Complete Pregnancy Care
Obstetrics is the medical specialty that deals with the care of pregnant women from the moment of conception until the birth of her baby or babies.
The private practice of Obstetrics allows a pregnant woman to choose a specialist doctor that she finds reliable and accessible, and who is available to provide the highest level of personalised attention throughout the pregnancy to the delivery of her baby.
The Obstetrician is the specialist doctor responsible for carrying out the necessary scans and check-ups to ensure the health and welfare of mother and baby during the pregnancy.
Fortunately the condescending attitude that prevailed only a decade ago has evolved into a balanced relationship.
Nowadays a pregnant woman expect to receive accurate and reliable information that enables her to understand the nature of the tests and screenings that she is undertaking and to make informed decisions in relation to her pregnancy and childbirth.
This relationship of trust is particularly beneficial when the cooperation of the mother is vital to ensuring a healthy pregnancy, an adequate fetal development and a safe delivery.
Private Complete Pregnancy Care. What We Offer
Our complete Antenatal Care Plan has been designed to ensure the best possible care throughout your pregnancy.
We advise on which ultrasound scans and blood tests need to be done, when, and what for.
You will enjoy the highest level of personalised attention, plus will receive expert advice on all aspects of your health (nutrition, exercise, etcetera) and the health of your baby.
Dr. Berral attends personally all antenatal clinics and carries out the required scans. Fetal assessment is performed using high definition 2D, Doppler and 3D/4D ultrasound scanning.
Blood tests, including the new 12th week combined screening for chromosomal abnormalities, can be done in the comfort of our premises on the same day as the scans. Samples are immediately sent to be analysed and the results are with us promptly. In the days prior to the delivery of your baby or those after your due date, we can do the fetal monitoring and fetal wellbeing check-ups. If you wish, you can request our complementary services of nutrition and dietetics or our personalised antenatal and parent-preparation classes.
Every pregnant woman should attend her Obstetrics clinics in the weeks indicated to monitor the evolution of the pregnancy and detect incidents that could be affecting or would affect in the future the health of the mother or the baby.
Visits are programmed according to your own individual needs. The follow-up of a single pregnancy with no complications includes a number of ultrasound scans, quarterly blood tests, and other tests such as the 12th week combined screening.
Maternal weight and blood pressure are checked at each antenatal clinic.
Various issues such as weight gain, diet, physical activity, etcetera, important for the mother's health and wellbeing, are also dealt with.
In multiple pregnancies - twins or triplets - or pregnancies with specific complications -gestational diabetes, hypertension, poor foetal growth, the existence of malformations, placenta praevia, transverse or breech position, and others- individualised plans of attention are issued for the correct follow-up of each particular case.
In pregnancy there may be circumstances that require an urgent visit: severe pain, dizziness or fainting, swelling, sudden increase or decrease in weight, vaginal secretions, bleeding, or other unexpected problems.
If you are suffereing any of those or doubt the normality of any of the symptoms or changes that you are experiencing, you should communicate it.
You should also contact your Obstetrician if you have fever or have contracted any disease that requires medical treatment.
Our Clinic is an independent centre where Dr. Berral and his team work to provide the highest standard of medical care in a warm and relaxed atmosphere.
We offer the most advanced technology, the latest testing and screening available and an extensive experience in Obstetric care.
All of this is accomplished while we encourage women's participation in the management of their prenatal care.
Dating Scan. Early Pregnancy Scan and Clinic.
The first antenatal clinic and scan should be booked as soon as you have news of your pregnancy.
The scan will confirm the pregnancy and assess the potential risks that may exist for the mother or the fetus.
A 5-week gestation can be confirmed by an ultrasound scan.
The Early Pregnancy scan is recomended to every pregnant woman. It is a particularly important examination for women who are experiencing pain or bleeding in the pregnancy and those who have had previous miscarriages or ectopic pregnancies. This scan is important to::
- Confirm the pregnancy.
- Verify the presence of fetal heart beat.
- Determine the gestational age and give an indication of the expected date of delivery.
- Ascertain the location of the pregnancy to ensure that this is not an ectopic pregnancy.
- Find out the presence of twins or multiple gestations.
- Diagnose diseases of the ovaries or other pelvic structures that may affect the evolution of pregnancy.This scan is also essential for determining the optimal timing for other antenatal investigations, such as the 12th week scan and combined screening.
Your medical and obstetric history will be taken up in the course of this visit.
It is also the right time to ensure that you are familiar with the more important principles of care to ensure your wellbeing and the health of you baby:: diet, exercise compatible with pregnancy and lifestyle in general.
All these factors will influence the evolution of your pregnancy.
During the first trimester of, and up to the week 13th of a pregnancy, ultrasound scans are rather performed transvaginally in order to obtain images of greater definition and quality.
This examination is absolutely painless and does not present any risks for the baby or the mother.
Week 12. Nuchal fold Scan and Combined Screening.
The week 12 ultrasound scan is recommended to every pregnant woman.
The Nuchal Translucency (NT), also known as nuchal fold, is an accumulation of fluid that appears on the back of the fetal neck between week 10 and 14 of gestation.
A thickened nuchal translucency, and other soft markers, such as the absence of nasal bone, is associated with an increased risk of Down syndrome and other chromosomal abnormalities.
The Nuchal Translucency is a transitional marker. The Nuchal Translucency scan has to be performed between the week 11 and 13 of the gestation, and ideally at week 12.
The week 12 scan is also a complete ultrasound check up.
- Confirmation of gestational age and expected date of delivery.
- Complete study of the fetal anatomy for the early diagnosis of fetal malformations. Many malformations of the bones, members and internal organs are visibly at this time (spina bifida, cranial abnormalities, limb deformities, etc.).
- Study of the first trimester soft markers for chromosomal abnormalities, such as the absence of fetal nasal bone or an increased fetal nuchal translucency.
- 3D and 4D first trimester scanning for the study of the fetus morphologic appearance.
The week 12 ultrasound scan is currently the most reliable non-invasive test for the early detection of Down Syndrome, the most common statistically, with 1 in every 600 pregnancies affected.
The information obtained with the nuchal translucency scan can be used in combination with a study of biochemical markers that are obtained from a simple blood test done to the mother.
This test measures two chemicals present in the mothers bloodstream: the free bHCG and the PAAPP-A. The levels of these markers, along with information gained from the ultrasound and other relevant data, such as maternal age and weight, are used in the 'combined screening' of the week 12, which allows the detection of pregnancies at high risk of aneuplodias, such as Down syndrome and syndrome of Edwards, in approximately 90% of cases. The Nuchal Translucency scan on its own has a detection rate o f approximately 70% of pregnancies with chromosomical defects.
The week 12 combined screening is valid for mothers over 35 years and for twin pregnancies.
It is also a totally innocuous test that does not present even the small risk of loss associated to invasive tests such as corial biopsies or amniocentesis.
Week 20 Scan. "Fetal Anatomy" or "Anomaly Scan".
The "Fetal Anomaly" or "Fetal Anatomy" Scan is normally done at 20 weeks.
At this point babies are fully formed and have the right size to allow a detailed study of their anatomy.
The main purpose of this scan is to assess fetal health and in particularly the diagnosis of malformations.
A detailed ultrasound of high diagnostic accuracy is performed during which each part of the fetal body is examined.
Baby's growth, amniotic fluid, umbilical cord and placental position are also checked.
The 3D/4D ultrasound, with their ability to memorize body volumes, greatly improves the diagnostic capacity of fetal malformations.
The images of the face profile, for example, allow to study the degree of malformations such as congenital cleft lip or cleft palate.
When a problem is detected, it can be visualized with clarity, which facilitates its understanding on the side of the parents. This also helps medical specialists to plan future interventions.
The anatomical study conducted at week 20 checks the development and movement of all the fetal organs that are present.
Attention is paid to the head, brain, face, spine, arms, hands, fingers, legs, feet, heart, lungs, intestines, kidneys, bladder, genitals and bone structures.
If the baby appears normal in this ultrasound, the chances of having a serious anatomical malformation are rare, but not nonexistent.
There are malformations that appear or become visible in more advanced stages of pregnancy, such as diaphragmatic hernias, pelvic kidney dilations, hydrocephalies, cardiac malformations with inverted flow, cysts in the abdomen or pelvic structures, and others.
The third trimester ultrasounds will review the fetal anatomy and monitor the development of vital organs.
Third Trimestre Scanning.
The Third Trimester Scanning completes the previous anatomical studies and monitors the baby's growth and placental function in the weeks preceding the birth.
In the last trimester checkups must be performed at least monthly to assess the baby's overall development and growth.
Third Trimester Scans will also:
- Measure the baby to ensure a correct development, calculate the percentile of growth, and report on the estimated fetal weight at birth.
- Check whether the baby presents any loops of the umbilical cord
- Assess the blood flow through the cord, essential to guarantee proper fetal growth.
- Check the state of the placenta and the volume of fluid around the baby.
- Study the fetal position to identify whether the baby is cephalic or breech, and the baby's movements.
The number of ultrasounds scans to be performed in this will normally be determined by the progress in the baby's growth and the normality of the other relevant parameters.
Una posición de nalgas or transversa to partir de la semana 34, por ejemplo, requerirá controles para observar si se ha producido el cambio to posición cefálica.
Similarly a calcified placenta or a shortage of amniotic fluid will require a more comprehensive monitoring of fetal well-being.
Sometimes 'fetal biophysical profile' studies are required to assess the volume of amniotic fluid, the movements of the baby and the pattern fetal breathing.