Pregnancy: Importance of antenatal care

Pregnancy: Importance of antenatal care

Representational image. News 18

In the traditional antenatal care, maternal and foetal issues are only addressed during pregnancy management after they became evident. It has long been believed that late in pregnancy is when the most intense surveillance should be put into place because that is when the majority of foetal and maternal issues become apparent. There has been a paradigm change in the antenatal care since that mindset, with the entire focus shifting to first trimester where we offer screening for aneuploidies, screening for preeclampsia and detection of structural abnormalities all in the first trimester.

Major prenatal deaths and childhood disabilities are brought on by aneuploidies. As a result, the most prevalent trigger for invasive prenatal diagnosis is the discovery of chromosomal abnormalities. In the first trimester of pregnancy, substantial aneuploidies can be effectively screened for. About 90% of foetuses with trisomy 21 and other major aneuploidies can be detected through screening using foetal nuchal translucency in combination with maternal serum free human chorionic gonadotrophin and pregnancy-associated plasma protein-A, with a false-positive rate of 5%. By including in the ultrasound examination an assessment of the nasal bone and flow in the ductus venosus and across the tricuspid valve, and second, by performing the biochemical test and the ultrasound scan at 12 weeks, it is possible to improve the performance of first-trimester screening.

The risk of miscarriage relates to invasive testing, such as amniocentesis or chorionic villus sampling (CVS), hence these procedures are only used in pregnancies that are thought to be at high risk for aneuploidies

A significant contributor to maternal and neonatal morbidity and mortality is preeclampsia. A higher risk of difficulties for women and babies is linked to early-onset diseases that necessitate preterm delivery. According to the available data, taking low-dose aspirin before 16 weeks of pregnancy considerably lowers the incidence of preterm preeclampsia. In order to provide prompt therapeutic intervention, it is crucial to identify pregnant women who are at risk of developing preeclampsia during the first trimester of pregnancy enabling effective therapeutic intervention in time.

It is noteworthy that the triple test, a first trimester prediction model developed by the Fetal Medicine Foundation (FMF), has undergone successful internal and external validation. The triple test combines maternal factors with measurements of mean arterial pressure, uterine artery pulsatility index, and serum placental growth factor. With a 10% false-positive rate, the FMF triple test provides detection rates of 90% for early preeclampsia and 75% for preterm preeclampsia, respectively with a 10% false-positive rate.

First-trimester ultrasonography can be used to identify structural anomalies, such as malformations of the central nervous system (CNS), abdominal wall, and, more recently, cardiac and facial problems. Because more anomalies are being found in the first trimester,
detailed evaluation of foetal anatomy is increasingly being acknowledged as a crucial component of the first-trimester ultrasound.

It is obvious that foetal malformations should be screened for and diagnosed during the first trimester. Patients should learn about these issues early in pregnancy, when they have the most discretion in making decisions. If termination is chosen, it can be carried out at the least expensive and most risk-free time for the patients.

We have to adopt first trimester screening for our patients as a standard of care.

The author is Head, Department of Fetal Medicine, Amrita Hospital, Faridabad. Views expressed are personal.

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