Pregnancy: Importance of antenatal care


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In conventional antenatal care, maternal-fetal problems are addressed only after they become apparent during pregnancy management. It has long been believed that the third trimester of pregnancy is the time for the most rigorous monitoring, as it is the time when most fetal and maternal problems are evident. There has been a shift in focus to the first trimester, which offers aneuploidy screening, preeclampsia screening, and structural abnormality detection all in the first trimester.

A major prenatal death and childhood disability is brought about by aneuploidy. Consequently, the most common trigger for invasive prenatal diagnosis is the detection of chromosomal abnormalities. Substantial aneuploidy can be effectively screened for in the first trimester of pregnancy. Approximately 90% of fetuses with trisomy 21 and other major aneuploidy are 5-5 by screening using fetal nuchal translucency in combination with maternal serum-free human chorionic gonadotropin and pregnancy-associated plasma protein A. It can be detected with a false positive rate of %. Second, by including evaluation of the nasal bones and evaluation of flow through the venous tract and tricuspid valve on the ultrasound examination; It is possible to improve performance. semester screening.

Because the risk of miscarriage is associated with invasive tests such as amniocentesis and chorionic villus sampling (CVS), these procedures are reserved for pregnancies considered to be at high risk for aneuploidy.

A major contributor to maternal and neonatal morbidity and mortality is pre-eclampsia. A high risk of difficulty in women and babies is associated with early-onset diseases that require preterm birth. Available data show that taking low-dose aspirin before 16 weeks of pregnancy significantly reduces the incidence of preterm preeclampsia. To provide prompt therapeutic intervention, it is important to identify pregnant women at risk of developing pre-eclampsia early in pregnancy and to provide effective therapeutic intervention in a timely manner.

It is worth noting that the triple test, a first trimester predictive model developed by the Fetal Medicine Foundation (FMF), has been successfully validated internally and externally. The triple test combines maternal factors with measurements of mean arterial pressure, uterine artery pulsatility index, and serum placental growth factor. The FMF triple test with a false positive rate of 10% has an early preeclampsia detection rate of 90%, an early preeclampsia detection rate of 75%, and a false positive rate of 10%.

Early pregnancy ultrasound can be used to identify structural abnormalities such as central nervous system (CNS) malformations, abdominal wall, and more recently cardiac and facial problems. Because more abnormalities are seen in early pregnancy,
A detailed assessment of fetal anatomy is increasingly recognized as an important component of early pregnancy ultrasound.

It is clear that fetal malformations should be screened and diagnosed early in pregnancy. Patients learn about these issues early in pregnancy when they have the most discretion in making decisions. If termination is chosen, it can be performed at the least costly and risk-free time for the patient.

We should adopt early pregnancy screening of patients as a standard of care.

The author is Head of Obstetrics and Gynecology and Senior Consultant at Amrita Hospital, Faridabad. Views are personal.

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