Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
PRENATAL SCREENING
PREPARED BY:
SUGAHSHINI A/P SIVASAMY
NURUL SYAZANA BT ZULMAJDE CHE
NUR AINA ATIRAH BT AZIZAN
PRECONCEPTION SCREENING
Definition
• Maternal age
– Below 20 y/o : STI, preterm delivery, anemia,
preeclampsia
– Above 35 y/o : obstetric complication,
perinatal morbidity and mortality, maternal
mortality,
• Paternal age
– Associated with increase risk of genetic
disease in older man but the incidence is still
low
Social
• Entire community
– eg : rubella vacination, folic acid fortification
• All individuals in particular population
– Program delivered by primary health care
professional to all couples who want to have
children
• High risk individual
– Those who want to conceive child but have risk
factor such as known genetic problem, diabetis,
smoker, heavy alcohol drinker
• Preconception to prevent genetic causes:
– Congenital heart anomalies
– Neural tube defect
– Hemoglobin disorder
– Down syndrome
– G6PD deficiency
• Family planning
• Folic acid supplementation and
fortification
• Iodine and iron deficiency
management
• Minimisation of exposure to teratogens
including alcohol, drugs, tobacco and
illegal drugs
• Minimisation of exposure to
workplace/environmental teratogens
including pesticides and herbicides
Preconception integrated program cont.
• Genetic condition
• G6PD conditon
• Hemoglobin disorder
• Cystic fibrosis
• Tay Sach disease
• Etc
Ethical, legal , social issue
• http://www.toolkit.bornhealthy.org/my-
pccs.htm
• http://www.toolkit.bornhealthy.org/pccs-
background.pdf
• Williams obstetric 24th edition
ANTENATAL CARE
Antenatal care is defined as care of the pregnant
woman before delivery of the infant.
• Blood pressure
• Urine tested for protein and glucose
• Amniocentesis (if required)
History taking
• Past history of fetal anomalies
• Family history of fetal anomaly
• Advanced maternal age (>35years)
• Diabetes mellitus
• Drugs and high alcohol intake
Cont..
Clinical examination
• Abnormal amniotic fluid volume
– Polyhydamnios ( eg, CNS and GIT anomalies)
– Oligohydramnios (eg,obstructive uropathy)
• Malprentation
• Abnormal fetal growth
• Twins
• Complications of pregnancy
Screening for NTD
• Maternal serum alpha fetoprotein (AFP)is
used as a screening test for open neural
tube defect.
• AFP is produced by yolk sac first and then
by fetal liver, in pregnancy they are
present in small amoun in maternal serum
and amniotic fluid.
• Levels of AFP are high in early pregnancy
and declines when it progresses.
Cont...
• In open NTD, AFP leaks into amniotic fluid and
then into maternal serum causing a rise in
MSAFP (higher than normal value)
• Further investigation is needed (amniocentesis,
ultrasound)
• Rhesus iso-immunisation
-Spectrophotometric scanning to assess
for fetal haemolytic disease to estimate
the amt. of bilirubin excreted by the fetus
-Done at frequent intervals to monitor the
effect on fetus of the rising antibody titre
in the mother
RISK OF AMNIOCENTESIS
• Haemorrhage result from perforation of the
placenta or vessels in the umbilical cord (can
be prevented by using US guided
visualisation during the needle aspiration)
• Infection
• Rhesus isoimmunisation (accidental transfer
of fetal blood to maternal circulation)
• Effect on fetal; trauma, orthopaedic postural
deformities, preterm labour and amniotic fluid
leakage
CHORION VILLUS SAMPLING
• Used primarily to
diagnose genetic or
chromosome
abnormalities in the
fetus
• This procedure
performed at 8-12
weeks (1st trimester)
• Transabdominal or
transcervical (most
widely used)- sample
of chorionic villi
aspirated via syringe
(US guided)
Indications for CVS
• Chromosomal analysis
• Inborn errors of metabolism
• DNA analysis
CVS
Advantages Complications
• http://www.toolkit.bornhealthy.org/my-
pccs.htm
• http://www.toolkit.bornhealthy.org/pccs-
background.pdf