Risk Assessment at 11–14-Week Antenatal Visit: A Tertiary Referral Center Experience from South India
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Present study carried out in a tertiary referral hospital in South India attempts to determine the predictive value of integrated screening at 11–14-week antenatal visit.
To determine the detection rate of fetal abnormalities at 11–14 weeks and also to predict the placental dysfunction disorders based on early integrated evaluation.
Integrated screening performed on 440 women between 11 and 14 weeks, including detailed maternal history [medical history, bad obstetric history (BOH)], body mass index (BMI), mean arterial pressure (MAP), detailed ultrasound and maternal serum biochemistry as part of combined first-trimester screening for aneuploidy.
There were two proven Down’s syndrome foetuses; both detected with combined screening test. There were 12 fetuses with major anomalies, out of whom 7 (58.3%) detected in 11–14-week scan. Among 440, 114 pregnancies (25.9%) developed complications in pregnancy, including 33 (7.5%) gestational hypertension, 8 (1.8%) pre-eclampsia, 41 (9.38%) SGA, 13 (2.9%) abortions, 22 (5%) indicated and 9 (2.04%) spontaneous preterm deliveries, 38 (8.63%) GDM and 3 (0.6%) stillbirth/IUD. Among the risk factors, age >35 years, BMI >23 kg/m2, BOH, MAP >105 mmHg and PAPP-A <0.5 MoM correlated well with adverse outcome. Using early integrated screening, 78.9% of obstetric complications could be predicted although 306 (69.5%) were labeled high risk, among whom 90 (29.4%) developed adverse pregnancy outcomes.
Majority of fetal abnormalities can be detected, and majority adverse pregnancy outcomes can be predicted at 11–14-week antenatal visit, although this study shows high screen positivity and low specificity in a tertiary referral unit.
KeywordsEarly integrated screening 11-14 weeks screening Pyramid of care Placental dysfunction disorders Serum biochemistry Pregnancy risk prediction
Compliance with Ethical Standards
Conflict of interest
There are no conflicts of interests for any author (financial or otherwise).
Institutional ethical committee clearance has been obtained for the study.
Written informed consent has been taken from all patients for prospective data collection about their pregnancy details and delivery.