Prenatal Diagnosis Center
PRENATAL DIAGNOSIS CENTER
VIBHAVADI  HOSPITAL 

The advanced technology in molecular genetics, cytogenetics and also ultrasound technology  now a day, make the possibility of diagnosis of almost all congenital anomaly before birth.

PRENATAL DIAGNOSIS CENTER
VIBHAVADI  HOSPITAL 
The advanced technology in molecular genetics, cytogenetics and also ultrasound technology  now a day, make the possibility of diagnosis of almost all congenital anomaly before birth.

The prenatal Diagnosis center at Viphavadee Hospital  will provide the service of all possible prenatal diagnosis. The services will perform by medical team with the experienced and well trained in different specialty, include prenatal genetics, prenatal diagnosis, maternal fetal medicine,ultrasonography and also prenatal cardiology. The advanced in Ultrasound equipment can demonstrate the moving picture of the fetus as early 6-7 weeks gestation. The improvement in the resolution of the real time picture will make the possibility to identify the anomaly in the fetus by the time of second trimester. The new technology such as Doppler ultrasound and 4D ultrasound will improved and confirmed the detection of the congenital anomaly such as congenital heart disease and some smaller defect in the face and body of the fetus.

The services at Prenatal Diagnosis center: 
1. Early pregnancy (< 13 weeks) :

Ultrasound scanning for gestational age accurately, viability, fetal number, the chorionicity and  amnionicity in multiple pregnancies,  and marker for chromosome abnormality.
             
The abnormal biochemical screening (PAPP-A and free Beta HCG) and abnormal ultrasound screening (increase skin nuchal fold) will improve the detection rate of  the chromosome abnormality fetus especially for Down Syndrome as high as 70-80%.

2. Second trimester (16-20 weeks) :

Ultrasound scanning for soft marker which increases the risk of the fetus having a chromosomal anomaly.

The following are considered to be soft markers :
1. The skin nuchal fold (6mm)
2. Echogenic bowel
3. Echogenic foci in the fetal heart.
4. Short femur < 3rd centile.
5. Dilated renal pelvis (pyelectasis) > 5mm.
6. Choroid plexus cysts
Other findings such as 2 vessel cord, abnormal head shape, and the abnormal in the hands and feet are not considered soft markers but will increase the risk for chromosomal abnormality as well.

The maternal age (35 years old and older) and the abnormal biochemical screening (triple markers) will be  another risk factor for chromosomal abnormality fetus.

The couple at risks for chromosomal abnormality and for other genetic diseases  will received Genetic counseling and offered for definite diagnosis. The second trimester  prenatal diagnostic procedures such as amniocentesis, cordocentesis  with the ultrasound assisted. The amniotic fluid as well as the fetal blood can perform for chromosome study or DNA study which can detect abnormality and  genetic diseases, such as Down syndrome, thalassemia  and other single gene defect.

3. Second trimester (20-24 weeks) Anomaly scan:

The 20 weeks anomaly scan is to reassure the woman that her baby appears to have no obvious structural abnormalities. The standard for 20 weeks anomaly scan :
1. Gestational age can be established by measurement of the bi parietal diameter, head circumference, abdominal circumference and femur length
2. Head shape, internal structures of the brain (Cerebellum, ventriclular size, cisterna magna)
3. Spine longitudinal and transverse
4. Abdominal shape and content at the level of the stomach.
5. Genito urinary system (kidneys and bladder)
6. Longitudinal Axis-Abdominal thoracic appearance (diaphragm, stomach)
7. The umbilical cord insertion.
8. Thorax at level of 4 chamber cardiac view, right and left cardiac out flow tracts.
9. face and lips
10. Arms and hands (Boney structure of the upper and lower arm, position of the wrist joint and hand)
11. Legs and feet (boney structure of upper and lower leg, position of the foot)

Fetal normality by the 20 weeks anomaly scan can reassure that the fetus will have no obvious structural abnormalities. The detection rates for significant abnormalities will vary for different type of congenital abnormality:
Type of abnormality                  Detection rate by 20 weeks anomaly scan
Anencephaly                  100 %
Open spinal bifida                            90%
Hydrocephalus                60%
Diphragmatic hernia                            60%
Abdominal wall defect                            90%
Major kidney problems                        85%
Major limb abnormality                     90%

Some of the congenital abnormality will not be able to detect by this scan such as Cerebral palsy, Autism, and some of the abnormal that will present late in gestation or even after birth. The value of  identifying fetal abnormality at this stage is that it offers parents option. Some, probably for the majority, for serious lesions, will  elect to terminate the pregnancy. Those couples who choose to continue the pregnancy have the opportunity to prepare themselves through discussions with  the expert or the self-help group for appropriate care during pregnancy and following delivery. Some of the abnormality can be treated after birth. The couple who do not wish to be informed of a risk of congenital abnormality may consider not having a scan.

4. Fetal echocardiography to detect the congenital heart disease :

Integrate the ultrasound scanning and Doppler ultrasound study can diagnosis fetal cardiac and blood vessel defect.

The indication for performed this study :

Maternal exposure to medication that will  increase the cardiac abnormality.

Known case with congenital heart disease in either parent.
Previous child with congenital heart disease
Other family member with congenital heart disease
Unable to demonstrate normal cardiac scan in a routine examination.   

5. 4-D ultrasound examination:

This examination will demonstrate the 3 dimension image of the fetal surface area and also the movement of the baby. The useful of this scan is possibility increasing in the psychological bonding between the parents and the baby. The diagnosis of congenital anomaly in the face, spine hand and feet  can be assessed. The 4-D ultrasound examination will provide unique information or merely supplemental information to the conventional scan.

6.  Assessment fetal well being: Gestationl age>28 weeks :

For assessment of fetal growth and fetal well-being .

Measurement fetal parameters will allow assessment of fetal size and growth of the fetus which assist in the diagnosis of intrauterine growth retardation. The Biophysical profile and fetal blood flow study will be demonstrated the fetal well being.

The medical team:
1. Dr. Aphornpirom Ketupanya M.D., MSc. (clinical epidemiology)
Diplomate American Board of OB-GYN.
Cert. American Board of Maternal and Fetal Medicine.
Cert. in Prenatal Genetics, UCLA, USA

2. Dr. Supavit Muttamara.M.D., FACOG
Diplomate American Board of OB-GYN

3. Dr. Chutawadi Vuthiwong.M.D.
Cert. Prenatal Diagnosis, University College London, UK.

4. Dr. Aungkana  Gengsakul MD.
Cert. pediatric cardiology, University of British Columbia, Canada
Cert. prenatal and adult congenital Heart Disease, University of Toronto, Canada

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Vibhavadi Hospital:
51 /3 NgamwongwanRoad, Chatuchak, Bangkok ,Thailand 10900
Tel.66-2941-2800, 66-2941-2900
Fax.66-2561-1466
Our Foreign Service Department:
at (662) 561-1111 or
E-mail: fsd-vgh@hotmail.com