We are located at the Corner of Toorak Rd & Tooronga Rd in Tooronga Village Complex. (See Contact Us page for Google Map)

2. Parking

Enter via Tooronga Rd and park at B3 (Red) at the far end of rows M or L near “Exit Tooronga” Sign

Then  take lift “Lift to Office Entry” to Level 1 or take lift outside the centre entrance to Level 1

3. Accompanying people and children

Partners or other support persons are welcome to attend your scan. Very young children are rarely able to understand all the images or concentrate for the scan duration. If they then seek your attention your own enjoyment and involvement in the scan may be diminished. Unsettled children may disrupt the concentration of the doctor performing your scan.

4.DVD recording

Many couples like to have a DVD copy of their pregnancy scan. This is available for the 12 and 20 week scans.
DVDs are provided complementary by the practice .

You will also be given a photographic keepsake of your baby.

5.Waiting time

We endeavour to keep waiting times to a minimum but will sometimes run late. Our staff will let you know if there are any delays when you arrive. Unfortunately, delays are an unpredictable element of our work. Some scans are difficult or complex, and sometimes we find an unexpected problem which requires more time to deal with. As we are a specialist practice, emergency scans will be prioritised.

If we are having major delays, our staff will telephone you ahead of time. Leaving a mobile or other contact number with us when you book your appointment helps us keep you informed. You are welcome to make a telephone enquiry near to your appointment time to ask about any delay.

We  have 2 doctors scanning and delays in one particular room may mean a patient in the waiting area may be seen ahead of you.

6.Reports

The doctor who sees you will perform the whole ultrasound examination, write the report and explain and discuss results directly with you. Reports can be printed immediately after your scan for you to take to your doctor.

7.Charges

Fees will be available at the time of booking your appointment. We are not a bulk billing centre. Payment on the day is expected. If you have a Pension Card, please present it to our staff on arrival.



We are a group of specialist Obstetricians and Gynaecologists with additional qualifications and experience in women’s ultrasound. We are committed to personalized scanning by medical practitioners in a welcoming environment that is comfortable and respectful of women. The doctor who sees you will perform the whole ultrasound examination, issue the report, and explain and discuss results directly with you. You will know the results of your scan before you leave our practice.

You are welcome to ask questions at any time during the scan, although a complete answer may not be possible until the end of the scan.

What is Ultrasound?

Ultrasound examinations use sound waves that are of a higher frequency than human hearing. The sound waves are reflected from tissue that they pass through, and are changed into an image on a TV screen by a sophisticated computer. The examination, which may sometimes be called a “scan”, allows the doctor performing the scan to examine many tissues and organs of the body, and to see normal and abnormal anatomy. If is particularly suitable for the examination of the female pelvis.

How is the examination performed?

Ultrasound waves are sent out from the small metallic crystals within a plastic case: the ultrasound prove. Gel is first spread on the skin or the probe to allow the ultrasound waves to pass from the probe into the body. The probe is then moved over the skin. There is no pain or other sensation from the ultrasound waves.

Abdominal and Vaginal Ultrasound.

For most women, both techniques will be used but a vaginal scan will almost always allow clearer views as the probe is close to the pelvic structures.

A full bladder is only required when a vaginal scan cannot be performed. If this applies to you, then please attend with a full bladder. Ultrasound waves travel easily through fluid and a large bladder will create a window into the pelvis allowing the ultrasound to reach the pelvic organs to create a diagnostic image. Without a full bladder the ultrasound waves are scattered by bowel gas. A full bladder will make the images obtained from abdominal scanning as clear as possible. For a vaginal scan an empty bladder is required.

Vaginal Scanning

To perform a vaginal san, a thin probe is placed gently into the vagina and moved close to the cervix, where the views of the uterus are best. The probe is moved gently within the vagina to view all the pelvic organs. This is associated with minimal discomfort and is usually short, lasting only a few minutes. The scan is very similar to a vaginal examination and generally more comfortable than a smear test.

Vaginal scanning has revolutionized the non-invasive assessment of gynaecological disorders. Using this technique, the uterus and ovaries can be assessed from the close proximity of the vagina. This allows much clearer views and more detail of the delicate structures within the female pelvis.

When is the best time to have the scan?

A vaginal scan be done at any time during the menstrual cycle, even when you are bleeding. It is not necessary to change your appointment if this happens. However, our preference is to perform a scan shortly after the period has finished. This is the best time to assess the pelvis for polyps or cysts, though any time of the cycle will allow good views of the uterus and ovaries.

Why are scans used in Gynaecology?

The value of Ultrasound in gynaecology varies with the age, and the reason for the scan.

1. Young girls and adolescents.
Scans are not commonly ordered in this age group, but when they are it can be worrying for them. In this age group only abdominal scans are performed and a very full bladder is needed. If the bladder is not full enough we will provide further drinks until the bladder fills.

A very common reason for scans in young girls is pelvic pain associated with the start of their periods. Absence of periods may also be a reason for a scan. Young girls are always scanned with their mothers present though many adolescents prefer to be seen with a friend rather than a parent. The doctor will always explain the findings to both the girl and a her mother, or the adolescent and their accompanying person.

2. The fertile years.
This is the age group in which most scans are performed. During these years ultrasound is very good at assessing the menstrual cycle in all phases. Ultrasound can distinguish abnormal findings from the normal changes that occur during the menstrual cycle.

The major reasons for scans are listed:

1. Bleeding between periods
2. Heavy periods
3. Period or pelvic pain
4. Absence of, or irregular periods
5. Excess hair growth
6. Possible fibroids
7. Suspected pelvic mass
8. Difficulty conceiving

The ultrasound examination may detect fibroids and polyps of the uterus, which can be the cause of abnormal bleeding. Cysts of the ovaries are a very common cause of pain and these are usually easily seen with ultrasound. Other problems that might be detected include evidence of pelvic infection (fluid in the tube) and occasionally bowel problems.

3. Postmenopausal years.
We perform many scans in this age group for unexpected problems. The common reasons are listed:-

2. Screening for Ovarian Cancer: It is in this age group that many scans are performed to screen for ovarian cancer, particularly in those women with a family history of breast or ovarian cancer. The ovaries will be assessed regardless of the reason for the scan. In older women the ovaries should be very small. Occasionally a cyst may be present, and the great majority of these are simple or benign cysts. Some cysts may cause concern, and to make sure there are no features of cancer, a repeat scan in a few weeks or months may be suggested.

3. Tamoxifen screening: This is a drug used to reduce the rate of breast cancer recurrence. It is associated with an increased risk of polyps, and occasionally cancer of the endometrium (lining of the uterus). These complications are very rare but many women will have regular scans to check for changes that might suggest problems. Some women will need a Saline Infusion Sonohysterography (see Other Procedures).

Common Findings

Endometrial Polyps: Polyps occur in the lining of the uterus or endometrium. They are fleshy overgrowths of tissue that can cause spotting between periods or heavy bleeding with the period. They are common in the premenopausal years, and are almost always benign and are easily treated.

Ovarian Cysts: The ovaries are active organs, which naturally develop cysts during each menstrual cycle. Small ovarian cysts (follicles) are normal especially in the lead up to ovulation (egg production) at mid-cycle. The follicle changes in appearance after ovulation and can be seen up until the next period. The doctor scanning you will assess any cyst to determine whether it is a natural cyst (which will resolve by itself), or a pathological cyst, which might need removal. Luckily most cysts do not need surgery.

Endometriosis: is a condition where there is bleeding into a cyst each month. The same tissue (endometrium) that lines the uterus and sheds each month is found in these cysts outside the uterus. It is commonly found in the ovaries and is almost always associated with pain. Endometriosis cysts do not resolve spontaneously. Unfortunately, ultrasound cannot detect all cases of endometriosis, and further investigations by your gynecologist may be necessary to make this diagnosis.

Polycystic Ovaries: are an ovarian condition that is commonly diagnosed in women who have irregular periods, and sometimes also excess hair growth and acne. The ultrasound findings are usually confirmed with hormone blood tests, which are organized by the referring doctor.

Fibroids: are masses that occur commonly in the uterus. They are made of uterine muscle, and grow into a ball shape within the normal muscle layers of the uterus. They undergo fibrosis with time; hence their name “fibroid” i.e. like fibrous tissue. They vary in size from very tiny to large masses, and are almost always benign. Most cause no problems, and do not need to be removed or scanned again.

Other procedures.

1. Saline Infusion Sonohysterography: This procedure is used occasionally to diagnose polyps in the lining of the womb (endometrial cavity). A very fine plastic catheter (tube) is passed through the cervix and into the womb – this feels very much like a smear test, and causes minimal discomfort. The doctor then performs a vaginal scan while inserting a small amount of saline (salt water) into the womb. The saline outlines any growths within the cavity. This procedure is only suggested when the normal views from vaginal scanning cannot distinguish normal from abnormal findings. If the doctor suggests this procedure he/she will explain in detail how it is performed.

2. Tubal Assessment with Levovist: Levovist is an ultrasound contrast medium that can be used to demonstrate the Fallopian tubes. It may be recommended in some women who are having difficulty conceiving. The procedure is very similar to saline infusion, though the catheter used has a small balloon that can be inflated to keep the catheter in place. This procedure sometimes makes women feel faint or have period pain, so you should allow extra time to rest after the test. Period pain medications such as Nurofen taken half an hour before the procedure may be helpful.

3. Cyst Aspiration: It is possible to pass a needle into a cyst under ultrasound guidance and then to aspirate the fluid from the cyst. This procedure is only performed when there is a persistent cyst that has no features of cancer. If the doctor thinks this is a possible option for treatment he/she will discuss this with you and the referring doctor.

Welcome to Women’s Ultrasound Melbourne at the Epworth Freemasons and at Tooronga Village.

We are a group of specialist Obstetricians and Gynaecologists with additional qualifications and experience in women’s ultrasound. We are committed to personalized scanning by medical practitioners in a welcoming environment that is comfortable and respectful of women. The doctor who sees you will perform the whole ultrasound examination, issue the report, and explain and discuss results directly with you. You will know the results of your scan before you leave our practice.

The reproductive organs in a female consist of the vagina, cervix, uterus, fallopian tubes and the ovaries (see above diagram). The ovary produces the eggs which are fertilized in the fallopian tubes. The embryo then travels along the fallopian tube in the first few days of life and eventually attaches itself in the cavity of the uterus, growing into a full term baby. One of the common causes of infertility (inability to fall pregnant) is a blockage of the fallopian tubes. The fallopian tubes are about 15cm long and arise from the upper uterus on both sides. The other end of the tubes has a wide opening which lies over the ovary to pick up the egg at the time of ovulation. The patency (openness) of the fallopian tubes can be confirmed by performing a tubal patency test with an ultrasound contrast medium called Levovist.

It should be noted that this test cannot detect mild endometriosis or adhesions in the pelvis.

Diagram 1

How is the test performed?
A fine catherer is inserted into the uterus to allow for the contrast to be injected close to the tubal openings in the uterus (see below for details).

Diagram 2

Vaginal ultrasound examination is used to visualize the contrast as it passes through the uterus and into the tubes, and as it spills around the ovaries.
The most commonly used dye is a special ultrasound contrast agent (echo-enhancing agent) called Levovist. It is a suspension of galactose (a form of sugar) and palmitic acid, both of which occur naturally in the human body and therefore are non toxic. When shaken together they form tiny bubbles which are detectable by ultrasound. This substance is also non allergic.

What happens on the day?
A vaginal ultrasound examination is performed before the tubal patency test to assess the pelvic organs. We search for any abnormalities that may be relevant to your fertility or future pregnancies. Common abnormalities found are uterine fibroids and polyps. Sometimes the abnormal findings point to a cause of the fertility problems such as endometriosis, so that surgical treatment may be necessary. In these circumstances the Tubal patency test may be replaced by a tubal assessment at the time of any future surgery.

After the vaginal ultrasound examination is finished a speculum is inserted into the vagina as in a pap smear. The cervix is visualized and then cleansed by an antiseptic solution. The thin catheter is then introduced into the cervix and passed up into the uterine cavity. Very occasionally the catheter cannot be inserted into the cervix. If this occurs, the test is abandoned at this point. Once the catheter is in place a small balloon at the tip of the catheter is blown up to keep the catheter in place. At this time some patients may experience a period like discomfort.

Once the catheter is in place the speculum is removed and the vaginal probe is reinserted into the vagina. A small amount of saline is first introduced into the catheter to enhance the views of the cavity and to assess whether the cavity shape is normal, and to also exclude a polyp or other pathology. The Levovist solution is then injected into the catheter, and the movement of the Levovist micro bubbles can be clearly seen on the screen as the solution passes through the cavity and into the fallopian tubes. The ultrasound specialist performing your test will be able to determine whether the tubes are patient and will inform you straight away.

When is the best time to do the test?
The best time to do the Tubal Patency test using Levovist is between day 5 and 12 of the menstrual cycle. This is to avoid disruption of a pregnancy should there be one in the uterus in the second half of the cycle.

Do I have to have any special preparation?
There is no real preparation necessary except that you should take some mild painkillers such as Naprogesic about 1 hour before the test. Most women easily tolerate the test with very little discomfort. Most women like to have a friend or relative with them to provide support.

What happens after the test?
The vaginal examination and tubal patency test will take about 20minutes. You will need to allow about 1 hour at the practice. You can resume normal activity as soon as you leave the clinic, including returning to work. You may experience some mild crampy, period like discomfort after the test which could last for up to 1 hour. You will be given a sanitary pad to wear for the rest of the day as there will be a small leakage of fluid and blood from the vagina. If you continue to experience significant discomfort more than 24 hours after the test you must contact the doctor who referred you because of the very small chance of an infection.

Very occasionally a woman may experience severe pain and faintness. This could be due to tubal spasm or rarely due to cervical shock. Some women have a very sensitive cervix and are prone to cervical shock; if this is known about in advance it is a contra-indication to the test. These more severe symptoms always resolve within a few hours.

What does it cost?
The fee charged by the doctor performing the test is partially covered by Medicare, but unfortunately the Levovist solution and the special catheter are not covered by Medicare. Therefore the out of pocket cost is more than for a normal ultrasound examination. The exact cost is available from the WUME or from your referring doctor.

Summary
The Tubal Patency Test using Levovist is a very safe and effective test to examine the patency of the fallopian tubes. In comparison to laparoscopy, which is also used to determine tubal patency, no general anesthetic is required, and it is much less painful. Mild period like cramps should be expected. There is no specific preparation necessary, but taking pain tablets one hour beforehand may reduce your discomfort (if any). Ideally you should have the test performed just after you have finished your period. The results will be explained by the specialist doctor as soon as the test is completed.

About WUME
All ultrasound scanning and procedures at WUME are performed by highly trained obstetricians and gynecologists who have specialized further in the area of ultrasound diagnosis and management. If you have any questions about this test they will be happy to answer them, and can thus also give you your results immediately.

At any time during the scan you are welcome to ask questions, though a complete answer may not be possible until the end of the scan.

What is Ultrasound?

Ultrasound examinations use sound waves that are of a higher frequency than those we can hear. These sound waves are reflected from tissue that they pass through, and are changed into an image on a TV screen by a sophisticated computer. The examination, which may sometimes be called a “scan”, allows the doctor performing the scan to examine many tissues and organs of the body, and to see normal and abnormal anatomy. It is particularly suitable for the examination of pregnancies, and especially fetal anatomy.

Ultrasound mechine

How is the examination performed?

Ultrasound waves are sent out from small metallic crystals within a plastic case, the ultrasound probe. Gel is first spread on the skin to allow the ultrasound waves to pass from the probe into the body. The probed is then moved over the skin. There is no pain or other sensation from the ultrasound waves.

A full bladder is not needed.

A full bladder is not required for pregnancy scans. However, a little urine in the bladder is often useful since this will often allow better views of the lower part of the uterus (womb).

What about vaginal scanning?

Vaginal scanning may be necessary in early pregnancy when the abdominal views can be very poor. To perform a vaginal scan, a thin probe is placed gently into the vagina and moved close to the cervix, where the views of the uterus are best. This is associated with minimal discomfort. In this way excellent views of fetuses as small as 2mm can be seen. After 12 weeks vaginal scanning is rarely needed. The doctor will only suggest a vaginal scan when it is necessary for diagnostic views.

Why are scans performed in pregnancy?

There are many reasons to have a scan in pregnancy, which depend on the gestation or number of weeks of pregnancy.

1. First Trimester Scans (less than 14 weeks)
It is common in early pregnancy to have a scan when the dates are unsure, or you have experienced pain or bleeding. Listed are some important reasons why your doctor might order a scan in the first few weeks of pregnancy.

1. Confirm the fetus is alive by seeing fetal heart movements
2. Calculate when the baby is due.
3. Diagnose twins or triplets.
4. Check for ovarian cysts or uterine fibroids.
5. Diagnose an ectopic pregnancy (pregnancy in the tube)
6. Screening for Down syndrome. This scan is performed between 11 and 13 weeks only. For further information see the First Trimester Down syndrome Screening Pamphlet.

2. Mid-trimester scan (18 to 20 weeks):

Most women will have a scan between 18-20 weeks. At this time the fetus is large enough to be easily seen and so detailed assessment of many structures can be made. At this stage many of the list above will also be checked.

ultrasound image

For most women this scan will reassure them that their baby appears normal. By showing structures and organs that appear normal it is possible to rule out a large number of abnormalities. The doctor who performed the scan will reassure you that the ultrasound anatomy of the baby is normal, before you leave the scan room.

During the scan you will be shown much of the baby’s anatomical detail. The doctor will be able to show you the baby’s head and brain, the heart, stomach and bladder, the spine, the arms and legs. The baby’s movements will be seen, and you will be given a photo of your baby to take home. If you wish, you may also purchase a DVD copy of the scan for a small fee.

The scan can only assess the anatomy or structure of the baby, but in this way many of the common congenital abnormalities may be detected. In most fetuses spina bifida, cleft lip (hare lip), severe dwarfism, and major heart defects can be excluded.
For a very small number of women the scan will identify a major fetal abnormality. However, even with the best ultrasound equipment not all abnormalities can be seen. In particular, developmental delays such as intellectual delay, cerebral palsy or autism cannot be detected. If there is any problem found, the doctor who performs your scan will discuss any findings with you during the scan. The doctor may then suggest an amniocentesis to exclude possible chromosomal causes for the problem.
The placental site will also be assessed, and the pelvis inspected for any cysts or fibroids.

3. Third Trimester Scan (after 26 weeks):

Late in the pregnancy, your obstetrician may order another scan. Commonly, this will be performed to assess placental site, especially where there has been bleeding. The position of the baby’s head may suggest a breech presentation, or the doctor may be worried the baby is not growing properly. Regardless of the reason for the scan, the doctor will reassess the baby in detail each time you attend, though in later pregnancy, it may be difficult to see some parts of the baby’s anatomy.

Late in pregnancy the images of the baby will not appear as clear as at the mid trimester scan, however much useful information about the baby’s well being can still be assessed.

Late in pregnancy the images of the baby will not appear as clear as at the mid trimester scan, however much useful information about the baby’s well being can still be assessed.
To fully assess the pregnancy the baby’s weight will be estimated, measurement made of the fluid around the baby (amniotic fluid index), and the Doppler blood flows measured in the umbilical artery. These three measurements help to assess the baby’s general health.

Other investigations in pregnancy

As ultrasound gives a continuous moving picture, it is of great assistance in guiding a needle to an area within the body. Thus, procedures such as amniocentesis and chorion villous sampling are performed while watching the needle with ultrasound. These techniques are used to diagnose chromosome problems such as Down syndrome. There are pamphlets available on these procedures in the waiting room.

Does Ultrasound cause harm?

Ultrasound has been used on pregnant women for over 40 years. Despite intensive investigations by many research groups there has been no confirmed evidence of any harm to the developing baby, or to the mother. In many countries, including Australia, it is routine to have two scans per pregnancy, though more than two scans may be needed in high risk situations.

Endometriosis is a common gynaecological condition defined as presence of endometrial like tissue outside the uterus which impairs quality of life. In more severe disease, there may be ovarian cysts and deep infiltration of the pelvic organs. Deep endometriosis may involve the bowel, most commonly rectosigmoid colon. Using transvaginal and transabdominal ultrasound with bowel preparation allows good views of this area to make a more extensive assessment of the pelvis. This may influence surgical decision making to allow time for complex surgery and sometimes the presence of a bowel surgeon to work with your gynaecologist.

Bowel preparation empties the lower bowel so that clear images can be obtained. Views of the bowel are often hindered by the presence of gas and faecal material which can obscure both bowel and other pelvic structures.

The ultrasound will be done both transabdominally and transvaginally assessing the whole pelvis with detailed views of uterus, ovaries, rectosigmoid, bladder and surrounding structures. You will be able to see the images and discuss the findings at the time of your scan.

Why have tests for Down syndrome?

1. Down syndrome is a congenital chromosome abnormality also called Trisomy 21. This means there is an extra chromosome 21 in every cell of the body.

2. Children with Down syndrome always have an intellectual and a physical disability.

3. All pregnant women of any age have a small risk of delivering a baby with Down syndrome. As women age, the risk of delivering a baby with Down syndrome increases.

Background Facts and Down syndrome:

1. It is possible to assess the risk of your fetus having Down syndrome with an ultrasound examination of the fetus at 12 weeks.

2. Fetuses with Down syndrome tend to have more fluid in the back of the neck than normal fetuses. The measurement of the fluid layer in the back of the neck than normal fetuses. The measurement of the fluid layer in the back of the neck is called the nuchal translucency.

3. About 80% of Down syndrome fetuses will have a nuchal translucency measurement that is thicker than most normal fetuses. However, some normal fetuses will have a thick nuchal translucency.

4. The scan alone cannot make a final diagnosis of Down syndrome. Even if the scan is normal it does not completely exclude the possibility that a fetus might be affected.

5. Most often the nuchal translucency is combined with a blood test to detect Down syndrome.

6. A definite diagnosis of Down syndrome requires an invasive needle test (Chorion Villus Sampling or an Amniocentesis). If your test shows a high risk for Down syndrome you will be offered one of these tests. These needle tests carry a risk of miscarriage of about 1 in 200.

What is your risk of having a baby with Down syndrome?

The figures below show how the risk of having a baby with Down syndrome increases with the mother’s age. These figures also show that the risk of a Down syndrome fetus is higher at 12 weeks than at birth. This is because many Down syndrome fetuses die naturally during the pregnancy (resulting in a miscarriage or still birth).

Maternal age related risks of having a live born child with Down syndrome and the risk of carrying an affected fetus at 12 weeks of pregnancy.

12 week scan

This is the best time in pregnancy to assess the risk of Down syndrome with an ultrasound examination. It is usually performed as an abdominal examination. It is usually performed as an abdominal scan, but sometimes it is necessary to do an internal (vaginal) scan. A full bladder is not needed but sometimes a little urine in the bladder can be helpful.

This scan will:
1. Confirm that the fetus is alive and has a heart beat
2. Check for multiple pregnancy – twins etc.
3. Assess the size of the fetus. This allows an accurate due date to be given. It also allows a
personalized risk of Down syndrome in your fetus. Risk calculation can only be made if your fetus is
between 45 and 84mm in size (11 weeks 2 days and 13 weeks 6 days).
4. Measure the amount of fluid in the skin at the back of the neck (nuchal translucency)
5. Check for any other obvious physical abnormalities of the fetus.
6. Check for uterine or ovarian abnormalities.

It is known that in all 12 week fetuses there is some fluid present in the skin at the back of the neck. Even in normal fetuses this layer can appear prominent. Multiple studies worldwide have shown that if there is more fluid than usual, the risk of Down syndrome is increased.

Ultrasound Image

Combined screening test for Down syndrome

The best test currently available to screen for Down syndrome in pregnancy involves combining risks that are generated from a blood test as well as the ultrasound results and the maternal age.

This blood test of maternal serum screen is best taken at 10 weeks of pregnancy but can be used in the risk calculation if it is taken between 9 and 13 weeks. The blood test measures the levels of two pregnancy proteins called PAPP A and BhCG. In Down syndrome the PAPP A tends to be low and the BhCG tends to be high.

Using a computer program developed by researchers in London, you will be given a specific risk level of your fetus having Down syndrome. The risk assessment program combines the following measurements to calculate an overall or combined risk.

1. Age of the mother

2. Crown-Rump length of the fetus (age of the fetus)

3. Fetal Nuchal Translucency measurement

4. PAPP A

5. BhCG

You will be given a personalized risk for your pregnancy being affected by Down syndrome. This will be in the form of a risk ratio.
E.g. 1 in 20 meaning 1 chance in 20
1 in 1000 meaning 1 chance in 1000
The high risk result is a risk greater than 1 in 200 (e.g. 1 in 120)

Most women will have a low risk (96%), however, 4% of women will be given a high risk. Most women with a high risk will still have a normal baby.

Women who are given a low risk may still have a baby with Down syndrome though this is very unlikely.

Decision Making

The scan does not tell you that the fetus had Down syndrome, nor down it tell you that it is normal. It is your decision what to do with the risk information. Individual couples can react quite differently to the same risk level. Some see a risk of 1 in 300 as being very high, while other might see the risk as being low.

As a rule of thumb, if the risk is more than 1 in 300 we would offer the option of having an invasive diagnostic test, either CVS (Chorion villus sampling) or an Amniocentesis. These tests can tell you with certainty whether or not the fetus has Down syndrome. Both these diagnostic needling techniques carry a small risk of miscarriage of about 1 in 200.

What other tests can be useful?

1. Second Trimester Maternal Serum Screening. This is a blood test taken from the pregnant woman between 14 to 20 weeks of pregnancy. This test measures 3 to 4 proteins in the woman’s blood that are only found in pregnancy. It is similar to the first trimester maternal serum screen used in combination with the 12 week scan. By combining the mother’s age with the level of these 4 proteins, it is possible to calculate a risk for her fetus having Down syndrome. This result is independent of an ultrasound scan, and can lead to a Down syndrome detection rate of about 70%. This test is offered at many public hospitals and is also very useful if the 12 week combined screen has been missed for any reason.

Note: It is usual for women to have only one of these blood tests in pregnancy, either the first trimester with the nuchal translucency scan, or the second trimester alone. There is only a single rebate associated with these tests.

20 week scan. All women are advised to have this scan regardless of their age, number of children or previous investigations (including CVS or Amniocentesis). At this scan a detailed anatomical assessment of your fetus will be made. If this is normal then may major fetal abnormalities can be excluded. This is considered the single most important scan of pregnancy. However, it is not a screening test for Down syndrome which is poorly detected at this later gestation. This is because the early skin thickening seen at 12 weeks disappears as the pregnancy progresses and has usually resolved by 20 weeks. This scan is best performed between 19 and 20 weeks of pregnancy.

Chorion Villus Sampling and Amniocentesis
CVS (chorion villus sampling) and Amniocentesis are both diagnostic tests for chromosomal abnormalities of the unborn child. Both tests are equally accurate in the diagnosis of chromosomal abnormalities.

Who is offered an Amniocentesis or CVS?
1. Women of 35 years or over at the estimated of delivery.
2. Women in whom a screening test for Down syndrome has suggested a high risk for Down syndrome, or other similar chromosomal abnormality.
3. Women who have previously had a child with a chromosomal problem.
4. Women who are at low risk for chromosome abnormalities but are extremely anxious.
5. Women and their partners who are known to be at particular risk of carrying a baby with a disease such as cystic fibrosis, thalassemia, or the more rare metabolic disorders.
6. Women and their partners who are known to carry a chromosomal rearrangement that may lead to babies with more severe chromosomal problems.

What are chromosomal abnormalities, and what is Down syndrome?
Each cell in the body normally contains 23 pairs of chromosomes. Half the chromosomes come from each parent, and pair up to make 46 chromosomes. Normal males are denotes as 46 XY and normal females as 46 XX. Sometimes an error occurs during fertilization and the fetus may end up with more or less chromosomes.

Down syndrome refers to an extra chromosome 21 and this is denoted as 47 +21. Another name commonly used for Down syndrome is Trisomy 21 (meaning 3 chromosomes of number 21). Babies, if born alive with Down syndrome, usually can expect to have a healthy long life. The main problem these children face is one of intellectual delay and learning difficulties. Most will need a sheltered environment throughout their lives. Some babies with Down syndrome have major structural abnormalities, such as heart abnormalities, though the majority born alive will not have major problems.

1. Trisomy 18 – Edwards syndrome (usually lethal)

2. Trisomy 13 – Patau syndrome (usually lethal)

3. XO – Turners syndrome (infertile females)

4. XXY – Kleinfelters syndrome (infertile males)

Why are older women offered an Amniocentesis or CVS?
As the age of a pregnant woman increases, the chance of her having a fetus with Down syndrome or other chromosomal abnormality increases. This is because women store their eggs from the time that they are babies, and as the years go by more errors in cell division start to occur. These errors are part of the normal ageing process, and are not influenced by the general health of the mother, or how many healthy children she has.

What is the difference between CVS and Amniocentesis?
These two tests take a different tissue sample from the pregnancy that can then be tested from chromosomal abnormalities. Both tests are equally effective at diagnosing Down syndrome. This list below compares the main features of each test.

Why is an ultrasound examination needed with these tests?

Before the test is performed an ultrasound scan will be performed to check the following:-
1. That the fetal heart beat is clearly seen.
2. To localize the placenta and fetus.
3. To check the amount of fluid around the baby before Amniocentesis.
4. To assess if twins are present.
5. To check whether the fetus looks normal. If the fetus has a suspected problem a rapid result may be organized (see FISH).

During the test the ultrasound will be used to guide the needle to the best and safest position, thus minimizing the potential for damage to the pregnancy and other organs.

After the test a scan will be performed to check the fetus is still moving and has a heart beat.

Safety Issues
All our procedures are performed using a needle guide. This means that the needle has a fixed route into the uterus. This has been shown to be the safest way of performing these tests, and minimizes any damage to other organs.

CVS and the Amniocentesis are both performed by passing the needle through the mother’s abdominal wall. A sterile technique is used thus minimizing infection and pregnancy loss from the procedure. Trans-vaginal CVS is no longer performed in our practice because of the higher miscarriage rate associated with this route.

What will happen on the day of the test?

The doctor who will perform the test will also perform your scan. At this time the procedure will be explained in detail, and any questions answered.

The procedure is performed in the Ultrasound room under ultrasound guidance. This amount of discomfort with both these tests is small. Most women find that these tests are like having blood taken and are easily tolerable. The whole procedure takes only a few minutes. The needle is in the mother’s abdomen for only a minute or two. At the end of the procedure the fetus is checked.

A full bladder is not required for either the CVS or the Amniocentesis. A little urine in the bladder may be useful in some circumstances. If you feel uncomfortably full, please ask our staff if you may go to the toilet.

All women undergoing these tests are asked to wait 30 minutes before heading home to rest. Occasionally a woman may faint after a test, and if you are prone to this you should tell the staff so that arrangements can be made for you to lie down after the procedure.

We recommend that a companion drives you home just in case you feel a little pain or faintness, however most women are quite capable of driving themselves home if need be. We recommend that patients rest at home until the following day, although there is no reason to go to bed.

Arrangements should be made for another adult to care for children under the age of 5 for the rest of the day. Very active sports or very physical jobs should be avoided for a day or two, though other normal activities are fine.

What complications can occur?

1. Miscarriage. CVS and Amniocentesis both have a small risk of causing a miscarriage. For both tests this risk is less that the background risk of miscarriage at the same gestation. The world literature suggests that amniocentesis has a slightly lower miscarriage rate than CVS. In our hands the risk of miscarriage from a CVS is well below that suggested by the world literature. This is probably related to our experienced doctors, and the fact that we use a needle guide and no longer perform trans-vaginal CVS (see Safety Issues). If a miscarriage occurs due to an Amniocentesis or a CVS it usually happens within 2 weeks of the procedure.

2. Bleeding. This complication is more common after CVS than Amniocentesis. It is still a rare complication. If it occurs we advise that you contact your doctor immediately. We will organize to scan the pregnancy again to make sure that the fetus is still alive. Most women who have bleeding will not miscarry, but will go on to have a normal healthy baby.

3. Fluid Leakage. This is a rare complication of Amniocentesis. It occurs in approximately 1 in 100 procedures. In most women the leakage will stop spontaneously, but in a small proportion it may lead to ongoing loss and miscarriage. If you suspect any fluid loss you should contact your doctor so that it can be confirmed or excluded. Another scan will be ordered if there is a high suspicion of this complication. Fluid leakage is very rare after CVS.

4. Fetal risk. With CVS after 10 weeks and Amniocentesis after 15 weeks there are no reported fetal abnormalities due to the tests. Some fetal abnormalities will be discovered at a later date, which are not due to the test, but would have occurred anyway. Because of this, all women are offered a scan at 18 to 20 weeks to try and detect this sort of problem. CVS performed before 9 weeks is thought to be associated with rare limb deformities. We have not had a case like this in our practice taking into account the natural background rate for these abnormalities.

5. Laboratory failure. Very rarely there can be a problem in the laboratory, which means that the specimen fails to give a result. In a very small percent of specimens the result may be difficult to interpret, and it may be necessary to repeat a test.

Results:
The laboratory testing is very similar for both Amniocentesis and CVS. The laboratory process is complex and involves and involves growing cells until there are enough of them in the middle of the dividing phase to allow the chromosomes to be examined. This process takes between 10 and 14 days. Your doctor will receive the results as soon as it is available and will notify you of the result.

Rapid results: A new test has been devised to give a quicker result. This test is called a FISH test (Fluorescent In Situ Hybridisation) and it is designed to test for Trisomy 21 (Down syndrome) and several other common abnormalities. It is not considered a complete test and in all circumstances the full result will be available in 10 to 14 days. This test is offered to couples that are very anxious, or at a particularly high risk of abnormalities. This test has no Medicare Rebate and costs an additional $150-$200. If you wish to have this additional test please let us know.

Chorion Villus Sampling and Amniocentesis

CVS (chorion villus sampling) and Amniocentesis are both diagnostic tests for chromosomal abnormalities of the unborn child. Both tests are equally accurate in the diagnosis of chromosomal abnormalities.

Ultrasound detection of Down syndrome at 12 weeks of Pregnancy

Why have tests for Down syndrome?

1. Down syndrome is a congenital chromosome abnormality also called Trisomy 21. This means there is an extra chromosome 21 in every cell of the body.

2. Children with Down syndrome always have an intellectual and a physical disability.

All pregnant women of any age have a small risk of delivering a baby with Down syndrome. As women age, the risk of delivering a baby with Down syndrome increases.

Ultrasound in Pregnancy

Ultrasound examinations use sound waves that are of a higher frequency than those we can hear. These sound waves are reflected from tissue that they pass through, and are changed into an image on a TV screen by a sophisticated computer. The examination, which may sometimes be called a “scan”, allows the doctor performing the scan to examine many tissues and organs of the body, and to see normal and abnormal anatomy. It is particularly suitable for the examination of pregnancies, and especially fetal anatomy.

Ultra Test of Tubal Patency Using Levovist

The reproductive organs in a female consist of the vagina, cervix, uterus, fallopian tubes and the ovaries (see above diagram). The ovary produces the eggs which are fertilized in the fallopian tubes. The embryo then travels along the fallopian tube in the first few days of life and eventually attaches itself in the cavity of the uterus, growing into a full term baby. One of the common causes of infertility (inability to fall pregnant) is a blockage of the fallopian tubes. The fallopian tubes are about 15cm long and arise from the upper uterus on both sides. The other end of the tubes has a wide opening which lies over the ovary to pick up the egg at the time of ovulation. The patency (openness) of the fallopian tubes can be confirmed by performing a tubal patency test with an ultrasound contrast medium called Levovist

Pelvic ultrasound in gynaecology

Ultrasound examinations use sound waves that are of a higher frequency than human hearing. The sound waves are reflected from tissue that they pass through, and are changed into an image on a TV screen by a sophisticated computer. The examination, which may sometimes be called a “scan”, allows the doctor performing the scan to examine many tissues and organs of the body, and to see normal and abnormal anatomy. If is particularly suitable for the examination of the female pelvis.

Ultrasound for assessment of deep endometriosis with bowel preparation

Endometriosis is a common gynaecological condition defined as presence of endometrial like tissue outside the uterus which impairs quality of life. In more severe disease, there may be ovarian cysts and deep infiltration of the pelvic organs. Deep endometriosis may involve the bowel, most commonly rectosigmoid colon.

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Freecall: 1800 670 182  Email: info@womensultrasound.com.au
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