Skip to main content

Tag: scan

Week 4 of Pregnancy

Graphic of Week 4 of pregnancy. An illustration of a zygote in the uterus.

Week 4 of your Pregnancy

Your Baby’s Remarkable Beginning



This blog post is part of a series that breaks down early pregnancy week by week. Today we will be talking about Week 4 of your pregnancy journey! Within this article, we’ll delve into the astonishing advancements occurring during this initial phase of pregnancy. Although your baby remains incredibly minuscule, measuring at no more than 1 millimeter (similar to a poppy seed), a realm of growth and transformation is already well underway.

Key Concepts: Gestational Weeks vs. Post-Conception Weeks

Understanding the difference between gestational weeks and post-conception weeks is crucial for accurately tracking the progress of your pregnancy.

Gestational Weeks: Gestational age refers to the age of the pregnancy and is measured from the first day of the mother’s last menstrual period (LMP). This is the standard method used by healthcare providers to track pregnancy. For example, at 4 weeks gestation, the embryo is about 2 weeks post-conception. Gestational age is crucial for determining the due date and monitoring the baby’s development.

Post-Conception Weeks: Post-conception age, also known as embryonic age, is measured from the time of conception. It provides a more precise timeline of the baby’s development. For instance, at 4 weeks post-conception, the embryo is undergoing significant developments, such as the formation of the placenta and the beginning of the amniotic sac.

Pregnancy Checklist at 4 Weeks

While it’s still early in your pregnancy, there are some important steps you can take:

  • During the initial 4 weeks of pregnancy, you may not experience noticeable symptoms. To verify your pregnancy, consider taking a pregnancy test.
  • Once you’ve confirmed your pregnancy you may think about your first prenatal visit with your doctor, even though it may not occur for another couple of weeks. With us, this would be our Viability/Dating Scan. During this visit, our specialists, like Miss Shaz Khojasteh, will check for single/multiple pregnancies, date the pregnancy and check main structures of the gestational sac. 
  • Focus on adopting healthy diet and lifestyle habits. Say goodbye to smoking and alcohol, opt for nutritious foods, and stay well-hydrated.
  • The NHS provides valuable recommendations for expectant mothers, including considering the importance of taking supplements during pregnancy. Additionally, it’s essential to recognise how emotional changes that often accompany pregnancy can impact your relationships.

Developmental Milestones: Week 4

By Week 4, your baby develops from being a single-cell zygote to a blastocyst. Rapid cell division shapes the future. At this stage, your embryo completes its journey from the fallopian tube to the uterus, burrowing into the uterine lining. Half becomes your future child, and the other forms the placenta—a vital nutrient carrier.

The amniotic sac, often called the “bag of waters,” forms around the embryo, along with the yolk sac, important for your baby’s digestive system.

Your embryo now consists of three unique cell layers:

  • The endoderm—nurturing your baby’s digestive system, liver, and lungs.
  • The mesoderm—laying the foundation for your baby’s heart, sex organs, bones, kidneys, and muscles.
  • The ectoderm—shaping your baby’s nervous system, hair, eyes, and outer skin layer.

What is seen on the Ultrasound: Week 4?

One of the common queries we receive at the London Pregnancy Clinic is whether having an ultrasound at 4 weeks gestation is a requirement. At this stage, around the fourth week of pregnancy, significant developments are occurring. The blastocyst is in the process of dividing into an embryo and placenta. However, it’s crucial to understand that an ultrasound of your uterus during this early stage will typically reveal what appears to be a minuscule dot known as the gestational sac, and it’s important to note that a heartbeat is not typically detectable at this early point of development. Detecting a more advanced pregnancy may require waiting until a later stage.

Thinking ahead: Week 4?

The next steps in your pregnancy journey involve preparing for your first ultrasound appointment. It’s completely normal to eagerly anticipate your first ultrasound, but it’s essential to be aware that at 4 weeks of gestation, the gestational sac is typically too small to be easily visible on the scan. For a clearer image of your pregnancy, it is generally advisable to wait until around 5 weeks or later, when the development progresses. However, it’s worth noting that in certain cases, skilled sonographers with extensive experience may be able to discern subtle indications of pregnancy by closely observing changes in the uterine lining. You can use our booking system to calculate your optimal scan date range by entering your Last Menstrual Period(LMP) HERE.


Week 4 of your pregnancy signifies the remarkable commencement of your baby’s journey. While ultrasound visuals may not reveal much at this early stage, rest assured that a realm of development is quietly unfolding within your body. Join us as we look forward to exploring the upcoming stages of your pregnancy journey, complete with the changes and milestones that await.

It’s crucial to remember that every pregnancy is unique. Therefore, we recommend consulting your healthcare provider for tailored guidance and attentive care during this special period. Our team is here to provide support throughout your exciting pregnancy journey!

Once again, heartfelt congratulations on your pregnancy. Stay tuned for further updates as we continue to monitor your baby’s week-by-week growth.

Latest Stories

Continue reading

10 Week Pregnancy Scan Explained

Graphic of 10 week Scan. An illustration of a mother thinking about the normal development of her baby.

The 10-Week Scan

Answering your questions about the Earliest Anomaly Scan At 10 Weeks



This blog post discusses the benefits of the 10-week scan, how it is done, and frequently asked questions. It also highlights that the 10-week scan is the best scan to combine with Non-invasive prenatal testing (NIPT), which is a blood test that can be done at 10 weeks to screen for common chromosomal abnormalities. At the London Pregnancy Clinic, We have a unique and individual approach in that we do not ‘leave any stone unturned’ – we provide the most comprehensive assessment of the development of your baby possible at each stage of pregnancy.

Understanding the 10-week Scan:

Typically, the 10-week scan is performed using either a transabdominal or transvaginal ultrasound. A skilled sonographer will place a transducer on your abdomen or within your vagina. This transducer emits sound waves into the uterus, bouncing off the fetus to create a real-time image on the ultrasound screen. The entire procedure generally lasts between 15 to 30 minutes.

Comprehensive Screening:  

In the realm of prenatal care, knowledge is power. The 10-week pregnancy scan, often regarded as the earliest anomaly scan, holds a special place in the hearts of expecting parents. It’s an opportunity to unveil critical insights into your baby’s development, offering early detection of potential fetal anomalies and precise pregnancy dating. This pivotal examination, conducted through either a transabdominal or transvaginal ultrasound, is an indispensable tool in ensuring a smooth and informed journey towards parenthood.

Benefits of the 10-week Scan:  

The advantages of the 10-week scan are numerous and profound:

Early Detection of Fetal Abnormalities: At the 10-week mark, this scan can identify up to 10 major fetal anomalies, providing parents with vital information to make informed choices about their pregnancy.

Accurate Pregnancy Dating: Precise dating of the pregnancy aids parents in planning for their baby’s arrival and arranging future prenatal appointments with confidence.

Reassurance for Parents: Pregnancy is a time of great joy but can also bring anxiety. The 10-week scan offers peace of mind, assuring parents that their pregnancy is progressing as expected.

Optimal Pairing with NIPT: When combined with NIPT, the 10-week scan offers the most accurate information on the baby’s health. NIPT, a blood test conducted at 10 weeks, screens for common chromosomal abnormalities, such as Down syndrome, trisomy 13, and trisomy 18, complementing the 10-week scan perfectly.


Many pregnant women in the UK are anxious about the health of their babies in the early weeks of pregnancy. This may be due to a number of factors, including:

  • Previous miscarriage
  • IVF pregnancy
  • Unintentional alcohol consumption
  • Missed doses of folic acid
  • Use of certain medications
  • Severe morning sickness
  • Bleeding
  • Unhealthy diet
  • Sudden loss of pregnancy symptoms

If you are concerned about any of these issues or others, our 10-week scan is the perfect solution for you. It is designed to provide early reassurance for expectant parents.

The 10-week scan is also ideal for any pregnant woman who wishes to have NIPT at the earliest possible stage. Many parents choose to screen for the risk of Down syndrome in the first trimester. This is now possible with a non-invasive blood test at 10 weeks. However, the majority of fetal abnormalities are structural (physical), and some of these may be more severe than Down syndrome.

Unfortunately, NIPT will miss all structural abnormalities. That is why we take the opportunity to conduct an early screening of the baby’s structures to rule out 10 major structural abnormalities before performing NIPT.

Should I Delay My NIPT until 12-14 Weeks, Post NHS NT Scan?

Opting to delay your NIPT until after your NHS (National Health Service) Nuchal Translucency (NT) scan at 12-14 weeks is an approach that is becoming increasingly outdated. We firmly believe that the most effective method is to perform both the dating scan at 10 weeks and the NIPT at 10-11 weeks. This approach offers several advantages, particularly regarding early testing.

Admittedly, some fetal structures and organs may not be fully visualized at the 10-week mark, and certain structural anomalies may remain undiagnosed due to the fetus’s ongoing development. However, the benefits of conducting both tests as early as technically feasible outweigh these limitations.

  • IVF pregnancy
  • Unintentional alcohol consumption
  • Missed doses of folic acid
  • Use of certain medications
  • Severe morning sickness
  • Bleeding
  • Unhealthy diet
  • Sudden loss of pregnancy symptoms

If you are concerned about any of these issues or others, our 10-week scan is the perfect solution for you. It is designed to provide early reassurance for expectant parents.

The 10-week scan is also ideal for any pregnant woman who wishes to have NIPT at the earliest possible stage. Many parents choose to screen for the risk of Down syndrome in the first trimester. This is now possible with a non-invasive blood test at 10 weeks. However, the majority of fetal abnormalities are structural (physical), and some of these may be more severe than Down syndrome.

Unfortunately, NIPT will miss all structural abnormalities. That is why we take the opportunity to conduct an early screening of the baby’s structures to rule out 10 major structural abnormalities before performing NIPT.

Your Frequently Asked Questions About 10-week Scan

Do I need a full bladder for the 10-week scan? No, a full bladder is not necessary for the 10-week scan.

What sets the 10-week scan apart from the nuchal translucency scan? In comparison to the nuchal translucency scan, the 10-week scan is more comprehensive. While both can measure the fluid at the back of the baby’s neck, the 10-week scan extends its scope to assess various aspects of the baby’s development, including the heart, brain, and spine.

Is the 10-week scan safe? Yes, the 10-week scan is a safe and well-established procedure. Ultrasound technology has been a trusted method for safely imaging babies in the womb for many years.


If you’re considering delaying your first scan or wish to explore further options, the London Pregnancy Clinic provides innovative Early Ultrasound Screenings. These include the Early Fetal Scan, conducted between 12 and 16 weeks, which can exclude more than one hundred serious anomalies. Moreover, our Early Fetal Echocardiography is designed to identify up to 80% of detectable severe fetal heart defects. We highly recommend this scan for all babies with increased nuchal translucency (NT) measurements, fetal anomalies, or other unusual findings detected at the 11-13 week scan.

In conclusion, the 10-week pregnancy scan is an essential early step in ensuring the health and well-being of your growing family. It empowers parents with valuable insights and peace of mind, setting the stage for a smooth journey into parenthood. And remember, at the London Pregnancy Clinic, we offer a range of pioneering early ultrasound screenings to cater to your specific needs, ensuring the best possible care for your precious one.

Book NIPT + Scan from £490

Latest Stories

Continue reading

Understanding NT’s 95th Percentile

Graphic of understanding NT's 95th Percentile. A baby on a timeline with abstract representations of measuring tools.

Understanding NT’s 95th Percentile:

Nuchal Translucency (NT) Thickness Measurements in the 1st Trimester and What to Do if NT is Increased?



Nuchal Translucency (NT), developed over 30 years ago in the early 1990s, remains a pivotal screening marker for evaluating early fetal well-being. Widely used, it screens for chromosomal and genetic conditions, as well as heart defects and other structural anomalies in the developing fetus. To get an understanding of NT’s 95th percentile we will discuss the importance of NT measurements, variations in cutoff values, and what to do if your baby’s NT measurement falls above the 95th centile but below the 3.5mm threshold.

The Significance of Nuchal Translucency Measurements:

NT refers to measuring the clear fluid space at the back of the baby’s neck during an ultrasound scan. According to NHS guidelines, it is measured between the 11th and 14th weeks of gestation. Presently, it is a cornerstone of the NHS Chromosomal Syndromes Screening Program conducted through Combined Screening Testing (CST). This program relies on the enduring significance of NT to assess the risk of chromosomal syndromes in the first trimester of pregnancy. Elevated NT measurements can indicate potential chromosomal abnormalities such as trisomy 21 (Down syndrome) and genetic conditions like Noonan syndrome, as well as heart defects and other structural anomalies. However, there is a significant level of uncertainty regarding what constitutes an abnormal NT measurement.

Variations in Cutoff Values:

One of the challenges with NT measurements is determining what constitutes an abnormal measurement. There is considerable variation in the cutoff values used by different research papers and guidelines. The majority of research studies and international society guidelines use the 95th centile as the threshold for abnormal NT measurements. This means that if your baby’s NT measurement falls below the 95th centile, it is considered normal. However, the NHS guidelines use a more conservative cutoff of 3.5mm. This 3.5mm cutoff is equivalent to the 99th percentile, representing a higher threshold for what is considered abnormal by NHS.

The Importance of Gestational Age:

It’s crucial to understand that the 95th centile for NT measurements varies with gestational age. Younger fetuses at 11 weeks tend to have naturally smaller NT measurements compared to those closer to 14 weeks. Therefore, determining whether your baby’s NT measurement is normal or not depends on both the absolute measurement and the gestational age.

Understanding NT’s 95th Percentile Measurements:

We understand that expectant parents might find it challenging to locate validated data concerning the 95th centile cutoff for their baby, as such data is not readily accessible online. To provide support, we have developed an NT thickness reference table based on highly esteemed international data from the study conducted by Wright et al in 20081. Additionally, we have cross-referenced data on normal NT measurements for the 10-11-week gestational period from Grande et al.’s publication in 20142, which closely aligns with Wright’s findings. Consequently, we have assembled a table that delineates the limit of an increased NT (95 centile) for each week from the 10th to the 14th week, utilising gestational age data recommended by the British Medical Ultrasound Society (2009)3.

Gestational Weeks 10+0 10+1 10+2 10+3 10+4 10+5 10+6 11+0 11+1 11+2 11+3 11+4 11+5 11+6 12+0 12+1 12+2 12+3 12+4 12+5 12+6 13+0 13+1 13+2 13+3 13+4 13+5 13+6 14+0 14+1
NT 95th centile mm 2.3 2.3 2.4 2.4 2.4 2.4 2.3 2.2 2.2 2.2 2.2 2.2 2.2 2.2 2.3 2.3 2.4 2.4 2.5 2.6 2.6 2.7 2.7 2.7 2.8 2.8 2.8 2.8 2.8 2.8

Our chart represents the distribution of increased NT measurements (> 95th centile) in relation to the gestational age. It’s important to note that, at every stage of gestation, normal NT measurements remain below 2.8 mm. Therefore, any NT measurement equal to or greater than 2.8 mm is considered elevated.

What occurs when there is a significant elevation in NT measurements? 

If NT thickness is 3.5mm or more (>99th centile) you will be referred to the fetal medicine unit (FMU) of your NHS hospital or FMU of a large regional NHS trust, where doctors will scan your baby to exclude structural anomalies associated with increased NT and offer further tests (CVS or NIPT). They will also offer fetal echocardiography at 16-20 weeks to exclude associated CHD.

What to Do if NT Measurement is Above the 95th Centile but Below 3.5mm (99th centile)?

The NHS adopts a conservative approach and does not acknowledge the 95th centile raised NT cutoff. Consequently, additional scans and tests are not scheduled for these babies before the routine 20-week anomaly scan conducted by the NHS. However, when the NT measurement surpasses the 95th percentile, it is advisable to proceed with further testing. In such instances, considering Non-invasive Prenatal Testing (NIPT) and an Early Fetal Anomaly Scan (Early Fetal Scan) are recommended.

SMART TEST – A Comprehensive Screening Option

For babies with elevated NT (between 95-99th centile), we have introduced the SMART TEST, which stands as the most advanced early reassurance package available. It comprises two expert early anomaly scans, Early Fetal Echocardiography, and the most comprehensive state-of-the-art NIPT panel. The SMART TEST can effectively rule out the majority of severe congenital heart defects (CHDs) and other structural anomalies associated with elevated NT, and reduce the probability of your baby being affected by chromosomal, genetic, or structural abnormalities.

While the SMART TEST is expensive, it is the most comprehensive early reassurance package available in the UK. For parents unable to afford the SMART TEST, there is a more affordable option of the Early Fetal Scan and an extended Panorama Test. The Early Fetal Scan screens for CHDs, but does not include a detailed examination of the fetal heart. You can further upgrade the scan and Panorama Test NIPT package to include eECHO.

If you have received concerning news about your baby’s increased nuchal translucency, we strongly recommend discussing the SMART TEST with one of our specialists.


Nuchal translucency measurements play a crucial role in assessing fetal well-being during the first trimester of pregnancy. Understanding the variations in cutoff values, gestational age, and available screening options is essential for making informed decisions if your baby’s NT measurement falls above the 95th centile but below the 3.5mm NHS threshold (99th centile). The SMART TEST, with its comprehensive NIPT panel and early fetal echocardiography, offers a valuable non-invasive screening option for parents seeking more information about their baby’s health. We are committed to offering you the best possible care, and you are always welcome to have a personal consultation with us to decide on the most suitable approach based on your individual circumstances.

Latest Stories

Continue reading

Possibility of Early Spina Bifida Diagnosis from 10 Weeks.

Graphic of Early Spina Bifida Diagnosis. A baby that is getting its spine scanned at 10 weeks.

Spina Bifida Early Diagnosis from 10 Weeks of Pregnancy

DR Fred Ushakov Headshot. London Pregnancy Clinic Medical Director. Specialist in Fetal Medicine & Obstetrical Ultrasound.

An Interview with Dr. Fred Ushakov



In honour of UK Spina Bifida Awareness Week, Dr. Ushakov, Founder and Managing Director of London Pregnancy Clinic, discusses the possibilities of early diagnosis of spina bifida. He is an internationally renowned expert in fetal medicine, with a primary focus on fetal spina bifida and is also currently affiliated with FMU UCLH. In recognition of UK Spina Bifida Awareness Week, we have had the privilege of asking Dr. Ushakov several vital questions about spina bifida.

Dr. Ushakov was interviewed by, our Specialist Sonographer in Fetal Medicine, Gynaecology & Fertility, Ms Shaz Khojasteh.

What sparked your interest in spina bifida?  

“In 1980, as a young obstetrician heavily involved in attending deliveries and particularly interested in ultrasound technology, I performed a scan on a young pregnant woman. I noticed something unusual about the baby’s brain, although I couldn’t quite discern the exact issue. Subsequently, I was present at her delivery, and to my surprise, the baby was born with spina bifida. This experience was truly shocking. It occurred over 35 years ago during the early stages of ultrasound technology when both knowledge and technology were limited.”

What actions did you take next?

“After that shocking experience, I became genuinely intrigued by effectively detecting spina bifida. I dedicated significant effort to mastering scanning techniques for identifying spina bifida in babies. Over time, I evolved into an expert in this field, with a particular focus on spotting it as early as 10 weeks into the pregnancy. And naturally, I made it a point to share this knowledge with my colleagues, advocating for early spina bifida detection.”

How many babies with spina bifida have you encountered?

“I’ve seen hundreds of fetuses with spina bifida during my career. It’s become a routine part of my work – conducting early scans to detect spina bifida and performing expert scans for babies already diagnosed with this condition. Spina bifida is actually relatively common. In the UK, it’s estimated that around 1 in every 1,000 pregnancies is affected by spina bifida. Even though it might not be as well-known as some other conditions, its effects on those who have it can be quite substantial. This is why early detection and awareness are so important.”

Why is spina bifida so important?

“Open spina bifida holds immense significance due to its prevalence as a major fetal structural defect. It adversely affects essential bodily functions, such as bowel and bladder control. Walking becomes a challenge for most babies born with open spina bifida, and some may also exhibit brain abnormalities. While treatments can enhance outcomes, a complete cure remains elusive. Many babies survive, but their lives are profoundly impacted by long-lasting disabilities. In essence, it’s a severe condition with enduring consequences.”

What do you consider the main issue with spina bifida?

“The primary concern regarding spina bifida, from my perspective, is the alarming lack of awareness. This lack of awareness extends not only to patients but also to primary healthcare providers. From my experience, many pregnant women take folic acid supplements without fully grasping their significance. It’s imperative to raise awareness and educate both the general public and healthcare professionals about this condition, its risk factors, and the crucial role of folic acid supplementation during pregnancy and early first-trimester spina bifida screening. Unlike the widely recognized Down’s syndrome, spina bifida remains relatively obscure. This is a significant concern because, for some babies with spina bifida, the potential outcomes can be even more challenging than those for Down’s syndrome.”

Fred, could you clarify why it’s essential to start taking folic acid immediately upon discovering pregnancy?

“Yes, immediate folic acid supplementation upon discovering pregnancy is of paramount importance. Neural tube formation is an early pregnancy event, usually concluding by the end of the 6th gestational week, approximately 28 days after conception. In babies with spina bifida, the neural tube fails to close correctly, leading to spinal cord and spine bone issues. This anomaly develops extremely early when the baby is less than 1 cm in size and has just initiated its heartbeat.

Folic acid plays a pivotal role during the critical period before and during the first six weeks of pregnancy when the baby’s spine is forming. In practical terms, most people discover their pregnancy around 4 weeks after conception, and by that point, they are already 4 weeks into the pregnancy. This leaves just two weeks during which folic acid can exert its most significant impact. Taking early action is the key to providing essential support for your baby’s neural tube development and minimizing the risk of spina bifida.”

Let’s delve into early Spina Bifida diagnosis during pregnancy. When can you identify this condition?

“With my level of expertise and the use of advanced 3D ultrasound scanners (Fig 1), I can diagnose the majority, probably over 90%, of open spina bifida as early as 10 weeks into the pregnancy. To put it differently, personally missing a diagnosis of spina bifida at that stage would be a great disappointment to me, and I would be highly motivated to conduct a thorough investigation into why such a diagnosis was missed. 

  • 3D Ultrasound GIF of baby at 10 week. Image by London Pregnancy Clinic - for educational purpose.

    Fig 1 – 3D ultrasound image of the baby at 10 weeks: All main structures are visible
  • It’s important to note that achieving a 100% accuracy rate in diagnosing spina bifida through ultrasound is a challenge. There can be significant variations in the presentation of spina bifida, and in some rare cases, the anomaly may go undiagnosed until delivery. While early detection is highly valuable, there are instances where the condition’s subtleties make it difficult to diagnose definitively with ultrasound.”

How can you diagnose spina bifida so early? Are you inspecting the baby’s spine?

“No, actually, it’s quite challenging to directly visualize spinal abnormalities at this early stage. What I’m primarily focused on is the fetal head and brain (Fig 2). In cases of open spina bifida, there’s a distinct phenomenon at play. There is a leakage of fluid from the brain through the hole in the spine, and this leakage creates a very specific brain anomaly known as Chiari 2 malformation. I’m essentially searching for the earliest evidence of this phenomenon in the ultrasound images. It’s a highly specific indicator – when this particular brain anomaly is present, it’s a strong indication that the baby has spina bifida.

Certainly, at 10 weeks, I also examine the fetal spine. The spine is not yet ossified, so it appears as dark lines running along the baby’s back, and often I can even discern individual vertebrae as bright dots (Fig 3). This level of detail means that very severe spinal deformities can be visible. Sometimes, spina bifida can manifest as a small bubble on the baby’s back at this early stage (Fig 4).”

  • Ultrasound GIF of baby's brain at 10 weeks. Image by London Pregnancy Clinic - for educational purpose.

    Fig 2 – Normal brain at 10 weeks: this baby has no spina bifida
  • Ultrasound GIF of baby's spine at 10 weeks. Image by London Pregnancy Clinic - for educational purpose.

    Fig 3 – Baby’s spine at 10 weeks: no deformities
  • Ultrasound GIF of baby with spina bifida at 11 weeks. Spina bifida cystica is seen at the bottom of the spine. Image by London Pregnancy Clinic - for educational purpose.

    Fig 4 – Baby with spina bifida at 10-11 weeks: spina bifida marked by the circle

Can other professionals detect spina bifida early?

“Yes, there are indeed many research studies indicating the possibility of early detection. One of the most significant research efforts comes from King’s College Hospital in London. Sonographers at this hospital have scanned over 100,000 babies at 11-13 weeks of pregnancy and were able to detect more than half of the fetuses with spina bifida. This achievement is truly impressive, although it’s important to note that it may not be applicable to all NHS trusts. King’s College Hospital has a dedicated unit, established protocols, and a comprehensive training program. Only a handful of other hospitals across the UK, including UCLH that I work for, have similar protocols in place.”

What is the situation like in an average NHS hospital?

“In NHS hospitals, there is a screening ultrasound program called the anomaly scan, which is typically conducted at 19-20 weeks into the pregnancy. During this scan, sonographers check for spina bifida among other anomalies.

Unfortunately, there isn’t a routine first-trimester screening for spina bifida, and the majority of cases are detected during the second trimester. In a 2019 survey of ultrasound units performing scans in the first trimester (11-13 weeks) in England, it was found that only 16% of them included a check of the fetal spine in their protocols.”

Tell us about the “crash sign” and its significance.

“Yes, indeed. Many research groups have proposed various methods for detecting spina bifida in the first trimester. In our case, we’ve come up with a marker that represents the ultrasound appearance of Chiari 2 malformation in the early fetal brain. It’s pretty obvious when you have a top-notch ultrasound scanner.

Now, why ‘CRASH’? We actually have a video up on YouTube that demonstrates it, and once you watch it, the name will make perfect sense.”

Any advice for patients seeking early spina bifida ruling out?

“If you’re keen to know early on, I’d suggest considering booking a 10 Week Scan with a professional having a special interest in this area. For those with previous pregnancies affected by spina bifida, arranging a 10 Week Scan at Fetal Medicine Unit at UCLH with a referral from your primary NHS care provider is an excellent choice. Alternatively, you can book a 10 Week Scan privately at London Pregnancy Clinic. At our clinic, we can combine this scan with non-invasive prenatal testing (NIPT). Please inform our admin staff about your worries, and we will arrange a proper scan for your baby.

If you prefer to stick with NHS services, ask your sonographer during the 11-13 weeks scan if they’re actively screening for spina bifida. Some hospitals in London may have established protocols for this. However, if your NHS provider doesn’t routinely check for spina bifida (which is the case for most hospitals), you might want to consider an early anomaly scan (Early Fetal Scan) at 13-16 weeks through a private provider. For those going the private scan route, it’s a good idea to check if the clinic screens for spina bifida at early stages. Advanced private ultrasound clinics are typically well-equipped, and their staff may have special training in fetal medicine.

Please note that the majority of sonographer-run clinics that provide NIPT or perform non-medical gender scans do not screen for spina bifida.”

It seems like you prefer screening for spina bifida at 10 weeks rather than at the time of the standard NHS scan around 12 weeks. Is that accurate, and could you tell us why?

“Yes, you’ve got it right. In the past, I used to advocate for spina bifida screening during the conventional nuchal translucency scan at around 12-13 weeks. But with the introduction of NIPT, which can be done as early as 10 weeks, I’ve started scanning for spina bifida even before the blood test. At 10 weeks, the little ones are really tiny, measuring less than 1.5 inches (around 35 mm).

Interestingly, with the help of state-of-the-art ultrasound technology (and we’re lucky to use the most advanced machines), many fetal structures are surprisingly easier to examine at 10 weeks compared to 12 weeks. The brain and spine, in particular, stand out as more visible structures.

I won’t bore you with all the technical stuff, but it’s somewhat paradoxical that I feel that an early screening at 10 weeks is actually probably more effective. Plus, it’s a relief for parents who are understandably anxious and want reassurance as soon as possible. But it’s essential to recognize that this type of screening demands a high level of expertise and top-notch ultrasound technology to be done effectively.”

Can other professionals detect spina bifida early?

“Yes, indeed. There are internationally renowned groups in Melbourne, Nice, and Berlin, among others, who also have experience in diagnosing spina bifida before the 11th week of pregnancy. At present, our joined expertise is largely based on anecdotal cases. This is because the incidence of spina bifida is relatively rare, occurring at a rate of 1 in 1,000 pregnancies. To establish statistically significant numbers and determine the detection rate of a 10-week scan, one would need to scan thousands and thousands of babies.”

What is the SMART TEST, and does it include screening for spina bifida?

“The SMART TEST is an innovative concept in prenatal care developed and offered by the London Pregnancy Clinic. It combines extended NIPT with expert ultrasound. The SMART TEST is unique in that it covers a wide range of structural anomalies, chromosomal conditions, and genetic diseases, and it can do so as early as 10 weeks into the pregnancy.

A primary target of the SMART TEST is indeed the earliest possible screening for spina bifida. The test incorporates advanced 2D and 3D ultrasound technology to thoroughly examine the fetal brain and spine at a stage when the baby has just transitioned from an embryo to a fetus. This comprehensive approach ensures early detection and peace of mind for expectant parents.”

Why do you believe that early detection of spina bifida is so crucial? After all, the condition can be diagnosed by the NHS anomaly scan at 20 weeks.

“I’m a strong advocate for early detection of spina bifida, and let me explain why. Spina bifida is a highly serious structural anomaly associated with severe disabilities. While we’ve made significant progress with in-utero surgical treatments, it’s important to understand that these treatments don’t cure the condition.

Moreover, it’s essential to highlight the significance of the surgical aspect. At UCLH, I’m part of the Fetal Surgery for Spina Bifida team, which is led by Professor Jan Deprest, an internationally renowned expert in fetal surgery. Our centre is the sole one in the UK commissioned by the NHS to provide this cutting-edge treatment. In my role, I conduct scans on the baby before and after the surgery. I take great care to evaluate the spinal lesion, perform a thorough examination of the baby’s brain, and perform a comprehensive top-to-toe scan of the entire baby. I’ve had the privilege of scanning hundreds of babies with spina bifida before and after surgery, contributing to their care.

Performing surgery on a baby with spina bifida while they’re still in the mother’s womb is an incredible feat. This complex procedure requires a skilled international team of doctors and medical professionals from the UK and Belgium. The delicate balance of providing life-changing treatment for the baby while ensuring the safety of both the baby and the mother is a remarkable achievement in fetal medicine.

However, almost half of mothers are not eligible for this ground-breaking surgical treatment, often due to the severity of the baby’s condition or additional fetal problems. For these parents, making difficult decisions about the pregnancy becomes a reality, often after 20 weeks. Even for parents eligible for surgery, the journey is challenging. They go through numerous tests, counselling, and procedures in a short time, adding to the stress.

All of this can be alleviated with early diagnosis. Early detection provides parents with the time and information they need to make informed decisions. For the most severe cases of spina bifida that are not operable, early detection helps parents understand their options from the start of the pregnancy. That’s why I advocate for screening for spina bifida as early as 10 weeks or at least at 12 weeks.”

Fred, as a conclusion, what advice or suggestions would you like to offer to future parents?

“If you are in the planning stages of pregnancy, consider starting to take folic acid supplements. Folic acid is most effective when taken before conception and during the first few weeks of pregnancy when the baby’s spine is forming. This simple step can contribute to the healthy development of your baby and reduce the risk of spina bifida.

Additionally, I’d like to emphasize the importance of early screening for spina bifida, which can now be done as early as 10 weeks into the pregnancy. This can provide you with valuable information, peace of mind, and ample time to make informed decisions about your baby’s health. If you have concerns or a history of spina bifida in your family, consider the SMART TEST at the London Pregnancy Clinic. It’s a comprehensive approach that combines NIPT and advanced ultrasound technology to screen for a wide range of conditions, including spina bifida.

Remember that knowledge is power. Being informed and seeking early detection can make a significant difference in the journey of your pregnancy. Stay well-informed, ask questions, and don’t hesitate to seek expert guidance. Your baby’s health is our priority, and we are here to help you every step of the way.”


(1) Karim, J., Pandya, P., McHugh, A. and Papageorghiou, A.T. (2019). OC23.06: Significant variation in practice for first trimester anatomy assessment: results from a nationwide survey. Ultrasound in Obstetrics & Gynecology, 54(S1), pp.60–61.

(2) Ushakov, F., Sacco, A., Andreeva, E., Tudorache, S., Everett, T., David, A.L. and Pandya, P.P. (2019). Crash sign: new first-trimester sonographic marker of spina bifida. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, [online] 54(6), pp.740–745.

(3) University College London Hospitals NHS Foundation Trust. (n.d.). Management of Fetal Spina Bifida. [online] Available at: [Accessed 21 Oct. 2023].

(4) Syngelaki, A., Hammami, A., Bower, S., Zidere, V., Akolekar, R. and Nicolaides, K.H. (2019). Diagnosis of fetal non‐chromosomal abnormalities on routine ultrasound examination at 11–13 weeks’ gestation. Ultrasound in Obstetrics & Gynecology, 54(4), pp.468–476.

(5) Rolnik, D.L., Wertaschnigg, D., Benoit, B. and Meagher, S. (2020). Sonographic detection of fetal abnormalities before 11 weeks of gestation. Ultrasound in Obstetrics & Gynecology, 55(5), pp.565–574.

Latest Stories

Continue reading

Spina Bifida Awareness Week

Graphic of Spina Bifida Awareness Week. A baby that is getting its spine scanned at 10 weeks.

Spina Bifida Awareness Week:

What is it? and how we can screen for it?



This week is Spina Bifida Awareness Week, a time to shine a light on this important condition. We look at what Spina Bifida is, how it can be detected and charities that spread awareness about it.

Comprehensive Screening:  

From the 16th to the 22nd of October, we shine a light on Spina Bifida Awareness Week. But first, let’s break it down. What exactly is spina bifida? It’s a condition where the spine doesn’t fully develop in the womb. It occurs when the spine and spinal cord fail to develop properly in the womb, resulting in a gap in the spine. This incomplete development can lead to both physical and intellectual challenges.

A surprising fact? As many as 10% of people might have a milder form of spina bifida. Most aren’t even aware of it. On the more severe end of the spectrum, open spina bifida impacts about 700 babies in the UK every year.

Now, here’s the uplifting part. Taking folic acid during the early stages of pregnancy can significantly reduce the risk of a baby developing spina bifida. However, many women still don’t know about this simple preventative measure. It’s essential for healthcare providers to share this knowledge.

Early Detection Makes a Difference! 

At our clinic, we’re proud to offer a specialised Ten-week Anomaly Scan. This scan is designed to detect signs of spina bifida at a very early stage. By identifying it early, families can make informed decisions and medical professionals can provide the best care options. Early detection can dramatically improve outcomes for affected pregnancies. Surgeons from UCLH and GOSH carried out the first procedure on babies in the womb in the UK back in 2018. This international team received their training at UZ Leuven1

While many might be more familiar with conditions like Down Syndrome, it’s vital to bring spina bifida to the forefront as well. Its prevalence is notable, and with the right measures like early detection and folic acid intake, we can make a difference.

Join Our Mission in Boosting Awareness: 

Knowledge is power. By understanding spina bifida, its risks, and the preventive steps, we can safeguard future generations. Let’s raise the bar of awareness together by educating ourselves and supporting charities like Shine. 

Shine Charity is a UK-based charity that supports people with spina bifida and hydrocephalus. The charity’s vision is a society where all those affected by spina bifida and/or hydrocephalus are empowered and enabled. Shine’s mission is to make a positive difference to the lives of people affected by these conditions.

Shine’s goals for 2022-2027 include:

  • Enabling babies and children with spina bifida and/or hydrocephalus to achieve their potential
  • Empowering young people with these conditions
  • Ensuring that adults with these conditions have the choices and opportunities to live healthy and independent lives

Watch the explainer video on the 10 week scan:

Latest Stories

Continue reading

NIPT and Scan: Why We Champion This Dual Approach

Graphic of a baby footprint in a heart with DNA strand on either side.

NIPT and Scan Approach: Why We Champion This Screening Method at London Pregnancy Clinic



At the London Pregnancy Clinic, we’re dedicated to providing expectant mothers with advanced screening options and the highest level of care. We firmly recommend combining Non-Invasive Prenatal Testing (NIPT) and Ultrasound screening. Let’s explore why we endorse NIPT and Scan approach and how it benefits our patients.

Why Choose Both NIPT and scan?

Comprehensive Screening:  

Ultrasound visually assesses the baby’s anatomy, checking for physical abnormalities and measuring growth. NIPT, known by brand names like Natera’s Panorama AI or Eurofins’ PrenatalSafe, examines fetal DNA in the mother’s bloodstream, providing insights into potential chromosomal abnormalities like Down’s Syndrome, Edwards syndrome, and Patau syndrome.

Increased Accuracy and Early Detection:  

By merging Ultrasound’s structural insights with genetic data from NIPT, we significantly reduce false positives and offer more accurate results. As early as 10 weeks, when your baby is the size of a strawberry, we initiate the dual screening process. At this stage, we conduct the earliest possible structural anomaly scan, the Ten-week Anomaly Scan, to search for structural anomalies that NIPT can’t detect. We can rule out severe physical abnormalities like Acrania, Spina bifida, Absence of arms, hands, legs or feet, and Alobar holoprosencephaly. Only after confirming your baby’s structural development do we proceed with the NIPT test.


Ultrasound Screening: 

Ultrasound employs sound waves to create images of the baby in the womb. A small probe, called a transducer, moves over the mother’s abdomen. The transducer emits high-frequency sound waves that bounce off the baby’s structures, and these echoes are converted into images on a screen.

Non-Invasive Prenatal Testing (NIPT): 

NIPT is a simple blood test taken from the expectant mother. This test detects tiny fragments of the baby’s DNA circulating in the mother’s bloodstream. By analysing these fragments, we can determine the risk of certain chromosomal conditions.

Is It Safe?

Absolutely. Both Ultrasound and NIPT are non-invasive and pose minimal to no risk to both mother and baby. However, it’s important to note that while NIPT is highly effective, it’s not a definitive diagnostic test. In cases of low negative predictive value, our doctors may recommend invasive tests like CVS or amniocentesis, which carry minimal miscarriage risk.

Our NIPT Options

As early as…
  • 10 weeks

  • 9 weeks

  • 10 weeks

Turnaround (Working Days)
  • 2-4

  • 5-7

  • 5-7

Lab Location
  • UK

  • US

  • US

No Call Results
  • <1%

  • <1%

  • <1%

Redraw Rate
  • 2%

  • 3%

  • 2%

Edward’, Patau & Down’s Syndrome
Di George Syndrome (22q del)
Turner Syndrome (45X)
Sex chromosomes aneuploidies
Twin pregnancies
  • Best

Vanishing twin syndrome
Fetal sex reveal (optional)
Scan + NIPT Price
  • £540

  • £540

  • £490

Extended NIPT + Scan Options
  • SMART Test £1690

  • Microdeletions £790

  • Rare Diseases £790

Other Early Ultrasound Screenings Offered

For those looking to delay their first scan, London Pregnancy Clinic offers pioneering Early Ultrasound Screenings, including the Early Fetal Scan conducted between 12 and 16 weeks, which can exclude more than one hundred serious anomalies. Additionally, our Early Fetal Echocardiography is designed to identify up to 80% of detectable severe fetal heart defects. It is a scan we highly recommend this scan for all babies with increased nuchal translucency (NT) measurements, fetal anomalies, or other unusual findings detected at 11-13 weeks scan.


At the London Pregnancy Clinic, we believe in providing the most comprehensive care possible. By endorsing the dual Ultrasound and NIPT approach, we ensure that our patients receive a detailed, accurate, and safe assessment of their baby’s health. Whether you choose the ten-week scan or another early anomaly scan, we’re here to guide and support you every step of the way.

If you have further questions or would like to schedule an NIPT and scan, please contact the London Pregnancy Clinic.

Book NIPT + Scan from £490

Latest Stories

Continue reading

Harmony NIPT Test – Yesterday’s News

Harmony NIPT Test – Yesterday’s News



TDL Genetics ends Harmony NIPT provision after a decade. With outdated technology, high no-call rates, and fierce competition, Harmony loses its shine. As leading NIPT providers, we’re reviewing TDL’s new offering. But for now, our advanced menu offers the latest prenatal screening. Remember – ultrasound still crucial for detecting 2/3 of fetal abnormalities.

End of an era…

TDL Genetics (The Doctor’s Laboratory) have announced last week that it will cease providing Harmony NIPT in its UK laboratories. TDL started providing Harmony Non-Invasive Prenatal Screening back in 2013.

Harmony NIPT, which was introduced by Ariosa Diagnostics in 2013, was for a long time a gold standard in Non-Invasive Prenatal Testing. The company was later acquired by the Swiss giant Roche Holdings, which was very successful at marketing the test and in many countries, the brand name ‘Harmony Test’ has become synonymous with ‘NIPT’. In the UK, this was particularly the case as it was one of the first NIPT tests to be approved by the NHS, and it offered in many state hospitals.

NIPT was first introduced by the now-defunct Sequenom, using the brand name MaterniT21Plus™, which was approved by the FDA in 2011. Harmony Test pioneered a new method of NIPT screening using a different cfDNA sequencing method. Harmony NIPT exhibited excellent clinical performance data at the time, helping it solidify its status as the preferred NIPT test by many healthcare professionals.

The future looks good!

In the past 10 years, NIPT has become a heavily researched space, meaning that many companies have raced to create their own NIPT test using a host of advanced technologies. A couple of such competitors are Natera’s ‘Panorama Test’ and Erofins’ ‘PrenatalSAFE Test’. This increased level of competition meant that patients could now benefit from much more advanced tests for chromosomal anomalies such as Down’s syndrome and screening for rare genetic diseases.

In this time, Harmony NIPT has fallen behind in terms of its technology versus the new tests. Furthermore, the equipment used for the test has become dated and as such many of the tests performed by TDL ended up failing to produce conclusive results due to ‘quality control issues’. These so-called ‘no-call’ results, or failure of one of the testing tubes, have become so prevalent with the samples we sent to TDL that we raised our first of many complaints with TDL back in 2021. Unfortunately, these lab challenges caused significant emotional distress for our expectant parents and frustration for our clinic’s team.

NIPT at London Pregnancy Clinic

In light of these developments, at London Pregnancy Clinic, being one of the top NIPT providers in the UK and leading international experts in fetal medicine, we set on the path of finding the best alternative NIPT. We were one of the first clinics in the UK to offer the advanced NIPT test from Invitae back in 2021. Since then, we have worked with many NIPT brands and have helped hundreds of patients navigate the best NIPT choice for them.

Our clinical team has spent months interviewing the laboratory teams of all major NIPT providers as well as auditing their clinical performance. We are now the leading provider of NIPT in London, and we feel responsible for our patients’ pathway to choose the best option in the market at every given time. We have the experience of providing the Harmony NIPT and other NIPTs, and the expertise to distinguish the performance of each test in the market. We do not offer any NIPT without thoroughly reviewing its characteristics and clinical data.

As of TDL’s new NIPT option, namely the Illumina VeriSeq NIPT, we are still waiting for the lab to send us clinical performance data and set up an interview with the lab team before we are able to offer the test to our patients. For now, we have many questions for the lab given the poor quality of performance of the Harmony NIPT in terms of no-call results which was much higher than Roche’s advertised levels from our experience. In the meantime, we are confident that our current menu of NIPT tests is the latest and most advanced screening options in the market with similar turnaround times to TDL.

As always, we will keep reminding our patients that NIPT should be done alongside a complete examination of the fetal anatomy via an ultrasound scan. The NIPT marketing machine has helped raise awareness of certain chromosomal anomalies, in particular Down’s Syndrome. However, NIPT can give you a false sense of reassurance as it is useless in screening for structural anomalies (physical defects) representing more than 2/3 of known fetal abnormalities and can often be detected using ultrasound.

Latest Stories

Continue reading

Meet The Team

As we are a small, close-knit team you will become accustomed to seeing a few familiar faces whenever you enter the clinic, so here’s a bit more about us.

Dr Ushakov is our Founder and Medical Director. A leading expert in the field, with over 30 years’ experience in Fetal Medicine, working in three different countries. Dr Ushakov is most likely the reason you have booked your appointment with us and his patient, individual approach to each and every scan will provide you with calming reassurance.

Alcinda is our clinical assistant and her kind, calm nature will put you instantly at ease throughout your appointment. Alcinda is also trained in phlebotomy so you may also experience her excellent bedside manner during your NIPT blood test.

If you have an email or telephone enquiry you will most likely speak to our medical secretary, Ella. She is on hand to answer any questions you may have throughout your time with us. You may recognise her from the warm welcome you receive when you first enter the clinic.

How big is the Embryo at 8 weeks?

Most pregnancy apps will make you aware of the size comparison of your baby against a fruit/ vegetable/ animal or even baked goods, but rarely do you see images showing just how your baby would fit into the palm of your hand!

Take a look at this image which shows you the real size of your baby at 8 weeks!

At 8 weeks Dr Ushakov will be able to check for the heartbeat, date the pregnancy, check for single/multiple pregnancies. He will also check the structures of the pregnancy at this stage including the gestational sac, yolk sac and placenta.

During the Viability scan you will find out the estimated due date (Which will give you plenty of time to pack up that hospital bag and plan out your babymoon)!

If you are interested in having the viability scan at City Ultrasound, you can book our scans or give us a call on 02036872939 for more information

Clinic Video Tour

City Ultrasound is a pregnancy care centre based in the City of London in close proximity to Spitalfields Market. We specialise in the early diagnosis of congenital anomalies, and have more than 30 years of expertise in fetal medicine. Our clinic is equiped with the latest ultrasound equipment with the latest 3D/4D technology to produce outstanding quality of imaging for diagnostic purposes.

Our clinic has been recently refurbished to provide a relaxing environment for our patients who come in for early pregnancy reassurance. Watch this short Video Tour introducing our clinic and our staff!