Video: First trimester screening [Sex and Down syndrome]

We appreciate the trust of this family that allowed Dr. Carlos Monsalve to show us his first trimester Screening 💑 📺 👀 To rule out congenital defects and identify for the first time the inclination of the genital tubercle.

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Hello, good morning, we are with you reminding you of the important pregnancy studies, we have 3. The first is the first trimester screening that will help us detect chromosomal problems, the second is the morphological study that will help us to detection of anatomical problems and the third is fetal echocardiography that will help us detect cardiological problems in the baby.

On this occasion we have the pleasure and pleasure of a couple who allowed us to record their first trimester screening study, that is, the screening for detection of chromosomal problems. This study is carried out between weeks 11 and 13 of pregnancy, it is a very simple study that is not invasive that will be performed with ultrasound with some measurements that in this study we are going to explain to you and with a sample of maternal blood, those We are going to integrate two results into a program and with this we can detect up to 90% of babies who could have a chromosomal problem. We talk about Down syndrome because it is the most common, the most frequent, but it also applies to more chromosomal problems.

We have been asked a lot on YouTube, by many couples who have doubts about whether ultrasound or ultrasound is dangerous for pregnancy or how many can be done throughout pregnancy. Currently it has been shown that ultrasound does not represent any risk for pregnancy, we even perform ultrasound as soon as the woman knows she is pregnant. Going to your first obstetric consultation with a positive pregnancy test, the only way to know if there is a pregnancy or not is with an ultrasound and we are talking about week 5. From then on, we do an ultrasound in all appointments. Why? Because it is the only way to know how development and growth is going and to be 100% sure that your baby’s development is adequate, so don’t worry, it does not represent any risk for the baby and yes, there is no number. limit of ultrasounds during pregnancy.

First trimester screening begins

Let’s see how your baby is settling in here, right now we’re going to put him here and we’re going to see him here. This is your baby’s head, it’s down and up here are the buttocks. What moves here is your baby’s little heart. Right now I’m putting a little pressure down here to see the way out, especially because of the little tails, how pregnant you were in your abdomen, to check that there isn’t… That the neck isn’t open, right? This looks closed… It’s closed, everything that is black on the ultrasound is water.

You see him in profile, he’s even here moving his mouth, those are swallowing movements, it’s very good to see him right now. His heart that we are going to listen to is this. He is going at a good pace, he is going fast, he is going strong as he should and he has a heart rate of 147, the normal is between 120 and 160 from now on, so he is perfect. If you see him in profile like this, there he opened his little mouth right now, we are going to see here a little point that shines, that is very important to see, it is the nasal bone, why is it important? Have you seen a baby with Down syndrome? They are flat, it takes longer for the nasal bone to ossify, so if I see the nasal bone now it does not rule out Down syndrome, but it is a good sign. Look, it has already started to move, it is also very important to see it move.

He moves his whole body, he moves his arms, he moves his legs, that is important to see, because there are diseases where they are rigid all the time, so if he moves, those types of diseases are ruled out. We start by looking at the little head here. Here he is, opening his mouth. This is the little head, seen from above. We begin to see the bones of the skull that are closing and ossifying, the line that divides the brain into its two halves and on the sides we see these gray stripes that are the choroid plexuses, which right now They occupy almost the entire head, it is important to see that there are no cysts, there are no tumors, it looks normal and here we measure its head that goes from one temple to the other. DBP 21.5, perfect, corresponds very well. We are measuring from the head to the buttocks. LCN 69.3 almost 7 centimeters, corresponds to 13 weeks and one day. His spine, look here are also the bones, although the spine strictly closes after week 15. This little black circle here is the stomach, which is also going to be important to see it full because it will tell us that the liquid What he swallows passes without any difficulty to the stomach and the stomach looks full here. An arm here, we begin to see the little hand, these are the little prints of the fingers, right now we see the little prints of the fingers, in week 20 when we do the morphological examination I see the phalanges of each finger. Look, from the shoulder to the elbow the arm bone, from the elbow to the wrist and from the wrist here. This is the arm bone, the humerus, from the shoulder to the elbow, humerus 9.5, here we reach the pelvis and here are the leg bones, this is a femur, it is with the legs bent like this, bent. Look at the leg, it’s bent, a little leg here then the knee and then down. He has already started to stretch this one, the knees are here and then the feet are over here, you are both flexed like this.

– If you want to stretch, does it fit? – If it still fits right now, later it won’t. Here we measure the leg bone, the femur. Femur 9.8, if you see it is a good relationship with your arm, it is normal 1 to 1 good. What matters most in this ultrasound is the nuchal translucency, it is the chubby that we have back here, in babies with chromosomal problems it has been seen that they have very chubby. Just then if I need your baby to cooperate a little more, to get out of that position. I’m going to move you a little… Let’s do it now… The only thing we do is generate vibrations to see if it moves, look here at the little hand, see the little fingers and here the other one, there she is already moving her finger. This tummy that you see here is the umbilical cord, with colors… Here it is going to be painted, this is your baby’s circulation. We just have to move a little to be able to look over there. Here you can see the nasal bone, upper jaw, mouth, lower jaw and the little fingers of the hand: 1, 2, 3, 4, these are the 4 in the front and the thumb here, 5.

– Yeah! – And the other one is stuck here, here is the head and here are the little fingers of this other hand. Here you also begin to see, the thumb and the other 4 fingers here… 3, 4 and the thumb 5 and at week 20 we measured the phalanges of each finger. We are going to expand the size a little to continue seeing the circulation. That little vessel is the ductus venosus, which is important to see because when it is altered it is mainly related to heart problems and chromosomal problems. It’s normal, IP of the ductus venosus 1.69 I’m just waiting for it to move so I can measure the translucency at the back of the neck… The tummy that looks very closed. Column that looks very good, well formed, has a very good size.

Nuchal translucency and Down syndrome

Here! This is the space we are going to measure. Do you see him in profile? – It’s on its side – And here is the space of nuchal translucency, what you see here is nuchal translucency. To begin with, he is very thin, which is good. When do we worry? When this space here is greater than 3 mm and has 1.2, OK? So, we’re not even halfway there, we’re talking about something low. I always try to measure it a couple of times to send the largest measurement. – Are your feet up there? – Yes, the little feet are passing through there. 1.1 we leave the largest measurement which is 1.2, normal. Yes, look at her little nose, her nose looks pretty there, right? – Yes – Moving. His arms, everything looks perfect.

Genital tubercle and sex

Would you like to know what it may or may not be? – Yes – Me right now… It is called genital tubercle, because boys and girls are the same until week 15, from week 15 onwards they differ and I can now give them 100%. Today I could give you 70% if you wanted, it would be 70%, it wouldn’t be 100. Do you want me to tell you what it could be or not? – But? – I say no – No? – You can wait until it is 100%. You decide – One wants one and the other wants another, we have a dilemma there, that’s why I say. You do not want to know? – It would be 70% – An approximate – Do you want me to tell you or not? – I’m not going to listen – I’m not going to listen! Now we see. I’ll explain a little, this is the head, the belly, the heart and here the buttocks. Here it starts to look like a little beak. Do you see it? That is the genital tubercle, it is called that because of what I was explaining to you, boys and girls are the same this week 15. Right now the difference between a boy and a girl is the position of this genital tubercle, normally in girls it is lying down and in boys it’s standing still. So… You want girl! Right now I’m telling you, just make sure it settles in well, I was already seeing it, but let me know, it’s already started to move, – In the past it was a thing… wow – Well, look how still it is, eh, it hasn’t stopped moving. Well, it doesn’t stop moving, it’s perfect. She already flexed her legs here, she already lowered one hand there to cover herself, she looks at how she is covering herself. Both of his hands are already down! Covering and covering there. And his feet here, his legs here and his hands here below, completely covering them. We move it a little bit here.

This is the genital tubercle, this ball here, okay? I put it here, I turned it a little to see it from the back. And see if it makes it easier for me to see the genital tubercle. But he looks at how his legs are here, bent and bent. Look, this is the thigh and here comes the knee and then the foot is like this. He is going to listen to the father who doesn’t want to be seen. Now we see, look… The most important thing about this ultrasound is what we have seen, it grows according to the length of pregnancy. I don’t see indirect signs of chromosomal problems, the gross anatomy that I can see right now looks normal, the fine anatomy we see at week 20. With pure ultrasound I can give you 60% that your baby is healthy. In other words, it is very good, we are just waiting for the blood sample. Look, here it was, it jumped, here it is, I just want to confirm… Where is it going, it just gave me an image… 70% Ok? I’m trying to see here between both of her legs. Come? Here is one and the other. – He moves a lot – I get the impression he could be a child. – Yeah? – Yeah. 70%, I recommend not buying things, not telling the whole family – Of course to no one, it’s a secret. Not everyone has a bet. – Look, here it comes, this is it. This is the genital tubercle there no longer… But at one point, it looked like upwards. See? But this is not a rule, it is not yet a law, that’s why I can’t give it 100% But next month it’s 100%, okay?

Well, everything was perfect with your baby, the important thing is that she came out very well, there are no detachments, there are no bruises. – Say hello – – Hello – The whole collar is tightly closed, right now there is nothing to worry about, super good. Everything looks perfect and here the neck is completely closed. – They marked me as a cyst, or a fibroid, something – Yes, wait for me, this one here. Yes, but no, this is the membrane, this is going to adhere and it is going to be removed. But it’s not a bruise, it’s not a detachment, it’s nothing. It’s normal and there’s your baby.

“Ultrasounds are completely safe for the baby and the mother, screening must necessarily be carried out between weeks 11 and 13, outside of this period it is useless”

Dr. Carlos Monsalve
Dr. Carlos Monsalve
Specialist in gynecology and obstetrics

Perinatology, invasive techniques and obstetric ultrasound.
Hospital Universitario La Fe, Valencia, España.

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