First Trimester Screening & Fetal Anomaly Scan

Time is flying past...very fast! I can't believe I'm into my 28th week now.

Things are just starting to get REAL for me. I can feel my babies moving a lot...everyday! It's awesome! :)

I've had quite a lot of scans done till todate. It could be due to the fact that we did IVF (with ICSI) and thus, a lot of scans were scheduled during my early pregnancy. I must admit that I do look forward to every single appointment as I know we will be seeing our little ones every time.

These were all my abdomen scan dates ever since the embryo transfer:-

11/3/2014 - beta hCG blood test, no blood detected in the womb (extremely glad!).

24/3/2014 - at 6w0d, saw 2 sacs, our twins' heartbeats detected: 113 & 124.

7/4/2014 - at 8w0d, our twins measured at 8w0d & 8w2d with heartbeats of 180 & 171.

21/4/2014 - at 10w0d, our twins measured at 10w4d & 10w3d with heartbeats of 183 & 171. [We can actually see the babies' hands and feet moving about! It's amazing! The sonographer can also see the babies' nasal bones too! There's no blood in the uterus. I had the last dose of Proluton Depot 250mg at the clinic.]

14/5/2014 - at 13w2d, we had the First Trimester Screening ["FTS"].

9/6/2014 - at 17w0d, our twins measured at 17w1d & 17w6d, weighed at 173g & 203g with heartbeats of 148 & 146.
[Genders confirmed. This was our last visit at Dr Wong Pak Seng's fertility clinic.]

7/7/2014 - at 21w0d, we had the Fetal Anomaly Scan [or simply the "detailed scan"].

4/8/2014 - at 25w0d, our twins are about 7 days and 3 days respectively behind their optimum size. Both their heartbeats were in the region of 150s.

First Trimester Screening ["FTS"]

Well, the FTS was the only test advised to us by Dr Wong. Some patients of Dr Wong are advised to either do an FTS or a Non-Invasive Chromosomes Check ["NICC"]. Both tests are non-invasive. However, FTS is very much cheaper than NICC. With NICC which is performed any time after 12 weeks of pregnancy, the accuracy of detecting Down syndrome is up to 99% compared to FTS' detection rate of 95%.

As we are only advised to run the FTS, we did just that.

FTS is performed between 11 weeks and 13 weeks 6 days of pregnancy. This screening involves a nuchal scan and a blood test. A nuchal scan is done by measuring the nuchal translucency (the fluid-filled space beneath the skin behind the baby's neck) ["NT"] and detecting the presence of the baby's nasal bone ["NB"]. Meanwhile, the blood test is to determine the levels of 2 hormones i.e. the Pregnancy Associated Plasma Protein-A ["PAPP-A"] & the free beta hCG.

I was very anxious while lying down to be scanned by the sonographer. Baby A [the baby nearest to my cervix who will be the elder of the 2 babies] is very co-operative and we got his NT measured at 1.33mm very quickly. However, Baby B [the baby furthest from my cervix who will be the younger of the 2 babies] was happily moving, flipping and dancing about, which gave the sonographer a really hard time! Haha! Finally, after much effort at every possible angle, the sonographer managed to measure Baby B's NT of 1.08mm. Nasal bones can be seen on both babies too. Subsequently, my blood was drawn.

The FTS results will be ready within 5 days (we were told that my blood sample will be sent to Taiwan for testing). So, the method of screening for FTS is by taking into account of my age, NT, NB, PAPP-A & free beta hCG. An NT measurement of less than 3mm is considered normal. The absence of NB may indicate a higher risk of baby having Down syndrome as recent studies shown that 3 out of 4 babies without their nasal bones had Down syndrome. The level of PAPP-A is relatively low and the level of free beta hCG is relatively high in cases of Down syndrome.

We were so relieved that my FTS results came back with a low risk of our babies having Down, Edward or Patau syndromes. I just couldn't bring myself to run the invasive tests such as the amniocentesis or the Chorionic Villus Sampling ["CVS"] if my FTS results came back with high risks. I don't even know what I'll want to do then...

In addition to just the NT scan and NB check, the sonographer also managed to see the gender of our babies despite all the acrobats performed by our little bubs! We were told that our babies will most likely be BOYS. We were thrilled and excited! This was later confirmed at our 17th week scan. Yaaay!


Fetal Anomaly Scan ["detailed scan"]

A detailed scan is to be performed between 18 weeks and 22 weeks of pregnancy. The purpose of this scan is to take a closer look at the development of the babies in mid pregnancy by examining the babies' organs and taking their measurements to allow early detection of any abnormalities (if any) which may or may not be treatable.

As Dr Wong no longer sees me after my first trimester, we have decided that we should be in the good hands of Dr Jason Lim Meng Hock for subsequent antenatal check-ups until delivery of our babies.

Dr Jason Lim performed the detailed scan on me at 21 weeks. He is definitely still a very professional doctor that I've met a couple of years back. He is serious-looking, firm, no-nonsence, well-mannered and definitely knows what he is doing all the time. Sounds scary? Haha!

Anyway, he was surprised when he saw two babies (well, Sunway Medical Centre couldn't locate my file; so Dr Jason Lim had merely took down notes of our history and we had 'forgotten' to inform him that we are having twins!). He said that he will then had to do two detailed scans. He started of with the babies' heads (shapes & structures to see if there are any visible brain problems), facial features i.e. the eyes, nose, mouth (no cleft lips), the spine (alignment of bones etc), hands & feet (with fingers & toes), the heart (the four chambers should be equal in size with the inflow & outflow of blood through the blood vessels), stomach and kidneys. Dr Jason Lim also did a quick check on the placentas and confirmed that Baby A's placenta was not low-lying in my uterus. What a relief!

I'd actually had a hard time lying motionless for a long period of time. Maybe I should not empty my bladder completely for future scans. Baby B, like always, was very active compared to Baby A. Baby A was in a head-down position with his legs up on my right ribs and facing my front while Baby B was breech with his head on my left ribs, facing my back. Thus, Dr Jason Lim had a hard time trying to have a good look at Baby B's heart and while he was at it, pressing his magic wand over and over on my tummy at every angle he could find (he never gave up trying!), I'd suddenly felt dizzy and started to have cold sweats! I'd quickly exclaimed that I was about to faint! However, Dr Jason Lim just calmly asked me to turn slightly to my left and he'd simply continued the scan as though that was a very common scenario. Haha! Hubby got very concerned though but I was fine after a while and the scan was continued.

In conclusion, Dr Jason Lim said that he couldn't find any visible abnormalities in both babies and that we should treat it as good evidence that the pregnancy is normal. We couldn't have been happier! :)


I couldn't wait to see Dr Jason Lim again in our next visit on 2/9/2014. Twelve more days to go!