News from RPA Fetal Medicine and Women’s Imaging

Fetal Echocardiography Clinics
Dr Ritu Mogra has recently been appointed as a staff specialist with a specific interest in obstetric and gynaecological imaging. Her major area of interest is fetal echocardiography and she recently spent a six month fellowship in London training in this area. Dr Mogra’s appointment will offer a service to women at high risk of having a child affected by a cardiac abnormality.

Two specialist cardiac scan clinics have commenced on Thursday and Friday afternoons:
• Early second trimester fetal echocardiogrpaghy: Friday (12-16 weeks).
• Standard second trimester fetal echocardiography : Thursday (18-20 week).

The scan will involve detailed examination of the heart by both transabdominal and transvaginal routes. The patient needs to bring previous ultrasound reports and any relevant information pertaining to the examination.

Direct referrals can be made to these clinics as per protocol including recommended indications.

a)  Early second trimester fetal echocardiography (scans at 14-15 weeks)

The following patients should be referred for assessment:

• Fetuses with nuchal translucency >95th centile at the time of first trimester screening (excepting those found to have an abnormal karyotpye who chose to terminate the pregnancy)
• Fetuses found to have Tricuspid Regurgitation or reversed flow in the ‘A’ wave of the ductus venosus during first trimester screening
• Fetuses suspected of having a cardiac anomaly
• Family history of congenital heart disease (previously affected pregnancy with major congenital heart defect)
• Mothers with insulin dependent diabetes mellitus with poorly controlled sugars.

Although most of the major structural malformations can be excluded at 14 weeks these patients will be rebooked at 19-20 weeks to further assess cardiac structures when the heart is bigger and can be assessed more accurately.

b) Standard second trimester fetal echocardiography (scans at 19 - 20 weeks)

The following patients should be referred for assessment:

All the above (as per 14-15 weeks) as well as
• Fetuses with an irregularity in heart rate (found in either the 2nd or 3rd trimester)
• Mothers using recognized cardiac teratogens: eg. anti-epileptic medication/ lithium
• Mothers with anti Ro- La antibodies
• Monochorionic twin pregnancy.

If any cardiac abnormality is found at the time of examination the patient will be referred to a pediatric cardiologist for further assessment and counseling.

Other new appointments
Dr Jane Woolcock and Dr Rajit Narayan have also started work in the Department as the Fellows in Obs / Gynae ultrasound and Maternal and Fetal Medicine respectively. In the event of an urgent referral / need telephone advice, they can be contacted through RPA switchboard ph 9515 6111.

First trimester screening
Currently NT ultrasound is combined with biochemistry (free BhCG and PaPP-A). It is planned for the future to add nasal bone assessment to this screening algorithm. The nasal bone ossifies at a later stage in fetuses affected by Down syndrome. The hypo-echogenic nasal bone is typically referred to as an ‘absent’ nasal bone at the 12 week scan – and is found in two thirds of Down babies and 1% of chromosomally normal fetuses.

The main reason for including this marker in the screening program is that it will significantly reduce the number of false positive screens – and will reduce the number of CVS / amniocenteses offered to women. The nasal bone is being used in some other ultrasound units in Sydney so this change will bring their policy into line with recent changes elsewhere.

It is anticipated that this marker will be introduced in July but this is dependent on completing staff training. 

Patient brochures on options for management of miscarriage

The RPAH Early Pregnancy Assessment Service has patient brochures regarding options for management of miscarriage including expectant , medical and surgical options. These can be downloaded from www.csgpn/antenatal under either “Pregnancy Assessment” or “Patient Information”.

Reminder regarding ANSC GPs Email Distribution List

All important and/or urgent information regarding the Antenatal Shared Care Program is emailed to all active ANSC GPs via a Distribution List. Please contact CSGPN to ensure that your email address is current. Those GPs without email addresses, any urgent information is either faxed or included in the weekly Broadcast Fax. Information is also included in the following month’s newsletter.

Educational Event : ANSC ½ Day Update

The ANSC ½ day Update will be held on Saturday 18 June between 1.00-5.30pm. Further information is included in the enclosed flyer. Parking is available in the carpark behind KGV building (Rate: $5/day) or street parking. Please note there is no flat –rate parking in the St John’s College Carpark (Rate: $4/hr) located on John Hopkins Rd.