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Author: London Pregnancy Clinic

NIPT: Non-invasive Prenatal Testing

Written by London Pregnancy Clinic on . Posted in Blog, NIPT.

NIPT (Non-invasive Prenatal Testing) is an optional blood test that can be performed in the first trimester from 10 weeks of pregnancy and is used to screen for some genetic conditions. Read more about NIPT:

How does NIPT work?

At City Ultrasound, we offer the Harmony Test, which is an extensively clinically validated type of NIPT. The Harmony Test is able to sensitively screen for:

  • Down Syndrome (Trisomy 21),
  • Trisomy 18,
  • Trisomy 13,
  • Fetal Sexing.

How does NIPT work?

Most of our genetic material (DNA) is contained within our cells; however, a small proportion of this circulates in our blood as cell-free DNA (cfDNA). When a woman is pregnant, the blood also contains cell-free DNA fragments from the placenta, which has a genetic make-up practically identical to that of the developing baby.

By taking a simple blood sample, the laboratory can isolate the cell-free DNA fragments and screen for risks associated with certain genetic conditions.

What can NIPT show me about my pregnancy?

At present, NIPT is an extremely sensitive test for Down’s Syndrome and it performs significantly better than the Combined Screening Test used by the NHS. However, it is important to understand that NIPT is a screening test—this means that it cannot give you a definitive diagnosis or 100% exclude any of the genetic conditions. Its purpose is to estimate whether the baby has an increased or decreased chance of the genetic conditions being tested for.

What are the limitations of NIPT?

As a screening test, NIPT can give an indication of your chance for these genetic conditions, but it cannot be used as a diagnostic tool—further tests would be needed for this. There are also instances where the test gives false-positive or false-negative results, which can give you a false sense of worry or security.

We, at City Ultrasound, strongly believe that the optimal method for checking the health of your baby during the first trimester includes the NIPT and ultrasound scanning (conducted by a specialist). More specifically, we believe that the combination of the Early Fetal Scan and NIPT is the ideal screening option. Of course, no screening program is 100% definitive, but this option allows for a detailed examination of the baby’s physical anatomy, such as the structure of the heart and brain (from the ultrasound), NIPT (as discussed above), as well as the assessment of Nuchal Translucency (NT), which examines the pocked of fluid behind the baby’s neck, giving us more information about the chances of different anomalies. This way we can offer the most information regarding all aspects of your baby’s health.

What’s next?

Normally, a “low chance” result from NIPT is very reassuring, as the test has a high negative predictive value (greater than 99%) for Down’s Syndrome.

As NIPT is not diagnostic, if a result was to suggest and increased chance of chromosomal anomaly, there would be an option to perform CVS (placental biopsy) or amniocentesis. While those are invasive and carry a small risk (0.5-1%) of miscarriage, these tests can give definitive results about the chromosomal abnormalities that may be present. Invasive tests are performed in specialist Fetal Medicine Units of hospitals. The decision to perform the invasive test is something that should be discussed with your healthcare team.

Read more here

Book your NIPT here

Suspected or confirmed COVID-19 after giving birth

Written by London Pregnancy Clinic on . Posted in Blog, Covid-19.

COVID-19 Guidance: Suspected or confirmed COVID-19 after giving birth

Risk to my baby

There is insufficient evidence to suggest that women with suspected or confirmed COVID-19 can pass on the virus to their babies. There has been some evidence of babies born to mothers with COVID-19, but in these few cases the babies are all well and seem to recover well from the virus. However, in most new case studies, babies born to symptomatic mothers were all well and tested negative for the virus. Uncertainty can always be unsettling, and the evidence is rapidly evolving, thus we recommend that you discuss any of your concerns with your healthcare team as they will be able to provide you with individualised advice and support.

Skin-to-skin contact and breastfeeding

After delivery, the healthcare team will examine you and your baby, after which you will be able to head home together. At this point if you have suspected or confirmed COVID-19 it will be your choice whether you wish to have skin-to-skin contact with you baby. On one hand, some countries are advising to isolate from your baby for 14 days; however, the Royal College of Obstetricians and Gynaecologists highlight that this time spent away from your baby can hinder feeding and bonding. Every case is different, which is why it is important to have a conversation with your healthcare team regarding your situation.

There is insufficient evidence to suggest that the virus can be passed on in breastmilk. Furthermore, the well-documented benefits of breastfeeding, including the building of the baby’s immune system, outweighs the risk of the virus, with the evidence that we currently have. The main risk of transmission to your baby would be the close contact. If are worried about this, there are a few precautions you can take in order to reduce the risk:

  • Wash your hands before touching the baby or anything in the baby’s environment (such as the breast pump),
  • Try to avoid coughing and sneezing while the baby is feeding,
  • Some women have been wearing masking while breastfeeding, if available,
  • ensure that you follow the recommendations for pump cleaning as well as sterilisation guidelines regardless if you are using formula or expelled milk (Sterilisation guidelines: https://www.nhs.uk/conditions/pregnancy-and-baby/sterilising-bottles/)
  • Consider asking an asymptomatic household member to feed the baby with the breastmilk you have pumped.

We understand that caring for your child, especially if you have suspected or confirmed COVID-19 can be incredibly stressful. There has been no evidence to suggest that women who have recently had a baby to be at an increased risk of contracting the virus or being seriously unwell from it. Ensure that you take care of yourself and stay well hydrated and nourished. As every case is different, it would be beneficial to have a conversation about caring for your child if you have suspected or confirmed COVID-19. Your healthcare team will be happy to answer any of your questions and reassure you wherever possible.

References:

https://www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-pregnancy/covid-19-virus-infection-and-pregnancy/#recently

https://www.nhs.uk/conditions/pregnancy-and-baby/sterilising-bottles/

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30365-2/fulltext

https://www.newscientist.com/article/2237352-coronavirus-what-we-know-so-far-about-risks-to-pregnancy-and-babies/

Prenatal Care and COVID-19 outbreak

Written by London Pregnancy Clinic on . Posted in Blog, Covid-19.

Summary of NHS and RCOG recommendations:

 The importance of prenatal care

The purpose of prenatal care is to identify, diagnose, treat, or prevent anomalies which may affect the health of the mother or the baby. Screening schedules have been carefully developed through evidence and expertise to ensure that the well-being of the pregnancy is effectively monitored throughout the whole gestational period. For this reason, it is incredibly important that you maintain contact with your maternity team and attend your prenatal care appointments. We understand that these are troubling and uncertain times, when attending a clinic may pose a level of anxiety, but please remember that prenatal care is essential in supporting a healthy pregnancy and reducing complications and it is strongly advised to attend appointments where they have been scheduled.

General advice

If you are asymptomatic and in good health, with no complications from previous pregnancies we recommended that you contact your maternity team if you are due for a routine scan. It is likely the appointment will still be carried out, but timings may change to accommodate staffing requirements as clinics are doing everything possible to protect the safety of their patients and staff. Alternatively, if you are between appointments, you should wait to hear back from your maternity team regarding your appointment. If you have any concerns or are uncertain about your scans, contact your maternity team. They will be able to provide you with advice specific to you, regarding your appointment times and any changes to these, if relevant.

Furthermore, it is important that you also contact your maternity team if you are concerned about your baby’s well-being or movements. Naturally, you may have concerns about entering a healthcare facility during this time, but any concerns you have regarding your pregnancy should be vocalised to your care team. If you are required to attend hospital, we want to reassure you that maternity units are doing everything they can to minimise the spread of COVID-19 and ensuring the well-being of all their patients and staff. Some of these changes include restrictions on numbers of visitors. This means that we unfortunately have to ask that if you are to attend a prenatal scan, that you attend alone if possible. This includes being asked not to bring your children with you.

Lastly, in the instance that your maternity team believes that there may be a need to reduce the number of face-to-face prenatal appointments, this will be communicated to you clearly. This will only happen taking into account evidence on the safe number of visits required to ensure a healthy pregnancy.

Attending prenatal appointments if I am self-isolating

If you are self-isolating, it is important that you follow government guidance and stay indoors, avoiding contact with others for 14 days. However, if you have an appointment scheduled during this time, it is important that you contact your maternity team to let them know that you are currently in self-isolation for suspected or confirmed COVID-19. Most likely they will reschedule your appointment until your isolation is over, however if it is decided that the appointment is urgently needed, arrangements will be made to ensure you are seen while the safety and well-being of others is also protected. If this is the case, it is important that you follow instructions from your maternity team.

Just to re-iterate, we completely understand that this is a stressful and unsettling time. The most important thing you can do is to keep regular contact with your maternity team and ensure that you do attend your appointments where they have been scheduled, if you are well. Prenatal care has been developed to reduce complications and support your pregnancy, and even during challenging times, this is still the case.

Please be aware that COVID-19 is an emerging, rapidly evolving situation and we recommend to check listed below references for the latest public health updates:

References

https://www.rcog.org.uk/globalassets/documents/guidelines/2020-04-17-coronavirus-covid-19-infection-in-pregnancy.pdf

https://www.unicef.org/coronavirus/navigating-pregnancy-during-coronavirus-disease-covid-19-pandemic

https://www.euro.who.int/en/data-and-evidence/evidence-informed-policy-making/publications/pre2009/what-is-the-efficacyeffectiveness-of-antenatal-care

https://www.thh.nhs.uk/services/women_babies/COVID-19_infection_pregnancy.php

https://www.rcog.org.uk/coronavirus-pregnancy

COVID-19 Guidance: Suspension of IVF and Fertility Treatments

Written by London Pregnancy Clinic on . Posted in Blog, Covid-19.

What is happening?

Following many recent requests from patients we have reviewed main official documents referring to the IVF treatment at this time.

As the COVID-19 pandemic continues to escalate in the UK, many NHS services are being downsized or suspended. Unfortunately, it has been announced that all fertility treatment (NHS and private) will be as stopped as of 15 April 2020. We understand that this must be incredibly disheartening to hear for those beginning, continuing, or planning to undertake fertility treatment.

In accordance to the Directions, clinics plan to stop treatments over the next three weeks, so that patients are able to complete any cycle they have started. As of now, it is not known how long these Directions will remain in force, as this is dependent on Government guidance on restrictions. We understand that this uncertainty may add additional stress and anxiety to an already challenging situation. Please look under the sub-heading: Additional Support for resources intended to provide support and guidance for managing this challenging time for you.

Moving forward, any decisions to re-open fertility clinics will be evaluated by UK professional fertility societies, such as The British Fertility Society and The Association of Reproductive and Clinical Scientists. They will have to evaluate the impact re-opening would have on NHS services and ensure that clinics are able to operate safely to protect the health of their patients and staff.  The Human Fertilisation and Embryology Authority (HFEA) is working on an exit strategy so that fertility treatment can resume as soon as possible when Government restrictions on travel and contact are lifted.

In line with the Directions to suspend fertility treatments, it has also been requested that all centres have put measures in place to keep patients informed of any changes to treatment plans, the reasons for these, as well as some mechanism of support for patients who have concerns or require support. Furthermore, we recommend you do try to maintain contact with your fertility clinic in order to understand the changes to your treatments and to be contactable when treatment can resume.

Dr Marta Jansa Perez, Director of Embryology at The British Pregnancy Advisory Service (bpas) commented in a statement that the decision to close fertility services was to “enable fertility professionals to deal with the current pandemic, to reduce the spread of the infection, and to avoid unsafe care due to staff shortages rather than because of any concerns about the impact of the virus on pregnant women and their babies. There is no evidence that Coronavirus presents a specific harm to pregnancies, and there is no evidence to suggest that becoming pregnant during this time would be unsafe.”

See Dr Marta Jansa Perez’s full statement here: https://www.bpas.org/about-our-charity/press-office/press-releases/bpas-comment-on-the-suspension-of-fertility-services/

Lastly, many women may be worried about how the pandemic will affect the funding that has been put in place for their fertility treatment. If your clinic does not contact you about this, we recommend that you contact your local commissioning group for more information: https://www.nhs.uk/service-search/other-services/Clinical-Commissioning-Group/LocationSearch/1

Additional support

Linked below, is an open letter to fertility patients, written by Sally Cheshire CBE, the chair of the HFEA

https://www.hfea.gov.uk/about-us/news-and-press-releases/2020-news-and-press-releases/an-open-letter-to-fertility-patients-sally-cheshire-cbe-chair-hfea/

Furthermore, the UK Fertility Network is offering support lines, which is open from 10am-4pm Monday, Wednesday, and Friday. They have also moved all support groups online and provide general support and guidance on their website.

https://fertilitynetworkuk.org/coronavirus-covid-19/

References

1 https://www.hfea.gov.uk/treatments/covid-19-and-fertility-treatment/coronavirus-covid-19-guidance-for-patients/

2 https://fertilitynetworkuk.org/coronavirus-covid-19/

3 https://www.hfea.gov.uk/media/3092/2020-03-23-general-direction-0014-version-1.pdf

4 https://www.arcscientists.org/

5 https://www.bpas.org/about-our-charity/press-office/press-releases/bpas-comment-on-the-suspension-of-fertility-services/

COVID-19: Childbirth and Birthing Partners

Written by London Pregnancy Clinic on . Posted in Blog, Covid-19.

We have reviewed recent publications by the Royal College of Obstetricians and Gynaecologists and compiled a summary of the guidance and recommendations regarding childbirth and birth partner. If you would like more information, please visit: https://www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-pregnancy/

We understand that this is a very stressful and challenging time for expecting mothers and with additional pressures on the NHS, maternity services will also be affected. The NHS has put into places measures to ensure that pregnant women are supported and cared for safely before, during, and after birth. This may mean that where possible, some consultations are provided over the phone or video call; however, please attend your routine check if they have been scheduled. This is incredibly important for the health of you and your baby.

Please read this guidance with caution as its purpose is to provide a concise summary of the most important points of childbirth during the pandemic. We also wish to reassure you that everything is being done in hospitals to ensure your safety and wellbeing, but if you have any additional concerns please contact your maternity unit or medical staff responsible for your care if you are already in hospital. We are all working together to ensure you have a healthy pregnancy, birth, and supportive postnatal care for you and your baby.

We would like you to be aware that if you have chosen to have a home birth or a birth in a midwife-led unit that is not co-located with an obstetrics unit, these services rely heavily on emergency ambulances and sufficient staff to keep your safe. In some places, this service can no longer be provided.

However, if you attend hospital for a birth you will be encouraged to have an asymptomatic birth partner with you. Plenty of studies have shown that having a birth partner with you makes a significant different to your safety and well-being during birth. Unfortunately, if your chosen birth partner is symptomatic of COVID-19 or has experienced symptoms within the last 7 days, you will be asked to arrange an alternative asymptomatic birth partner to protect your health and the health of the other patients and staff at the hospital.