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Early pregnancy screening · NT + blood markers

First Trimester Combined Screening in Nagpur

A carefully timed first-trimester screening pathway combining NT ultrasound, maternal serum PAPP-A and free beta-hCG to estimate early risk for common chromosomal conditions — interpreted with compassionate counselling by Dr. Kunda Shahane at Mayflower Fetal Medicine & High-Risk Pregnancy Centre.

11–13 weeks 6 days NT window PAPP-A + free beta-hCG FMF-style risk interpretation PCPNDT compliant
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Dr. Kunda Shahane, MBBS, MS, FIFM, FMF London
20,000+ fetuses evaluated
GE Voluson Signature Expert
Monday–Saturday, 10am–6pm
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Best timing
NT scan: 11 to 13+6 weeks
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Blood markers
PAPP-A + free beta-hCG
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Result type
Risk estimate, not diagnosis
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Specialist
Reviewed by fetal medicine expert
KS
Reviewed and interpreted by Dr. Kunda Shahane
MBBS · MS (Obs & Gynae) · FIFM · FMF (London) · Fetal Medicine Specialist, Nagpur
First trimester screening is not just a lab number or scan measurement. It needs correct timing, technically sound NT imaging, accurate clinical data and calm counselling when the result is ready.
What it means

What is first trimester combined screening?

First trimester combined screening combines two types of information: a specialised NT ultrasound scan and a maternal blood test measuring PAPP-A and free beta-hCG. These results are interpreted together with maternal age, gestational age and pregnancy details to calculate an individual risk estimate for common chromosomal conditions.

The purpose is not to label a pregnancy as “normal” or “abnormal.” The purpose is to identify which pregnancies have a low-risk reassuring pattern, and which pregnancies may need further counselling, NIPT, CVS, amniocentesis or a more detailed follow-up plan.

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Ultrasound component
The NT scan measures nuchal translucency and reviews early fetal anatomy, nasal bone and selected first-trimester markers where appropriate.
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Blood test component
Maternal serum PAPP-A and free beta-hCG are analysed and converted into pregnancy-specific marker values.
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Risk calculation
The ultrasound, blood markers and maternal factors are combined to estimate risk for Trisomy 21, Trisomy 18 and Trisomy 13.
The screening package

What is included in combined screening?

A good combined screening result depends on correct ultrasound measurement, accurate blood marker interpretation and clear counselling. The table below shows how each part contributes to the final risk estimate.

Component What is assessed Why it matters Important note
CRL / gestational age Crown-rump length confirms whether pregnancy is within the valid NT screening window. Risk calculation depends on exact gestational age, not just LMP dates. Timing critical
NT measurement Nuchal translucency thickness is measured in a standardised fetal position. Increased NT may be associated with chromosomal risk, cardiac concerns or other conditions. Specialist scan
Nasal bone and markers Selected ultrasound markers may be reviewed depending on fetal position and protocol. Additional markers may refine risk interpretation when technically visible. Position dependent
PAPP-A Pregnancy-associated plasma protein-A from maternal blood. Low values may influence chromosomal risk and may also guide closer pregnancy surveillance in selected cases. Blood marker
Free beta-hCG Hormonal blood marker interpreted with gestational age. Pattern may contribute to risk calculation for common trisomies. Blood marker
Maternal factors Age, weight, IVF history, diabetes status, smoking status if relevant, and pregnancy details. These details make the report personalised rather than a generic age-risk estimate. Individualised
Final risk report Risk estimate for Trisomy 21, Trisomy 18 and Trisomy 13. Helps decide whether reassurance, NIPT, CVS or amniocentesis is appropriate. Screening only
Correct timing

When should you book it?

The most important rule is not to miss the first trimester window. If you are unsure of dates, book early so Dr. Kunda can plan the viability/dating scan, blood test and NT scan in the correct sequence.

1
Around 6–10 weeks
Viability / dating confirmation if needed
An early scan may confirm intrauterine pregnancy, fetal heartbeat, twins and expected dates, especially after IVF, irregular periods or uncertainty about LMP.
2
From around 10 weeks
Blood sample planning
PAPP-A and free beta-hCG can be planned before or around the NT scan window depending on the laboratory pathway and clinical situation.
3
11 to 13 weeks 6 days
NT ultrasound scan
NT measurement is performed only when fetal size is within the valid screening range. This is why a late booking can make the screening window difficult.
4
After scan + blood results
Risk report and counselling
The result is explained in simple language: what the number means, what it does not mean, and whether any next step is required.
Who should consider it?

Who needs first trimester combined screening?

Most pregnant women can consider first trimester combined screening if they are within the correct gestational window. It is especially helpful when parents want early information before the anomaly scan.

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Routine first trimester pregnancy
For couples who want early screening for common chromosomal conditions along with a specialist NT scan.
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IVF / assisted conception pregnancy
Early pregnancy care often needs accurate dating, fetal number confirmation and carefully timed screening.
35+
Advanced maternal age
Age-related baseline risk can be refined by adding ultrasound and blood marker information.
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Previous chromosomal concern
If there is a previous affected pregnancy or family concern, counselling may include combined screening, NIPT or diagnostic testing options.
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Parents seeking a clear plan
The result helps parents decide whether reassurance is enough or whether additional testing is useful.
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Unclear previous reports
If an outside NT or lab report feels confusing, a specialist review can help interpret it correctly.
Understanding reports

How are results interpreted?

The result is usually expressed as a risk number, such as 1 in 5000, 1 in 500 or 1 in 50. The number must be interpreted in context — not read with fear and not ignored casually.

Low-risk pattern
Usually reassuring
A low-risk result reduces concern for the screened conditions, but it does not replace the 18–22 week anomaly scan or routine pregnancy care.
Intermediate / borderline
Needs thoughtful counselling
Depending on age, NT, blood markers and parental preference, Dr. Kunda may discuss NIPT, follow-up scans or diagnostic testing.
High-risk result
Not a diagnosis
A high-risk result means further evaluation is recommended. It does not confirm that the baby definitely has a chromosomal condition.
Choosing the right test

Combined screening vs NT scan vs NIPT vs diagnostic testing

Many parents are confused because several tests are available in early pregnancy. Each test answers a different question. Dr. Kunda helps you choose the right pathway instead of ordering tests blindly.

Test What it gives Strength Limitation
NT scan Ultrasound-based early fetal assessment and NT measurement. Visual assessment of early anatomy and markers. Less complete than combined screening if blood markers are not added.
Combined screening NT + PAPP-A + free beta-hCG + maternal factors. Balanced first-line screening with ultrasound and biochemical information. It is still a screening test, not a final diagnosis.
NIPT Cell-free fetal DNA screening from maternal blood. Higher screening accuracy for common trisomies. Does not replace ultrasound anatomy assessment or diagnostic testing when needed.
CVS / Amniocentesis Diagnostic sample for fetal chromosomes/genetic testing. Can confirm or exclude many chromosomal concerns. Invasive; needs specialist counselling and informed consent.
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GE Voluson Signature Expert for first trimester imaging
At Mayflower, first trimester ultrasound is performed on the GE Voluson Signature Expert, an AI-enabled fetal ultrasound platform supporting high-resolution imaging, structured workflow and precise fetal measurements. Technology supports the process — the final interpretation remains doctor-led and clinically contextual.
SonoNT support High-resolution imaging Structured fetal workflow Doctor-led interpretation
Visit flow

What happens during your appointment?

The visit is designed to feel organised and calm. Please bring previous reports, medication details and the exact date of your last menstrual period or IVF embryo transfer details.

1
History and dating review
LMP, IVF dates, previous scans, twin pregnancy status and medical history are reviewed before interpretation.
2
NT scan
The fetal position, CRL and NT measurement are checked carefully. Additional early markers may be reviewed if visible.
3
Blood marker coordination
PAPP-A and free beta-hCG are drawn or reviewed depending on whether the test is planned on the same day or already done.
4
Risk report explanation
Dr. Kunda explains the meaning of the risk estimate and the next step, if any, in practical parent-friendly language.
If something is flagged

What if the result is high-risk or the NT is increased?

A high-risk screening result can be emotionally difficult, but it is not the same as a diagnosis. The next step is careful counselling — not panic.

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Genetic counselling
Your exact risk, age-related baseline risk, NT value and blood marker pattern are reviewed in context.
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NIPT discussion
For selected pregnancies, NIPT may be appropriate as a next screening step after discussion.
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Diagnostic test options
CVS or amniocentesis may be discussed when a definitive chromosomal answer is needed.
Patient education video

Understanding pregnancy ultrasound timing

This video from Dr. Kunda Shahane explains when pregnancy ultrasound is usually planned. It is useful for parents trying to understand why first trimester timing matters.

Pregnancy ultrasound timing — Dr. Kunda Shahane, Mayflower Fetal Medicine
Common questions

FAQs about first trimester combined screening

What is first trimester combined screening?
It is a screening test that combines NT ultrasound with two maternal blood markers — PAPP-A and free beta-hCG — to estimate the chance of common chromosomal conditions such as Trisomy 21, Trisomy 18 and Trisomy 13.
When should I book combined screening?
The NT scan must be performed between 11 weeks and 13 weeks 6 days, when the fetal size is appropriate. The blood test may be drawn around the same window, and in some protocols from around 10 weeks.
Is this better than NT scan alone?
Yes, it is usually more informative than NT measurement alone because the blood markers add biochemical information to the ultrasound and maternal age-based risk calculation.
Does a low-risk result mean my baby is completely normal?
No screening test can guarantee a completely normal baby. A low-risk result is reassuring for the screened conditions, but structural assessment at the 18–22 week anomaly scan remains essential.
If the result is high-risk, does it mean the baby has Down syndrome?
Not necessarily. High-risk means the probability is increased compared with the cut-off used. It is not a diagnosis. Dr. Kunda will explain whether NIPT, CVS or amniocentesis is the appropriate next step.
What is the difference between combined screening and NIPT?
Combined screening uses ultrasound and maternal serum markers. NIPT analyses cell-free fetal DNA in the mother's blood and has higher screening accuracy for common trisomies. However, NIPT does not replace ultrasound assessment, and it is still a screening test.
Can combined screening be done in twin pregnancy?
Twin pregnancies need specialist handling because risk calculation, NT interpretation and blood marker interpretation are more complex. Dr. Kunda will advise based on chorionicity and scan findings.
Do I need fasting for the blood test?
Usually fasting is not required for PAPP-A and free beta-hCG blood testing. However, follow the instruction given by the laboratory or clinic team if any additional tests are planned.
Do I need a full bladder for the scan?
A moderately full bladder may help for transabdominal ultrasound. If a transvaginal approach is needed for better images, an empty bladder may be preferred. The doctor will guide you at the visit.
What if I miss the 13 weeks 6 days window?
Once the NT window is missed, first trimester combined screening cannot be performed in the same way. Other options such as NIPT, second trimester biochemical screening and anomaly scan planning can be discussed.
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First trimester screening gives parents early information — but information must be given with clarity, context and kindness. A number on a report should never create fear without explanation.
Dr. Kunda Shahane
Fetal Medicine Specialist · Mayflower Fetal Medicine & High-Risk Pregnancy Centre, Nagpur
Related services

You may also need

First trimester combined screening is part of a larger early pregnancy care pathway.

💓Fetal Viability Scan 📅Dating Scan 🔍NT Scan 🩸NIPT / Prenatal Screening 🧬Genetic Counselling 🧪CVS Testing 🧫Amniocentesis 👶Anomaly Scan

Book first trimester combined screening in Nagpur

The best time to plan is before the NT window closes. Share your LMP or IVF dates with the clinic team so the correct appointment timing can be advised.

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PCPNDT Act Notice
Mayflower Fetal Medicine Centre strictly complies with the Pre-Conception and Pre-Natal Diagnostic Techniques (Prohibition of Sex Selection) Act, 1994. Sex determination and sex-selective practices are strictly prohibited and punishable by law. All ultrasound and prenatal diagnostic services at this centre are performed exclusively for lawful medical indications — fetal anatomy assessment, fetal wellbeing, and diagnosis of maternal-fetal conditions. Disclosure of fetal sex is illegal and is not performed at this centre under any circumstances.
Medical Disclaimer
This page is for general patient education only and does not constitute medical advice, diagnosis, or treatment. First trimester combined screening is a screening test, not a diagnostic test. Please consult Dr. Kunda Shahane or your treating obstetrician for advice specific to your pregnancy. In an emergency, contact your nearest hospital immediately.