The reason we do screening during pregnancy are to analyse:
1. High Risk & Low Risk
2.Prevent Maternal Complications
3.Screen the fetus for Chromosomal errors , Structural Defects , Growth abnormalities
4.Decide the time and mode of safe delivery
FIRST TRIMESTER SCREENING FOR CHROMOSOMAL ANOMALIES
* Screening in the 1st trimester is between 8 – 14 weeks
* Ultrasound Marker: NT
* Biochemical markers: PAPP-A Fb-hCG
* Screening for Trisomy 21 at 11- 14 weeks
SECOND TRIMESTER SCREENING
CERVICAL LENGTH SCREENING ROUTINE TO PREVENT PRETERM LABOUR AND FOR GUIDELINE FOR CX STITCH
ASYMPTOMATIC SINGLETON PREGNANCY A TVS CL <25 MM IN SECOND TRIMESTER
- SCREEN AT 11-13 WEEKS AND THEN AT 22-22 WEEKS Second Trimester screening can be repeated between18-24weeks(Hb / blood sugar / TSH) & urine test as indicated Quadruple OR Triple marker NIPT Anomaly scan 3D/4D scan/ Fetal Echo Uterine artery Doppler Cervical length DIPSI screen 75 gms 2 hour blood sugar 6 Points Blood Sugar HbA1C
- Sequential Screening, Quadruple marker – 15-18 weeks, NIPT 9 week onwards, Amniocentesis – 15 weeks, Anomaly scan, Screening for GDM at 24 to 28 weeks, repeat at 32 weeks in high risk women i.e. Polyhydramnios / previous GDM / Parents & siblings diabetic.
- Screening for PIH- Blood Pressure, Water Retention – edema / rapid weight gain, Micro albuminuria, Spot test – Urine Protein /Creatinine ratio, LDH raised in HELLP Syndrome, Renal artery doppler
- Vaccination- Tetanus Toxoid – ONE DOSE
- Tdap –SECOND DOSE AT 24 WEEKS
- Influenza vaccine 24 weeks onwards
- hpB can be given if not immunised
- Targetted Vaccine in case of travel to endemic areas
- Post partum – HPV vaccine.
Third Trimester Screening
INFECTION SCREEN, Pelvic assessment – Does it improve your decision for normal delivery, Pelvic relaxation techniques, exercises like walking ,squatting, butterfly.
- Non Stress test vs Oxytocin Stress test from 30 weeks.
- Fetal cord blood pH during labour.
- Kick chart recording every kick / roll is 1 movement.
- Count 10 movements every day, should be around 6 in 1 hour.