The Journal of Obstetrics and Gynecology of India

, Volume 67, Issue 6, pp 421–427 | Cite as

Risk Assessment at 11–14-Week Antenatal Visit: A Tertiary Referral Center Experience from South India

  • Anusha Vellamkondu
  • Akhila Vasudeva
  • Rajeshwari G. Bhat
  • Asha Kamath
  • Sapna V. Amin
  • Lavanya Rai
  • Pratap Kumar
Original Article



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.


Early 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).

Ethical Standards

Institutional ethical committee clearance has been obtained for the study.

Informed Consent

Written informed consent has been taken from all patients for prospective data collection about their pregnancy details and delivery.


  1. 1.
    Neiger R. First trimester ultrasound in prenatal diagnosis—part of turning pyramid of prenatal care. J Clin Med. 2014;3(3):986–96.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Nicolaides KH. Turning the pyramid of prenatal care. Fetal Diagn Ther. 2011;29(3):183–96.CrossRefPubMedGoogle Scholar
  3. 3.
    Syngelaki A, Chelemen T, Dagklis T, et al. Challenges in the diagnosis of fetal non-chromosomal abnormalities at 11–13 weeks. Prenat Diagn. 2011;31(1):90–102.CrossRefPubMedGoogle Scholar
  4. 4.
    Rossi AC, Prefumo F. Accuracy of ultrasonography at 11–14 weeks of gestation for detection of fetal structural anomalies, a systematic review. Obstet Gynecol. 2013;122(6):1160–7.CrossRefPubMedGoogle Scholar
  5. 5.
    Pilalis A, Basagiannis C, Eleftheriades M, et al. Evaluation of a two-step ultrasound examination protocol for the detection of major fetal structural defects. J Matern Fetal Neonatal Med. 2012;25(9):1814–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Nicolaides KH. Screening for fetal aneuploidies at 11–13 weeks. Prenat Diagn. 2011;31(1):7–15.CrossRefPubMedGoogle Scholar
  7. 7.
    Santorum M, Wright D, Syngelaki A, et al. Accuracy of first trimester combined test in screening for trisomies 21, 18 and 13. Ultrasound Obstet Gynecol. 2016;. doi: 10.1002/uog.17283.Google Scholar
  8. 8.
    Khalil A, Syngelaki A, Maiz N, et al. Maternal age and adverse pregnancy outcome: a cohort study. Ultrasound Obstet Gynecol. 2013;42(6):634–43.CrossRefPubMedGoogle Scholar
  9. 9.
    Poston L, Caleyachetty R, Cnattingius S, et al. Preconceptional and maternal obesity: epidemiology and health consequences. Lancet Diabetes Endocrinol. 2016;4(12):1025–36.CrossRefPubMedGoogle Scholar
  10. 10.
    Friedman AM, Cleary KL. Prediction and prevention of ischemic placental disease. Semin Perinatol. 2014;38(3):177–82.CrossRefPubMedGoogle Scholar
  11. 11.
    Poon LC, Syngelaki A, Akolekar R, et al. Combined screening for pre-eclampsia and small for gestational age at 11–13 weeks. Fetal Diagn Ther. 2013;33(1):16–27.CrossRefPubMedGoogle Scholar
  12. 12.
    Sibai BM. First-trimester screening with combined maternal clinical factors, biophysical and biomarkers to predict preterm pre-eclampsia and hypertensive disorders: are they ready for clinical use? BJOG. 2015;122(3):282–3.CrossRefPubMedGoogle Scholar
  13. 13.
    Papastefanou I, Souka AP, Pilalis A, et al. First trimester prediction of small- and large-for-gestation neonates by an integrated model incorporating ultrasound parameters, biochemical indices and maternal characteristics. Acta Obstet Gynecol Scand. 2012;91(1):104–11.CrossRefPubMedGoogle Scholar
  14. 14.
    Vintzileos AM, Ananth CV. First trimester prediction of ischemic placental disease. Semin Perinatol. 2014;38(3):159–66.CrossRefPubMedGoogle Scholar

Copyright information

© Federation of Obstetric & Gynecological Societies of India 2017

Authors and Affiliations

  • Anusha Vellamkondu
    • 1
  • Akhila Vasudeva
    • 1
  • Rajeshwari G. Bhat
    • 1
  • Asha Kamath
    • 2
  • Sapna V. Amin
    • 1
  • Lavanya Rai
    • 1
  • Pratap Kumar
    • 1
  1. 1.Department of Obstetrics and GynecologyKasturba Medical College, Manipal UniversityManipalIndia
  2. 2.Department of Community MedicineKasturba Medical College, Manipal UniversityManipalIndia

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