Panel on Antenatal Screening

1. PANEL ON ANTENATAL SCREENING
Moderator
DR. Jyoti Agarwal
Co - Moderator
Dr. Jyoti Bhaskar
17/07/15

2. Panelists
• Dr. Raj Bokaria
• Dr. Seema Thakur
• Dr. Ila Gupta
• Dr. Renu Chawla

3. Facts ……
• 51 babies are born in India per minute
• Each year India has more births than the entire
population of Australia
• Number of births per day in Delhi is 988
(annual report on registration of birth and deaths in Delhi 2012)
Good Antenatal care is the key
component for achieving
Milleneium Development Goals

4. Pregnancy is a normal physiological process
• Each pregnancy is at risk for an
adverse outcome for both mother and her baby.
• Risk cannot be eliminated , it can be reduced
through effective , affordable and acceptable
maternity care

5. Goals of antenatal screening
• Any investigations offered should have
known benefits
• Should help us to identify patients for
whom additional care is necessary
• It should be cost effective
• Ensures that the pregnant women and her
foetus are in the best possible health

6. QUESTION
What are the mandatory
antenatal screening tests in the
first trimester of pregnancy that
should be performed for all
patients ?

7. Mandatory tests in first trimester
• Blood group and Rh
• Haemogram
• Hb electrophoresis
• VDRL
• Viral markers
• Oral glucose challenge test
• TSH
• Rubella
• ICT (for Rh negative )
• Urine routine and
microscopy
• Trans vaginal
ultrasound

8. Complete blood count
• Most common cause of anaemia in pregnancy
world wide is iron deficiency.
• 5 – 15% of maternal deaths is due to anaemia
• All pregnant women should be offered screening for
anemia early in pregnancy and at 28 weeks.
• This allows enough time for treatment of anaemia

9. Screening for Haemoglobinopathies
If the women is identified as beta
thalassaemia carrier then father of
the baby should be offered
thalassaemia screening without delay.

10. Asymptomatic Bacteruria
• Defined as persistent bacterial colonisation
of the urinary tract without urinary tract
symptoms
• Incidence 2 – 10 %
• Mandates treatment

11. WHY SUGAR TESTING ?
• Every 5 th women in ANC OPD has GDM
• Indian women have 11 fold increased risk of
developing GDM
• Recent (WHO criteria) prevalence is 16.5
• Due to high prevalence screening is essential
for all Indian pregnant women

12. QUESTION
Can you tell us the
accepted way to
screen for GDM

13. DIPSI :Diabetes in pregnancy study group India
Screening for GDM using
• Fasting plasma glucose
• Random blood glucose
• Urine analysis for glucose
Should not be done

14. Question
What are the optional
screening tests for first
trimester of pregnancy ?

15. Optional Screening Tests
• Pap’s smear
• Glcosylated Hb /
glucose tolerance test
• LFT - SGOT , SGPT
• KFT - serum creatine
• Serum vitamin D levels
• TORCH
• Serology for
tuberculosis ,
• Chlamydia ,
• Gonococcus,
• Group B Streptococcus
• Asymptomatic bacterial
vaginosis

16. Rubella susceptibility screening
• Helps to identify women at risk of
contracting rubella and
• Enable them to vaccination in the
post natal period
Ig G GOOD

17. Routine testing for Toxo ,
Cmv , & Herpes should
not be offered

18. Question
Is ultrasonography safe
during the first trimester ?

19. International society of ultrasound in
obstetrics and gynaecology (ISUOG)
• Use of B mode amd M mode is safe in all
trimesters of pregnancy
BUT
• Foetal exposure time should be minimised
• Doppler USG has thermal index 5 times
higher so its use in first trimester should be
restricted

20. Question
How often should we offer
ultrasound screening in
first trimester ?

21. Diagnostic value of routine USG in the
first trimester of pregnancy
Allows
• Better gestational age assessment
• Early detection of multiple pregnancy
• Early documentation of foetal cardiac activity
• Improved detection of foetal anomalies
• Simultaneously can detect undiagnosed
uterine anomalies , fibroids , cysts , etc

22. Question
What is the importance
of doing USG by the end
of first trimester ?

23. Screening for chromosomal problems
• Should be performed (11 - 13 +6 days)
(NT scan + Dual test )
• Triple or quadruple test (15 – 20 weeks )
Should be counselled that
screening does not provide a
definitive diagnosis

24. Causes of congenital malformations
• Idiopathic 60 %
• Multifactorial 20%
• Genetic 11 %
• Maternal disease (DM ,epilepsy ) 5 %
• Infections 2%
• Enviromental 1%
• Drugs 1 %

25. Question
Elaborate the screening tests
performed in
second trimester of pregnancy ?

26. Screening tests in second trimester of pregnancy
• Haemogram
• Urine routine
examination
• Glucose Challenge test
• ICT (if Rh negative )
• TSH (if on Rx )
• Targeted foetal
anomaly scan ( 18 - 20
weeks )
• Feotal
echocardiography
• TVS to rule out
incompetent os

27. Question
What is the significance of uterine
artery notching or increased PI on
ultrasound report ?

28. Alternative screening methods for
preeclampsia
• MAP
• Uterine artery notching
• Placental growth factor
• Protein induced growth factor
None of these test have satisfactory
sensitivity or specificity and hence
not recommended

29. Question
Would you like to screen all your
patients routinely for incompetent os to
prevent preterm birth ?

30. Question
Is foetal echocardiography routinely
needed for all antenatal patients ?

31. Women should be informed of the
limitations of routine
ultrasound screening

32. Screening for Down’s syndrome
• Targeted anomaly scan using soft markers
should not be used to diagnose
Down’s syndrome
• Relying only on USG to identify
Down syndrome is
not recommended

33. Question
What routine screening antenatal
tests are performed for all patients in
third trimester of pregnancy ?

34. Foetal growth and its wellbeing
• Ultrasound for
Foetal weight
Foetal presentation
AFI
Placental grading
placenta previa
• NST
• Haemogram
• Urine routine exam
• TSH (if on Rx )
• ICT (if Rh neg )
• High vaginal swab

35. Question
When are the foetal doppler studies
indicated and how often they
should be performed ?

36. Routine doppler
ultrasound should not be
used in low risk
pregnancies

37. Thank you all