Ultrasound

An ultrasound is done to determine the due date, the position of the baby and the placenta, the amount of fluid around the baby, and the size of the baby. It is also used to detect some fetal abnormalities. An abdominal ultrasound is painless, non-invasive, and accurate. Sound waves are bounced off the fetus and back to a video screen where they create an image of the baby.

Although there is presently no proven risk from ultrasound, it is done routinely, but only for the above reasons. If scheduled, you will need to have a full bladder. Please drink 32 ounces of water one hour before the exam, and do not urinate.

First Trimester Screen

This screening test is done at the perinatologist’s office. It is a combination of a special ultrasound and a blood test which provides information about the health of the fetus. It identifies women who may have an increased risk of having a baby with certain defects like Down Syndrome and Trisomy 18.

A small amount of blood is taken, usually from the fingertip, to measure the levels of proteins free Beta-human chorionic gonadotropin (hCG), PAPP-A, and alpha-fetoprotein (AFP), which are normally found in the blood of all pregnant women. The ultrasound exam measures a thin layer of fluid normally found at the back of the fetal neck called the nuchal translucency (NT). A large nuchal translucency (increased width) may be a sign of a chromosomal abnormality or a heart problem in the baby. This screen is safe for you and the fetus.

The blood test is ideally performed between 11-13 weeks, but any time between 10 and 13 weeks is acceptable. The blood test with the NT detects 91% of Down syndrome, 97% of Trisomy 18, and 40% of heart defects and some other birth defects.

*Insurance Notice*

You need to make a choice about receiving this service. While many insurance companies cover the cost of the Ultra-Screen (also called a first trimester screening), we cannot guarantee that your insurance company will do so. The fact that your insurance may not pay for a particular item does not mean that you should not receive it. There may be a good reason why your doctor recommended it. We want you to make an informed choice about whether you want to receive this service knowing that you might have to pay for it yourself.

It is recommended that you check with your insurance company about coverage for this test. The CPT (billing) codes that you will need are:

• Free beta-hCG: 84704
• PAPP-A: 84163
• Ultrasound: 76813

NIPT (non-invasive prenatal test)

This test may be performed instead of the first-trimester screen, and it is usually for selected patients based on medical history. It is peformed after 10 weeks and it has the highest rate of detection for Down Syndrome. If you elect this test, you will also have an AFP blood test to test of open neural tube defects. Recommended follow up to a positive result is genetic counseling and prenatal diagnosis. *The same insurance notice as above applies for this testing. The CPT (billing) codes you will need to check with your insurance are: 81507, 84702

Sequential Screening with Translucency (NT)

This is a two-step test to detect whether a fetus is at increased risk for Down Syndrome, trisomy 18, and open neural tube defects. There is a narrow window for testing (the first step must be performed between 10 and 13 weeks of pregnancy). It includes two blood draws and an ultrasound. The ultrasound measures the amount of fluid behind the baby’s neck called the NT. The blood tests measure PAPP-A, hCG, and dimeric inhibin A (inhA). These measurements are combined with some material information such as height and weight and are used to calculate whether the baby is at increased risk for Down Syndrome or trisomy 18. An AFP is also included to test for open neural tube defects. Recommended follow up to a positive result is additional testing that is more definitive, and referral to genetic counseling and prenatal diagnosis. CPT Codes Part I: 84163, 84702, 76813. CPT codes for Part II: 82677, 84702, 86336.

Quad Screen

This test measures four proteins in your blood: AFP, hCG, unconjugated estriol (uE3), and inhibin-A (inhA). It tells you what the chances are that your baby might have Down Syndrome or open neural tube/spinal defects. If problems arise during the formation of the brain and spinal cord, the infant may be born without a brain (anecephaly), or with an “open spine” (spina bifida). Alpha-fetoprotein (AFP) is secreted by every fetus as it grows. AFP can be detected in the mother’s bloodstream. A fetus with neural tube defects will secrete large amounts of AFP. The test is usually performed at 15 to 16 weeks of pregnancy and no later than 22 weeks. It is offered to all pregnant patients.

Genetic Screening

Testing for a mother’s genetic health in pregnancy is advised for the following: cystic fibrosis (CF), spinal muscular atrophy (SMA), and Fragile X. If any of these tests are positive, it is advisable that the father of the baby also be tested. Any additional genetic test may be advised based on the mother’s age or on other risk factors. Your physician or nurse will discuss these options with you if advisable.

Blood Sugar

Blood sugars are checked between 24 and 28 weeks to determine if you have gestational diabetes. The test consists of drinking glucose (sugar water) and having blood drawn one hour later.

RH TITER

If you are RH negative, a blood test will be done at approximately 28 weeks to determine if antibodies have developed. If you are RH negative, you will also be given separate informational material that explains the RH factor and the medication Rhogam.

CBC

A complete blood count may be checked between 24 and 28 weeks with your blood sugar test, and again at 35 weeks to check for anemia during your pregnancy.

NST

A Non-stress test is a test that measures fetal heart rate as the fetus moves. An instrument is attached to the mother’s abdomen (an electronic fetal monitor), and fetal movements are felt by the mother or noted by the doctor or nurse.

HIV

This is the blood test for the virus that may cause AIDS, and is advised for all women, especially those with increased risk factors.