How important is the 20 week scan??

[Marquand]

I turned 43 earlier this month and am now just past 20 weeks with DC3. How crucial is the 20 weeks anomaly scan exactly? I've not managed to get an appointment (South Africa, so private doctor). I've been calling them non stop, but clearly being a nuisance is not as effective as I had hoped. I've been told that I can have the scan up to 24 weeks, so all is not lost.

The way I am rationalising it, is that it is great if there is nothing wrong, but if there is anything wrong, what can you do about it anyway? (OF COURSE I'd rather have the scan). My 12 week scan went well, with my adjusted Downs risk 1 in just under 700, which apparently, given the years on my clock, is about as good as it gets. Does that count for anything at 20 weeks?

I guess you don't have to have the scan, but there are a range of issues that can get picked up that cannot be at 12 weeks. For example, with dc2 he had a white bowel which can be indicative of cystic fibrosis or an infection. In the case of some infections, there is stuff that can be done.

If an anomoly is picked up at the scan, whether severe or minor then it allows treatment in-utero in some cases, allows for a treatment plan to be put into place for as soon as baby is born, allows for the right people to be at the birth, or heaven forbid there was something really really really wrong it allows for you to make a decision thats right for you. Anomolies can be picked up that wont be able to be seen at 12 weeks. I would urge you to keep trying to arrange it.

There are issues with the mother that can be picked up too. I have a low-lying placenta covering previous c section scar picked up at my 20 week scan, which puts me at high risk of placenta accrecia. I'm having extra scans and will have a larger team of doctors from different departments present at the birth in case of haemorrhage. If this hadn't been picked up, the risks for me would be much, much higher.

They can detect a whole range of abnormalities. They also look specifically for a number of conditions (cleft lip, spina bifida, Edwards' and Patau's syndrome etc.)
If they were to pick up an abnormality, some things can be treated in utero, some might impact on where you give birth (eg if your baby will need extra support after birth or even surgery, they might suggest you give birth in a hospital with an obstetrician/neonatologist present), and some conditions might mean that the baby will die soon after birth and an abortion might be offered (have no idea about the laws on this is South Africa though) Obviously these conditions are rare, and odds are that everything will be fine, but in your position I would be doing everything I could to get the scan.

Just out of interest, do they not normally offer a 20 week scan in South Africa?

more important than the 12 week in many ways. It picks up issues with baby and mother meaning less risk during birth and if anything is picked up they can either manage it in utero or plan for post birth.

My SIL's 20 week scan picked up issues that required close monitoring during the pregnancy, a paediatrician to be present at the birth, and anti-biotics for a year afterwards. I wouldn't miss it.

20 wk scan is the anomaly scan; they'll look for any obvious defects in the brain, heart, liver, kidneys, bowel, or perhaps see for obvious signs of syndromes. It's not guaranteed but it means you can prepare if they suspect there is something to be concerned about.

It depends if knowing any of this would change your decision about the pregnancy? Would you want to know in advance if your baby had any potential health problems?

I don't think the decision to have the scan does just depend on whether you'd continue the pregnancy in light of certain issues, Shirkingfromhome - as has been said above, there are issues the scan picks up that can either be addressed during pregnancy, or which may impact how the birth is planned and handled, with a direct impact on the health of the baby and mother.

Spuriouser Interesting question, yours about the 20 week scan in South Africa, and it is a perfect example of the very crazy society we live in.

The SA medical system is completely schizophrenic. On the one hand, there is medical care provided by the government. In that system, you are lucky if the antenatal clinic has the facility to provide antenatal scans. I've just scanned through the 173 page "GUIDELINES FOR MATERNITY CARE IN health centres and district hospitals", and the 20 week anomaly scan wasn't even mentioned. www.rmchsa.org/wp-content/uploads/2013/05/Maternal-Care-Guidelines-2015_FINAL-15.6.15.pdf. About 80% of the population only has access to government provided medical care.

I am fortunate enough to be a part of the other 20%, and have access to truly world class medical facilities. It costs a helluva lot of money, but generally middle class people make sure they get that money from somewhere. I'm in a truly bizarre situation where I get a scan at every checkup with my normal doctor. However, she does not offer the 20 week scan (although she is a gynae, and has a scanner in her rooms). I'm not quite sure why, but it is not unusual. I believe it has to do with a belief that some super specialist has to do it. At a cost, of course. Although some 'regular' gynaes offer the scan, you cannot get in if you're not a regular patient. Apart from them there are only a few people in Johannesburg who offer the 12 and 20 week scans if you aren't a regular patient.

For my 12 week scan I couldn't get an appointment in Jhb either. Fortunately, we were going to be in Cape Town anyway in the window period, and I managed to get an appointment there. No such luck this time around.

So currently I run the risk of having multiple scans throughout the pregnancy, but missing out on the most important one. It is truly bizarre.

I guess at least if you're having multiple other scans, they'd be likely to pick up at least some potential issues. In the UK only the 12 and 20 week scans are routinely offered, so if you missed the 20 week one, you probably wouldn't be scanned again and things might be missed.

No Artioo2 I agree but it is a factor that people consider when they choose to opt out of scans such as these. Same as preparing for birth and aftercare. There are some people who's choices may mean they do not want to proceed with any medical procedures or interventions for the duration of their pregnancy.

Thanks for answering my question OP. It sounds like you are lucky to be able to see a private doctor!
I wouldn't rely on the other scans you have had, I am only guessing but they might have had a different focus, eg measuring the baby's length or checking the heartbeat, rather than specifically examining the kidneys, bones, heart etc. Though as I said, problems are fairly rare so if you really can't get the scan your baby will probably be fine regardless. Hopefully you will be able get an appointment though!