eclampsia or fetal growth problems in later pregnancy. Measurement of the length of the cervix (neck of the womb) can potentially identify women at risk of pre-term delivery when other risk factors are present (such as previous surgical treatment to the cervix). At this scan the position of the placenta is noted and where requested the sex of your baby can usually be determined.
You will be given the ultrasound report to bring to your 20 week appointment which would normally be immediately after the scan. If a MAT B1 form is needed in order to claim Statutory Maternity Pay from your employer please ask for one. It is valid after 20 weeks.
24 week Appointment
Routine check with Mr Miskry
28 week Appointment
Routine blood tests:
Full Blood Count – to check again for evidence of anaemia
Blood group – to screen for atypical antibodies that may cross the placenta and cause jaundice or anaemia in the baby
Toxoplasmosis – for those who are non-immune at the first trimester screen
Diabetes screen – Diabetes that develops during pregnancy is called gestational diabetes and does not normally have symptoms. It may be associated with increased birthweight of your baby and a number of other problems. As a result all women are offered screening. This involves drinking a set amount of a sugary drink at the laboratory (which provides a sugar ‘load’) and taking blood to measure sugar levels an hour later. Women with a higher than expected result will be asked to do a more formal ‘glucose tolerance test’ to establish whether they actually have gestational diabetes.
If possible please have this test a few days prior to your 28 week appointment to enable Mr Miskry to discuss the results with you.
32 week Appointment + fetal wellbeing scan
All women are recommended to have a formal scan at 32-34 weeks of pregnancy to objectively assess fetal growth and wellbeing.
34 week Appointment
Routine check with Mr Miskry
36 week Appointment
Routine blood tests and GBS screen
Full blood count – a final check for anaemia
Blood group and antibody screen
Toxoplasmosis – for those non-immune at first or second trimester screening
All women are offered a swab test to check for the presence of Group B streptococcus (GBS). GBS is just one of the many bacteria that can be present in our bodies. Up to 1 in 5 pregnant women carry GBS and in the majority of cases this does not cause disease. During childbirth babies become colonised by GBS and clearly most do not suffer any ill effects. However, although only a small number of babies develop infection (about 1 in 2000) this can be life-threatening. In view of this it is recommended that women known to carry GBS should be offered intravenous antibiotics in labour to prevent infection.
For further information see the Group B Strep Support website (www.gbss.org.uk)
Weekly appointments from now until delivery
Please note: Mr Miskry advises vaccination against flu (at any point in pregnancy) and whooping cough after 20 weeks. Please arrange with your GP.
During routine appointments at 148 Harley Street Mr Miskry may carry out a mini-scan. This provides a relatively low resolution image but allows him to show you your babies heart beat and position if indicated. This carries no additional cost.
24 hour Emergency Cover
During your pregnancy you will have consultant availability for emergencies 24 hours a day, 365 days a year.
Mr Miskry is on call the majority of the time, but clearly he needs to take some time off which may be at short notice. On average he has a weekend off every month and one night during the week. He is also occasionally required to be out of London at medical conferences. During these times Consultant cover is provided by a small group of colleagues providing the same level of care given by Mr Miskry.
We do not book patients who are expected to deliver during any pre booked weeks of annual leave. Dates of annual leave can be checked with Gail.