Thursday, May 28 2015 – We went to Kaiser for a full anatomy ultrasound of Rachel and the babies. This can be a long and arduous process, dependent entirely on the co-operation of the babies! We were at Kaiser for 3 hours. This can be an exciting time because you can find out the gender of your babies if you so desire and of course – IF the babies co-operate! 🙂
The technician looks at the positioning of your placenta, specifically looking for placenta previa. The umbilical cord will be checked to determine if it enters the abdomen normally and that it has three vessels. The technician will also look to see if there is enough amniotic fluid surrounding the baby to allow it to move freely at this stage. (It looked pretty cramped in there to me!)
- Brain – The technician assesses the fluid filled spaces of the brain & the shape of the cerebellum. They also are able to identify any cysts in the choroid plexus. Fetal cysts may indicate an increased risk for a chromosome abnormality; however, the majority of these cysts disappear by the 28th week of pregnancy with no effect on the baby.
- Face, Eyes, Nose, Lips – Depending on the positioning of your baby, the technician may or may not be able to detect if your baby has a cleft lip.
- Heart – Does the heart have four chambers? How are the inflow and outflow tracks? Are the heart and stomach in the correct position? Is the heart rate normal? A normal heart rate range for a fetus is 120-180 beats per minute. Does the muscle work normally?
- Spine – The spine will be evaluated in the long view and in a cross section. The technician will be looking to make sure that the vertebrae are in alignment and that the skin covers the spine at the back.
- Humurus, Tibia, Fibia – The technician scans/measures these major bones as well as checks the babies hands and feet.
- Genitalia – This is where you find out if you are having a boy or a girl (or both, or a combination there of, or all three!) Our ultrasound technician – Nikki, finally confirmed that we are having 3 boys! 🙂
- Anatomy – The scan will evaluate your baby’s stomach, abdominal wall, and diaphragm. The scan will determine if your baby has two kidneys and if his or her bladder is functioning properly.
We received a call back later in the afternoon from Kaiser about Baby C – they found a Choroid Plexus Cyst. If you remember back in week 12 they were concerned about Baby B being at risk for Trisomy 21. We were told that these cysts are found in 1-2% of all ultrasounds and while there is an increased risk in Trisomy 18 it is not a common occurrence. The only way to find out for sure is to have an Amniocentesis test – which we are not interested in doing because the test increases the risk of miscarriage. Both Baby A and B appear healthy with no issues. Science – don’t you just love it?
Here is an excerpt from the UCSF web page about the Choroid Plexus and Choroid Plexus Cysts:
The presence of isolated choroid plexus cysts (CPCs) on a second trimester ultrasound is a common cause of anxiety, although it is almost always an innocent finding. Here are the answers to some commonly asked questions about CPCs.
What are choroid plexus cysts?
The choroid plexus is the part of the brain that makes cerebrospinal fluid, the fluid that normally bathes and protects the brain and spinal column. In about 1 to 2 percent of normal babies — 1 out of 50 to 100 — a tiny bubble of fluid is pinched off as the choroid plexus forms. This appears as a cyst inside the choroid plexus at the time of ultrasound. A choroid plexus cyst can be likened to a blister and is not considered a brain abnormality.
What is going to happen to the cyst?
In the vast majority of cases, the cyst resolves or disappears and has no consequences.
What is the concern?
As mentioned, choroid plexus cysts are present in 1 to 2 percent of normal fetuses. However, in a very small percentage of fetuses with choroid plexus cysts, there is an associated chromosome disorder called trisomy 18. Fetuses with trisomy 18 have an extra copy of chromosome 18. Frequently, fetuses with trisomy 18 are stillborn. Survivors beyond infancy are rare. They have severe mental retardation and a variety of other problems including abnormalities of almost any organ system such as the heart, brain and kidneys. Fetuses with trisomy 18 have choroid plexus cysts about a third of the time. Therefore, when we see choroid plexus cysts, we are concerned that the fetus may have trisomy 18.
Trisomy 18 is rare. It is present in less than 1 in 3,000 newborns. Choroid plexus cysts are relatively common in normal fetuses. Most fetuses with a choroid plexus cyst are normal. Furthermore, many of the abnormalities associated with trisomy 18 can be detected by a careful ultrasound. In fact, fetuses with trisomy 18 almost always demonstrate abnormalities on ultrasound in addition to choroid plexus cysts, although some of these abnormalities can be quite subtle. If no additional abnormalities are detected by a thorough “level II” ultrasound, the likelihood the fetus has trisomy 18 is very low.
What are the odds that it is a sign of trisomy 18?
The precise rate of risk is difficult to estimate and is somewhat controversial, but most doctors believe it is well under 1 percent. In other words, a fetus with choroid plexus cysts but an otherwise normal ultrasound has a better than 99 percent chance of not having trisomy 18. A normal alpha fetoprotein (AFP) test further reduces the likelihood of trisomy 18.
Does the size of the cyst matter?
Ordinarily, the size does not matter, although multiple, large cysts are slightly more worrisome.
What is the next step after a cyst is discovered?
We can perform an amniocentesis, and count the number of chromosomes in the fetus to be certain there is not an extra copy of chromosome 18. At the same time, we can rule out other chromosomal abnormalities, such as Down syndrome, although we have no reason to suspect any of these in your case. However there is a small risk of amniocentesis causing a miscarriage.
How high is the miscarriage risk with amniocentesis?
The rate of risk for miscarriage with amniocentesis is difficult to determine. Many doctors cite 0.5 percent or 1 in 200.