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A model for a new pyramid of prenatal care based on the 11 to 13 weeks' assessment
Author(s) -
Nicolaides Kypros H.
Publication year - 2011
Publication title -
prenatal diagnosis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.956
H-Index - 97
eISSN - 1097-0223
pISSN - 0197-3851
DOI - 10.1002/pd.2685
Subject(s) - medicine , christian ministry , pregnancy , prenatal care , memorandum , public health , health care , pediatrics , family medicine , obstetrics , nursing , population , environmental health , law , political science , genetics , biology
One century ago it was recognized that with the methods and material at our disposal we were not making all the progress possible toward solving many problems of prenatal diagnosis and treatment (Ballantyne, 1901, 1921). In order to achieve these objectives it was urged that a new means of investigation should be undertaken which had not yet been tried, at least not yet attempted on a large scale and in a systematic fashion. This led to the introduction of prenatal care which constituted a major advance in the care of pregnant women and played a pivotal role in the substantial reduction in maternal and perinatal mortality achieved during the last century. In 1929, the Ministry of Health in the UK issued a Memorandum on Antenatal Clinics recommending that women should first be seen at 16 weeks, then at 24 and 28 weeks, fortnightly thereafter until 36 weeks and then weekly until delivery (Figure 1) (Ministry of Health Report, 1929). No explicit rationale was offered for either the timing or clinical content of visits, yet these guidelines established the pattern of prenatal care to be followed throughout the world until now. The high concentration of visits in the late third trimester implies that most complications occur toward the end of pregnancy and most adverse outcomes cannot be predicted from the first trimester. However, is this really the case? Scientific advances in the last 20 years have raised the hope that many pregnancy complications are potentially detectable from at least as early as the 12th week of gestation. It has become apparent that most major aneuploidies can be identified at 11 to 13 weeks’ gestation by a combination of maternal characteristics, ultrasound findings and biochemical testing of maternal blood. It is also becoming increasingly apparent that an integrated first hospital visit at 11 to 13 weeks combining data from maternal characteristics and history with findings of biophysical and biochemical tests can define the patient-specific risk for a wide spectrum of pregnancy complications, including miscarriage and fetal death, preterm delivery, preeclampsia, gestational diabetes, fetal growth restriction and macrosomia.