#apexdiagnostics

It is a screening test in form of ultrasound scan done from 11 to 14 weeks of pregnancy. To be precise it is done from 11 weeks 3 days to 13 weeks 6 days of pregnancy. It is usually done along with a blood test called dual marker and these both form a combined screening test.

It is known as NT /NB scan as doctor measures the nuchal anslucency (NT) and nasal bone (NB) of the fetus. It is also commonly known by name of level-I scan. The radiologist measures a fluid-filled space behind your baby’s neck known as nuchal transluceny. This measurement can help to detect the risk of your baby having a chromosomal abnormality such as Down syndrome.

In addition to nuchal translucency the doctor looks for nasal bone of fetus. Absent or short nasal bone indicates the possibility of underlying chromosomal abnormalities.

Other things like developing limbs, stomach bubble, intracranial structures, developing spine , placenta, cervical length etc are also assessed in the same scan. Some structural abnormalities can be ruled out in this scan like absent limbs, skeletal abnormalities , any abdominal wall defect with protrusion of the abdominal contents out etc. So it’s a type of early scan to rule out some abnormalities which are lethal and there is no point in carrying the pregnancy further.

In addition to these now a days pre-eclamsia screening is routinely done with the NT/NB scan. It helps to assess the risk of patient of developing hypertension ( increased blood pressure) in the course of pregnancy. In case of high risk the obstetrician gives some prophylactic drugs to the patient. Pre-eclampsia is a very common cause of bad obstetrics outcone like intrauterine fetal demise, growth restriction, premature deliveries etc.

In case this is your first scan it gives the additional information about the site of pregnancy and the exact dating.

So all in all it’s a very useful non invasive test and every patient must be recommended this scan to rule out underlying problems fetus may have.It also gives reassurance to the mother that everything inside is going fine and relieve her of undue stress.

What are the indications and right time to get NT /NB scan?

Now a days with the advancement of the medical field it is a routine to get level I USG for all the expecting mothers whether there is any history of any congenital abnormality in previous issues or not.

The importance increases if the maternal age is high, previous history of birth defects , previous fetal demise, maternal high BP and diabetes.

A nuchal translucency scan is done between 11 and 14 weeks of pregnancy. Ideally the time is 11weeks 3 days to 13 weeks 6 days.

What to expect and how to prepare yourself while going for nuchal translucency scan.

The first thing is you need not be fasting before going for scan. Many patients starve themselves before these scan and end up feeling miserable. There is no role of fasting in the obstetric scan.

You need to drink some water and you must have moderately full urinary bladder. There is no need to have extra-full bladder, just moderate pressure will be good for the scan.

Normally the scan is done trans- abdominally. The radiologist will apply some gel and gently move the ultrasound probe across your abdomen. Usually it takes about 15-20 minutes for the scan. However it all depends on the position of your baby. If the position is favorable the scan can be done easily in one go. Many a times you will have to wait until the baby lies in the favorable position required by the radiologist. You may be asked to come repeatedly in the ultrasound room after waiting for some time.

Some times trans vaginal ultrasound needs to be done for better visualization of the fetus. In that case ultrasound probe is gently inserted into your vagina which may feel a bit uncomfortable but usually is not painful.

What does the results tell?

The NT/NB scan results are usually combined with a blood test ( Dual markers) and these both assess the combined risk of chromosomal disorders in pregnancy.

Remember that a normal screening result (screen negative) isn’t a guarantee that your baby has normal chromosomes, but it does suggest that a problem is unlikely. Likewise, an abnormal screening result (screen positive) doesn’t mean that your baby has a chromosomal problem – just that your baby is more likely to have one. Most screen-positive babies turn out not to have a problem: Only about a third of babies with an increased nuchal translucency measurement turn out to have chromosomal defects.

Results are usually reported as ‘low risk’ or ‘high risk’. If the result comes out to be low risk then the pregnancy is considered to be normal and no further tests are usually done. If the result comes to be moderate or high risk then further assessment is done by invasive procedures such as chorionic venous sampling and amniocentesis which will give you a definitive result. A non invasive blood test know as NIPT (Non invasive prenatal testing) is also available now a days to diagnose the chromosomal abnormalities. Your obstetrician or genetic counselor will help you to choose between these tests.

Quality Healthcare according to WHO is the one which incorporates the following principles: Efficiency, People-centredness, Timeliness, Safety, Effectiveness, Integration and Equity. Quality healthcare is effective; This means you will be accurately diagnosed and treated (In some countries, only 35% of patients get correct diagnosis). Quality healthcare is efficient; That means your laboratory & imaging tests will not be repeated unnecessarily. Quality healthcare is equitable; This means all the people, regardless of their gender, race, ethnicity, geographical location and socioeconomic status, shall receive the good quality healthcare they need. Quality healthcare is integrated; If you have multiple chronic diseases, your medical care is coordinated across all the doctors. Quality healthcare is timely; That means you can see a doctor when you need to, without waiting for too long (In some countries, 74% of the patients have to wait between 60 to 120 minutes to be seen by a doctor).  Quality healthcare is safe; That means the care you receive doesn’t harm you. Around the world, nearly 14% of the patients are harmed from the healthcare they receive during their hospital stay. Quality healthcare is people-centred; This means that decisions about your care are tailored to your needs and preferences and you are treated with respect and compassion.

Quality in Medical imaging and diagnosis is fundamental to effective and efficient healthcare. The world is transitioning towards value-based patient care and from quantity to quality. It is important for both patients and practitioners. The first step to correct medical diagnosis is at correct testing. There are several ways of getting a medical test, it can be monitoring, lab testing, imaging and other forms.

The X-ray , Lab tests and ultrasonography are the most widely suggested examinations in both public health and preventive care . These are the ones where reports differ from different healthcare facilities and treating doctors get confused leading to unnecessary re-ordering of tests and resultant many-fold increase in expenditure borne by the patients.

The more specialized tests like CT-scan, MRI, Echocardiography, TMT, EEG etc. are primarily dependent upon the quality of machines, their technological advances and proper handling. The equipment and machinery for CT scan, X-Ray, MRI and Ultrasound must have a Quality Assurance and need to be updated frequently.

Equally important is the human part i.e the technicians handling the machines and the Doctors interpreting & reporting the tests. A radiologist has to interpret hundreds of images each day; every image is important and play a crucial role in correct diagnosis. A radiologist has to interpret the problem on the basis of the image that crosses their screen, an zero error reporting is what is required for quality imaging. The significance of high quality in medical imaging provides accurate results upon which the physicians totally depend for diagnosis.

Following are a few quality related factors that impact the healthcare:

Poor quality results in poor & late diagnosis. The precision and depth of testing and imaging plays a crucial role in providing information. Better the quality and clarity of the image, easier it would be to detect the disease at an early stage.

In some cases, the images from CT Scans, MRI, etc do not provide enough clarity to detect the disease at an early stage. The patient reports pain and suffering but the diagnosis is delayed due to poor quality in testing.

In the context of lab tests, the accuracy matters the most. The advancement of technology has helped the healthcare industry to associate different symptoms and reach a solid conclusion. Samples of blood, urine, saliva etc are tested under absolute isolation and detection. Super zooming of the samples allows defining the characteristics to a greater extent and thus preventing the disease from worsening.

The quality also means quick testing. Reduction in time taken for diagnosis means that the patients can have an early treatment. This also reduced other costs such as stay in the hospital, pain relievers etc.  Time matters the most in rapidly progressive life threatening diseases like Cancer or in trauma.

Less repeatability of the tests is essential in quality healthcare. If the tests are not well performed or are of poor quality, they need to be repeated  which again costs time and money and delays diagnosis.

There are several ways in which quality has an impact. It not only provides accuracy but also quickens the whole process, reducing the pain and suffering. Similarly bad quality leads to wrong and delayed diagnosis and prolongs the illness. These are the few reasons for which most of the hospitals and healthcare centres around the world have shut out the obsolete methods. The modern hospitals and practitioners are accepting only the test results from hi-tech diagnostic centres having advanced machineries and qualified staff. The quality impacts every individual and the healthcare industry as a whole. The need of the hour to improve diagnostic & imaging quality which in turn will raise the healthcare standards and let us achieve the WHO’s goal of Quality Healthcare.

What is a nuchal translucency / Level I scan?

It is a screening test in form of ultrasound scan done from 11 to 14 weeks of pregnancy. To be precise it is done from 11 weeks 3 days to 13 weeks 6 days of pregnancy. It is usually done along with a blood test called dual marker and these both form a combined screening test.

It is known as NT /NB scan as doctor measures the nuchal anslucency (NT) and nasal bone (NB) of the fetus. It is also commonly known by name of level-I scan. The radiologist measures a fluid-filled space behind your baby’s neck known as nuchal transluceny. This measurement can help to detect the risk of your baby having a chromosomal abnormality such as Down syndrome.

In addition to nuchal translucency the doctor looks for nasal bone of fetus. Absent or short nasal bone indicates the possibility of underlying chromosomal abnormalities.

Other things like developing limbs, stomach bubble, intracranial structures, developing spine , placenta, cervical length etc are also assessed in the same scan. Some structural abnormalities can be ruled out in this scan like absent limbs, skeletal abnormalities , any abdominal wall defect with protrusion of the abdominal contents out etc. So it’s a type of early scan to rule out some abnormalities which are lethal and there is no point in carrying the pregnancy further.

In addition to these now a days pre-eclamsia screening is routinely done with the NT/NB scan. It helps to assess the risk of patient of developing hypertension ( increased blood pressure) in the course of pregnancy. In case of high risk the obstetrician gives some prophylactic drugs to the patient. Pre-eclampsia is a very common cause of bad obstetrics outcone like intrauterine fetal demise, growth restriction, premature deliveries etc.

In case this is your first scan it gives the additional information about the site of pregnancy and the exact dating.

So all in all it’s a very useful non invasive test and every patient must be recommended this scan to rule out underlying problems fetus may have.It also gives reassurance to the mother that everything inside is going fine and relieve her of undue stress.

What are the indications and right time to get NT /NB scan?

Now a days with the advancement of the medical field it is a routine to get level I USG for all the expecting mothers whether there is any history of any congenital abnormality in previous issues or not.

The importance increases if the maternal age is high, previous history of birth defects , previous fetal demise, maternal high BP and diabetes.

A nuchal translucency scan is done between 11 and 14 weeks of pregnancy. Ideally the time is 11weeks 3 days to 13 weeks 6 days.

What to expect and how to prepare yourself while going for nuchal translucency scan.

The first thing is you need not be fasting before going for scan. Many patients starve themselves before these scan and end up feeling miserable. There is no role of fasting in the obstetric scan.

You need to drink some water and you must have moderately full urinary bladder. There is no need to have extra-full bladder, just moderate pressure will be good for the scan.

Normally the scan is done trans- abdominally. The radiologist will apply some gel and gently move the ultrasound probe across your abdomen. Usually it takes about 15-20 minutes for the scan. However it all depends on the position of your baby. If the position is favorable the scan can be done easily in one go. Many a times you will have to wait until the baby lies in the favorable position required by the radiologist. You may be asked to come repeatedly in the ultrasound room after waiting for some time.

Some times trans vaginal ultrasound needs to be done for better visualization of the fetus. In that case ultrasound probe is gently inserted into your vagina which may feel a bit uncomfortable but usually is not painful.

What does the results tell?

The NT/NB scan results are usually combined with a blood test ( Dual markers) and these both assess the combined risk of chromosomal disorders in pregnancy.

Remember that a normal screening result (screen negative) isn’t a guarantee that your baby has normal chromosomes, but it does suggest that a problem is unlikely. Likewise, an abnormal screening result (screen positive) doesn’t mean that your baby has a chromosomal problem – just that your baby is more likely to have one. Most screen-positive babies turn out not to have a problem: Only about a third of babies with an increased nuchal translucency measurement turn out to have chromosomal defects.

Results are usually reported as ‘low risk’ or ‘high risk’. If the result comes out to be low risk then the pregnancy is considered to be normal and no further tests are usually done. If the result comes to be moderate or high risk then further assessment is done by invasive procedures such as chorionic venous sampling and amniocentesis which will give you a definitive result. A non invasive blood test know as NIPT (Non invasive prenatal testing) is also available now a days to diagnose the chromosomal abnormalities. Your obstetrician or genetic counselor will help you to choose between these tests.