Good quality antenatal care is one of the most effective ways to prevent pregnancy complications. This examination is the routine care that women can expect to receive during their pregnancy. It is very important to go to all scheduled appointments where both, the mother and the baby, are closely examined. During these visits, risk factors can be identified and possible health consequences can be prevented or treated. To ensure the best care and health during pregnancy, a woman should go to her responsible health care professional already when anticipating a pregnancy.
A new model of antenatal care
Today, a standard antenatal care package of certain examinations and tests is available for pregnant women in most European countries. The origins of antenatal care in Europe can be traced back to the beginning of the 20th century in the UK. The introduction of the first model of antenatal care contributed substantially to the decrease of maternal and newborn mortality in the last century. Its content and shape was according to the knowledge and medical capabilities of that time. This included very few visits at the beginning of pregnancy where the doctor had limited options to diagnose and treat. The highest frequency of visits was set during the last trimester of pregnancy (see old model in graphic). Since then, the structure of antenatal care has largely remained unchanged.
Nowadays, however, many complications and diseases can be detected very early in pregnancy as medical knowledge and technology have improved substantially over the years. The possibility of early identification of risk factors and detection of complications at 11-13 weeks of pregnancy enables effective treatment or even prevention of a disease. Prof. Kypros Nicolaides (Fetal Medicine Foundation, UK) developed a new concept of antenatal care, which incorporates these developments and focuses on the very early weeks of pregnancy to identify high risks. These can be monitored very closely and can receive special medical care during the whole course of the pregnancy. Women identified to be at low risk in the beginning of pregnancy, on the other hand, do not need such frequent and specialised antenatal care. This inverted pyramid of care enables a much more individualised patient and disease-specific approach of antenatal care.
All expectant parents and families hope to have a healthy child, and parents want to do all they can to give their baby the best start in life. Especially parents with a higher risk find it reassuring to know that their unborn child is doing well. This is why a large number of expecting parents choose prenatal diagnosis during pregnancy.
Prenatal diagnosis aims to detect possible developmental anomalies and developmental disorders in the fetus mainly with ultrasound scans and blood tests.
The first trimester screening
The first-trimester screening between 11 and 13 weeks of gestation allows to detect a range of pregnancy-related risks without harming the baby. Within this timeframe, it is possible to detect about half of all anomalies that can occur in the organs of a fetus, and to determine the mother’s risk of developing preeclampsia or the the risk of a preterm birth.
The result of a first-trimester screening will be an assessment of the individual risk of the baby being born with a disorder or disability. This type of screening cannot guarantee absolute certainty. However, it can help the parents to decide whether they want to proceed with more invasive testing that will deliver a more conclusive result.
An invasive diagnostic procedure involves penetrating the mother’s body. The tests that are normally available are an amniotic fluid test (also called amniocentesis) or a placental biopsy (often referred to as chorionic villus sampling). It is essential to be aware that these procedures are associated with a risk of miscarriage of about 0.5% (i.e. one of 200 punctures). A new procedure involves a blood test, using the mother’s blood to detect genetic disorders. This test is significantly more reliable than the first-trimester screening but still does not provide absolute certainty.
Ultrasound screening for malformations
In an ultrasound screening between week 19 and 22 can be performed to either measure the baby’s size or to have a systematic examination for malformations. This procedure requires a special qualification on the doctor’s part. Especially expectant parents at risk, with a family history of genetic disorders or with an already sick-born child may benefit from this screening. The baby’s anatomic characteristics will be examined and a precise diagnosis established to exclude malformations.
Maternal record - a record documenting the pregnancy
EFCNI’s vision is a standardized electronic “maternal record” for today’s moving Europe. This record facilitates the treatment and care and helps health professional e.g. in emergency situations or for a following pregnancy to easily identify any risk factors and start adequate treatment or care. It should contain all important information about the status of the pregnancy, such as:
- the examination results of the mother’s health (rubella, blood group incompatibility)
- information about previous pregnancies
- the general medical history
- the expected day of birth
- the course of pregnancy
- relevant data about the child’s health and health indicators of the mother’s pregnancy
- important information from prenatal diagnostics results, cardiographic results
- ultrasound results
- fetal growth curves
- the results of the final examination after birth
This document enables all health professionals to immediately identify the mother’s and baby’s current situation including all relevant medical information.