L3 Prenatal Screening and diagnostic test

Suggest the benefit of prenatal screening. (7)

1. Detection of potential genetic or chromosomal abnormalities at an early stage

2. Couples can decide on further diagnostic test in early pregnancy

3. Enable early intervention and proactive care

4. Reduce anxiety and uncertainty

5. Allow couples to prepare emotionally, gather information about their pregnancy and future care for their child

6. Facilitate informed decision-making

7. Provide an opportunity for family planning, e.g.

   • The option of genetic counseling

   • Exploring reproductive technologies

   • Plan for future pregnancies based on the risk factors identified

List the high risk group for prenatal diagnostic testing (9)

• Maternal age ≥35

• Obesity (pre-pregnancy BMI >30)

• Aboriginal, African, Asian, Hispanic, South Asian ethnicity

• Family history of genetic disorders / DM

• Maternal health problems:

  • Hypertension, epilepsy, thyroid disease, heart, blood disorder

• Previous pregnancy with gestational DM

• Previous delivery of a baby large than 4000gm

• Corticosteroid use during pregnancy

• Multiple pregnancy

Suggest a test that will be do in every antenatal visit

Urinalysis for protein & glucose

Why HCG level drop gradually after the peak level at week 8 ?

• HCG function is to prompts the corpus luteum to continue secrete estrogen & progesterone in order to maintain the uterine lining thickness

• After week 8, the placenta is mature to take over the production of progesterone from corpus luteum

Suggest a prenatal screening that can act as an indicator of fetal life.

• Fetal movement count (Kick count)

What is the normal & abnormal findings of fetal movement count ?

Normal: women counts 10 distinct kicks of her fetus per 1-2 hours

Abnormal: No fetal movement for 12 hours —> notify nurse / doctor

Suggest a prenatal screening that can use to monitor the fetal heartbeat and uterine activity over time

• Cardiotocogram

Suggest a prenatal screening for fetal surveillance before the onset of labour

• Nonstress test (NST)

How to interpret the result of Nonstress test (NST)

• Reactive NST: ≥2 FHR accelerations within 20 mins period

• Non-reactive NST: ≤2 FHR accelerations during a 40 mins period

• Variable decelerations NST

  • No recurrent and < 30s → no further investigation

  • Recurrent: ≥ 3 episodes in 20 mins → extend monitoring

  • Persist for ≥ 1 minute → immediate attention