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Prenatal diagno o
               sis f
  ge tic diso rs
    ne       rde
CON TEN TS

• I ntro ctio
        du n
• Pu se o pre
     rpo f natal diagno    sis
• I ndicatio o pre
            ns f natal diagno   sis
• M e ds o pre
      tho f natal diagno     sis
• Pro m in pre
      ble s     natal diagno sis
Prenatal diagno is te
                sis     sting fo dise s o
                                r    ase r
 co
  nditio in a fe s be re it is bo The
       ns          tu fo            rn.
    aim is to de ct birth de cts su as
                te           fe    ch
    N e ral tu de cts, D o n syndro e
        u     be fe         w        m,
chro o m abno alitie and ge tic dise s
    mso al      rm s            ne      ase
Pu se o Pre
  rpo f       natal
    D iagno
          sis
Pu se o pre
          rpo f natal diagno
                           sis
•P rovid ing w id e s t p os s ib le rang e of c h oic e s to
w om e n at ris k of h aving c h ild w ith a g e ne tic
ab norm ality.

•P rovid e re as s u ranc e and re d u c e anx ie ty,
e s p e c ially am ong h ig h -ris k g rou p s .

•E nab le h ig h ris k w om e n to c ontinu e
p re g nanc y b y c onfirm ing th e ab s e nc e of a
c e rtain g e ne tic d is e as e .
• A llow th e c ou p le s to p re p are
  p s yc h olog ic ally for th e b irth of
  affe c te d b ab y.

• T o e nab le p re natal tre atm e nt of th e
  affe c te d foe tu s .

• P rovid e ris k inform ation to c ou p le s
  w h e n p re g nanc y te rm ination is an
  op tion.
I ndicatio fo pre
              ns r natal diagno
                              sis

• A dv d m rnal age >3 yrs o age
      ance      ate    ( 5     f   )
• Pre io s child w a chro o m abno ality
     vu           ith   mso al   rm
• F am histo fo a ge tic dise
      ily      ry r   ne     ase
• H isto o u x
        ry f ne plaine fotu lo s o pe
                      d e s sse r rinatal deaths
• A bno alitie ide d in u u
        rm s ntifie         ltraso nd
• Othe high risk facto like m rnal illne s
      r               rs      ate       sse
M e ds Of
   tho
 Pre natal
 D iagnosis
M e ds o pre
        tho f natal diagno
                         sis
      I N VA S I VE       N ON -I N VA S I VE

• A m nioc e nte s is   • U ltras onog rap h y
• C h orionic villu s    T w o d im e ns ional
  s am p ling (C VS )     (2 D ) u ltras ou nd
• C ord oc e nte s is    T h re e d im e ns ional
• F e tos c op y          (3D ) u ltras ou nd
                        • D op p le r u ltras ou nd
I nv e M e ds Of
    asiv     tho
  Prenatal D iagno
                 sis
A m ce sis
                         nio nte
• R e m oval of 1 0-2 0 m l of am niotic flu id from
  th e ab d om inal w all u nd e r u ltras ou nd
  g u id anc e arou nd 1 4 w e e k s of g e s tation and
  its analys is for c h rom os om e b as e d
  ab norm alitie s .

• E nab le s th e d oc tors to m e as u re th e alp h a-
  fe to p rote in le ve l in th e am niotic flu id w h ic h
  ind ic ate s w h e th e r th e foe tu s h as a b rain or
  s p inal c ord d e fe c t.
A m ce sis
   nio nte
Cho nic Villu S am
              rio        s    pling

• R e m oval of s am p le of c h orionic villi u nd e r
  u ltras onog rap h ic g u id anc e .

• C VS m ay b e u s e d ins te ad of am nioc e nte s is
  u nle s s a s am p le of th e am niotic flu id is
  ne e d e d .

• I n C VS , re s u lts are availab le m u c h e arlie r
  in th e p re g nanc y.
Cho nic Villu S am
  rio        s    pling
Co ce sis
                           rdo nte

• P e rc u tane ou s u m b ilic al b lood s am p ling or
  c ord oc e nte s is is u s e d w h e n rap id c h rom os om e
  analys is is ne e d e d u nd e r u ltras onog rap h ic
  g u id anc e .

• Vis u alis ation of th e u m b ilic al ve s s e ls b y
  trans ab d om inal u ltras ou nd and e nab ling foe tal
  b lood s am p ling .

• I t is u s u ally u s e d in th e m anag e m e nt of R h e s u s
  is oim m u niz ation.
Co ce sis
 rdo nte
F e sco
                               to py

• Vis u alis ation of foe tu s b y m e ans of an e nd os c op e .

• I t c an b e u nd e rtak e n to d iag nos e a s u b tle
  s tru c tu ral ab norm alitie s p ointing to a s e riou s
  d iag nos is .

• C an als o b e u s e d to ob tain foe tal s am p le s for s om e
  d iag nos is as inh e rite d s k in d is ord e rs and s om e
  m e tab olic d is ord e rs .
F e sco
   to py
N on-I nvas ive
 M e th od s O f
   P re natal
  D iag nos is
U ltraso graphy
                              no
• I t offe rs valu ab le m e ans for p re natal d iag nos is .

• U s e d for d e te c ting m u ltip le g e s tation, d oc u m e nt
  foe tal viab ility, c onfirm g e s tational ag e and loc aliz e
  p lac e nta.

• I t is a non invas ive te c h niq u e w ith no ris k to th e
  foe tu s or m oth e r.

• A s p e c ialis e d e x p e ns ive e q u ip m e nt and a s k ille d
  e x p e rie nc e d op e rator are ne e d e d .
• I t is offe re d to th os e w ith a h is tory of g e ne tic
  d is e as e .

• D e taile d foe tal anom aly s c anning is offe re d als o to
  all p re g nant w om e n arou nd th e 1 8 w e e k s of
  g e s tation as a s c re e ning p roc e d u re for s tru c tu ral
  anom alie s .

• I t c an id e ntify fe atu re s w h ic h s u g g e s t u nd e rlying
  c h rom os om al ab norm ality ind ic ating am nioc e nte s is .
U ltraso graphy
       no
2 U ltraso graphy
-D       no
       • 2 -D U ltras onog rap h y is a
         w id e ly u s e d te c h niq u e to
         p rod u c e live 2 D im ag e s of th e
         fe tu s .

       • T h is typ e c re ate s tw o
         d im e ns ional im ag e s th at h e lp
         d oc tors to d e te rm ine th e b ab y's
         g e s tational ag e and e valu ate it’s
         g row th and d e ve lop m e nt.

       • A s tand ard p re natal 2 -D
         u ltras ou nd e x am u s u ally tak e s
         ab ou t 2 0 m inu te s .
3 U ltraso graphy
-D       no
    • I t w as 1 s t d e ve lop e d b y O laf von
      R am m and S te p h e n S m ith at D u k e
      U nive rs ity in 1 987
    • 3-D U ltras onog rap h y is a w id e ly
      u s e d te c h niq u e to p rod u c e live 3-D
      im ag e s of th e fe tu s .
    • I n 3D fe tal s c anning , ins te ad of th e
      s ou nd w ave s b e ing s e nt s traig h t d ow n
      and re fle c te d b ac k , th e y are s e nt at
      d iffe re nt ang le s . T h e re tu rning
      e c h oe s are p roc e s s e d b y a
      s op h is tic ate d c om p u te r p rog ram
      re s u lting in a re c ons tru c te d th re e
      d im e ns ional volu m e im ag e of fe tu s 's
      s u rfac e or inte rnal org ans .
D o r U ltraso nd
  pple       u

   I t is a s p e c ial form of u ltras onog rap h y
   th at im ag e s and e x am ine s b lood flow .
   I t e x am ine s th e c h ang e in p itc h in th e
   s ou nd w ave s p rod u c e d , w h ic h p rovid e s
   inform ation ab ou t b lood flow . T h e
   d ire c tion of b lood flow is s h ow n in
   d iffe re nt c olors on th e s c re e n. T h is
   typ e of im ag ing c an p rovid e d e tails
   ab ou t c irc u lation w h ic h is p artic u larly
   h e lp fu l if th e m oth e r h as h ig h b lood
   p re s s u re or th e b ab y is g row ing m ore
   s low ly th an e x p e c te d .
Pro m in pre
            ble s     natal diagno :
                                 sis

• F ailu re to ob tain a s am p le or c u ltu re failu re .

• A n am b ig u ou s c h rom os om e re s u lt.

• A n u ne x p e c te d c h rom os om e re s u lt.

• R is k to th e m oth e r and th e foe tu s .
Prenatal Tre e
                              atmnt

• I n m os t s itu ations th e d iag nos is of p re natal
  ab norm alitie s h as a s u b s e q u e nt op tion of
  te rm ination of th e p re g nanc y.

• W h ile th is ap p lie s in m os t s itu ations , th e re is
  c au tiou s op tim is m th at w ith th e ad ve nt of g e ne
  th e rap y p re natal d iag nos is w ill, in tim e , le ad to
  e ffe c tive tre atm e nt in ueo
                                tr.
TH A N K YOU !

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Prenatal diagnosis

  • 1. Prenatal diagno o sis f ge tic diso rs ne rde
  • 2. CON TEN TS • I ntro ctio du n • Pu se o pre rpo f natal diagno sis • I ndicatio o pre ns f natal diagno sis • M e ds o pre tho f natal diagno sis • Pro m in pre ble s natal diagno sis
  • 3. Prenatal diagno is te sis sting fo dise s o r ase r co nditio in a fe s be re it is bo The ns tu fo rn. aim is to de ct birth de cts su as te fe ch N e ral tu de cts, D o n syndro e u be fe w m, chro o m abno alitie and ge tic dise s mso al rm s ne ase
  • 4. Pu se o Pre rpo f natal D iagno sis
  • 5. Pu se o pre rpo f natal diagno sis •P rovid ing w id e s t p os s ib le rang e of c h oic e s to w om e n at ris k of h aving c h ild w ith a g e ne tic ab norm ality. •P rovid e re as s u ranc e and re d u c e anx ie ty, e s p e c ially am ong h ig h -ris k g rou p s . •E nab le h ig h ris k w om e n to c ontinu e p re g nanc y b y c onfirm ing th e ab s e nc e of a c e rtain g e ne tic d is e as e .
  • 6. • A llow th e c ou p le s to p re p are p s yc h olog ic ally for th e b irth of affe c te d b ab y. • T o e nab le p re natal tre atm e nt of th e affe c te d foe tu s . • P rovid e ris k inform ation to c ou p le s w h e n p re g nanc y te rm ination is an op tion.
  • 7. I ndicatio fo pre ns r natal diagno sis • A dv d m rnal age >3 yrs o age ance ate ( 5 f ) • Pre io s child w a chro o m abno ality vu ith mso al rm • F am histo fo a ge tic dise ily ry r ne ase • H isto o u x ry f ne plaine fotu lo s o pe d e s sse r rinatal deaths • A bno alitie ide d in u u rm s ntifie ltraso nd • Othe high risk facto like m rnal illne s r rs ate sse
  • 8. M e ds Of tho Pre natal D iagnosis
  • 9. M e ds o pre tho f natal diagno sis I N VA S I VE N ON -I N VA S I VE • A m nioc e nte s is • U ltras onog rap h y • C h orionic villu s  T w o d im e ns ional s am p ling (C VS ) (2 D ) u ltras ou nd • C ord oc e nte s is  T h re e d im e ns ional • F e tos c op y (3D ) u ltras ou nd • D op p le r u ltras ou nd
  • 10. I nv e M e ds Of asiv tho Prenatal D iagno sis
  • 11. A m ce sis nio nte • R e m oval of 1 0-2 0 m l of am niotic flu id from th e ab d om inal w all u nd e r u ltras ou nd g u id anc e arou nd 1 4 w e e k s of g e s tation and its analys is for c h rom os om e b as e d ab norm alitie s . • E nab le s th e d oc tors to m e as u re th e alp h a- fe to p rote in le ve l in th e am niotic flu id w h ic h ind ic ate s w h e th e r th e foe tu s h as a b rain or s p inal c ord d e fe c t.
  • 12. A m ce sis nio nte
  • 13. Cho nic Villu S am rio s pling • R e m oval of s am p le of c h orionic villi u nd e r u ltras onog rap h ic g u id anc e . • C VS m ay b e u s e d ins te ad of am nioc e nte s is u nle s s a s am p le of th e am niotic flu id is ne e d e d . • I n C VS , re s u lts are availab le m u c h e arlie r in th e p re g nanc y.
  • 14. Cho nic Villu S am rio s pling
  • 15. Co ce sis rdo nte • P e rc u tane ou s u m b ilic al b lood s am p ling or c ord oc e nte s is is u s e d w h e n rap id c h rom os om e analys is is ne e d e d u nd e r u ltras onog rap h ic g u id anc e . • Vis u alis ation of th e u m b ilic al ve s s e ls b y trans ab d om inal u ltras ou nd and e nab ling foe tal b lood s am p ling . • I t is u s u ally u s e d in th e m anag e m e nt of R h e s u s is oim m u niz ation.
  • 16. Co ce sis rdo nte
  • 17. F e sco to py • Vis u alis ation of foe tu s b y m e ans of an e nd os c op e . • I t c an b e u nd e rtak e n to d iag nos e a s u b tle s tru c tu ral ab norm alitie s p ointing to a s e riou s d iag nos is . • C an als o b e u s e d to ob tain foe tal s am p le s for s om e d iag nos is as inh e rite d s k in d is ord e rs and s om e m e tab olic d is ord e rs .
  • 18. F e sco to py
  • 19. N on-I nvas ive M e th od s O f P re natal D iag nos is
  • 20. U ltraso graphy no • I t offe rs valu ab le m e ans for p re natal d iag nos is . • U s e d for d e te c ting m u ltip le g e s tation, d oc u m e nt foe tal viab ility, c onfirm g e s tational ag e and loc aliz e p lac e nta. • I t is a non invas ive te c h niq u e w ith no ris k to th e foe tu s or m oth e r. • A s p e c ialis e d e x p e ns ive e q u ip m e nt and a s k ille d e x p e rie nc e d op e rator are ne e d e d .
  • 21. • I t is offe re d to th os e w ith a h is tory of g e ne tic d is e as e . • D e taile d foe tal anom aly s c anning is offe re d als o to all p re g nant w om e n arou nd th e 1 8 w e e k s of g e s tation as a s c re e ning p roc e d u re for s tru c tu ral anom alie s . • I t c an id e ntify fe atu re s w h ic h s u g g e s t u nd e rlying c h rom os om al ab norm ality ind ic ating am nioc e nte s is .
  • 23. 2 U ltraso graphy -D no • 2 -D U ltras onog rap h y is a w id e ly u s e d te c h niq u e to p rod u c e live 2 D im ag e s of th e fe tu s . • T h is typ e c re ate s tw o d im e ns ional im ag e s th at h e lp d oc tors to d e te rm ine th e b ab y's g e s tational ag e and e valu ate it’s g row th and d e ve lop m e nt. • A s tand ard p re natal 2 -D u ltras ou nd e x am u s u ally tak e s ab ou t 2 0 m inu te s .
  • 24. 3 U ltraso graphy -D no • I t w as 1 s t d e ve lop e d b y O laf von R am m and S te p h e n S m ith at D u k e U nive rs ity in 1 987 • 3-D U ltras onog rap h y is a w id e ly u s e d te c h niq u e to p rod u c e live 3-D im ag e s of th e fe tu s . • I n 3D fe tal s c anning , ins te ad of th e s ou nd w ave s b e ing s e nt s traig h t d ow n and re fle c te d b ac k , th e y are s e nt at d iffe re nt ang le s . T h e re tu rning e c h oe s are p roc e s s e d b y a s op h is tic ate d c om p u te r p rog ram re s u lting in a re c ons tru c te d th re e d im e ns ional volu m e im ag e of fe tu s 's s u rfac e or inte rnal org ans .
  • 25. D o r U ltraso nd pple u I t is a s p e c ial form of u ltras onog rap h y th at im ag e s and e x am ine s b lood flow . I t e x am ine s th e c h ang e in p itc h in th e s ou nd w ave s p rod u c e d , w h ic h p rovid e s inform ation ab ou t b lood flow . T h e d ire c tion of b lood flow is s h ow n in d iffe re nt c olors on th e s c re e n. T h is typ e of im ag ing c an p rovid e d e tails ab ou t c irc u lation w h ic h is p artic u larly h e lp fu l if th e m oth e r h as h ig h b lood p re s s u re or th e b ab y is g row ing m ore s low ly th an e x p e c te d .
  • 26. Pro m in pre ble s natal diagno : sis • F ailu re to ob tain a s am p le or c u ltu re failu re . • A n am b ig u ou s c h rom os om e re s u lt. • A n u ne x p e c te d c h rom os om e re s u lt. • R is k to th e m oth e r and th e foe tu s .
  • 27. Prenatal Tre e atmnt • I n m os t s itu ations th e d iag nos is of p re natal ab norm alitie s h as a s u b s e q u e nt op tion of te rm ination of th e p re g nanc y. • W h ile th is ap p lie s in m os t s itu ations , th e re is c au tiou s op tim is m th at w ith th e ad ve nt of g e ne th e rap y p re natal d iag nos is w ill, in tim e , le ad to e ffe c tive tre atm e nt in ueo tr.
  • 28. TH A N K YOU !