Antenatal screening RPD.pdf

Pre-conceptional Counselling and screening in pregnancy  Lesson learning outcomes (LLOs) 1. Outline the concept of pre pregnancy counselling 2. Outline screening in pregnancy 3. Describe the routine and targeted screening 4. Understand the role of first and second- trimester ultrasound sc...

Pre-conceptional Counselling and screening in pregnancy  Lesson learning outcomes (LLOs) 1. Outline the concept of pre pregnancy counselling 2. Outline screening in pregnancy 3. Describe the routine and targeted screening 4. Understand the role of first and second- trimester ultrasound scans in antenatal screening. 5. Describe the 20-week screening scan. 6. Outline biochemical tests 7. Outline use of doppler in prenatal screening Preconception Counselling Defines preconception care as a set of interventions aimed at identifying and modifying biomedical, behavioural, and social risks to a woman's health or pregnancy outcome through prevention and management Reduce the chances of poor obstetric (maternal, and fetal) outcomes. Health education and promotion Allowing for risk assessment and intervention Medical optimisation before pregnancy Family planning Achieving a healthy body weight/Life style modifications Screening and treatment (NCDs, Infections etc) Genetic counselling Updating appropriate immunizations (Rubella, varicella etc) Reviewing medications for teratogenic effects Environmental exposure (Workplace, domestic) Foilc acid (High dose where applicable) Psychosocial factors - Intimate partner violence Substance use Screening in pregnancy Do we need antenatal screening ? Triage pregnancies to low risk and high risk groups Planning of subsequent follow up and management Diagnostic testing where relevant For better maternal and fetal outcome Make informed decisions about their health Screening - Methods History Investigations Questionnaires (standardised) Haematological/Infection screening Check lists / Algorithms Urine Previous medical conditions Biochemical Tests Examination USS/Doppler studies BMI. SFH Serum markers Height (Biochemical) Blood pressure Genetic / NIPT Murmurs Fetal MRI Screening - Haematological Screening - Urine /infections BG/Rh MSU - Asymptomatic bacteriuria. Anaemia (FBC) Urine for proteins Red cell antibodies HIV, Syphilis, HepB Screening - Biochemical Rubella susceptibility PPBS/GCT Screening - Serum Markers (Biochemical) PAPP-A B-hCG Alpha FP uE3 Inhibin A Pregnancy-associated plasma protein A (PAPP-A) Acts by increasing the bioavailability of insulin-like growth factor (IGF) Low levels of PAPP-A defined as less than 0.4–0.5 MoM Low levels associated with adverse fetal outcomes - GHT, FD>24 wks, BW 99th percentile has a sensitivity of 31% and specificity of 99% for major congenital heart defects Raised NT is associated with numeric chromosome abnormalities, fetal anomalies such as cardiac defects, diaphragmatic hernia Combination of Screening tests First trimester combined screening Aneuploidy screening - maternal serum free b-hCG and PAPP-A at 9–10 weeks fetal NT at 12 weeks High risk/ Intermediate risk/ low risk Intermediate risk - USS for NB, Doppler Ductus venosus, TR High risk - Confirmatory INVASIVE TESTING by CVS (11-15 wks), Amniocentesis (>15 wks) Second trimester screening Noninvasive prenatal testing (NIPT) Cell free fetal DNA present from as early as 6–7 weeks of gestation Rhesus (Rh) status determination Fetal sex determination Prenatal care - Concepts