- The document discusses the benefits of first trimester antenatal care, including screening for fetal anomalies and maternal-fetal complications. It notes that detailed ultrasound examination and markers in the first trimester can predict many complications later in pregnancy and allow for early intervention. Conditions like Down's syndrome, open neural tube defects, congenital heart defects, preeclampsia, and fetal growth restriction can potentially be detected through a combination of ultrasound assessment, medical history, and serum markers in the first trimester. This represents a shift away from traditional late pregnancy surveillance to an earlier risk assessment approach through innovations in first trimester screening.
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
Selective progesterone receptor modulators (SPRMs)
Stimulates growth :
Up regulating epidermal growth factor (EGF)
Down regulating tumour necrosis factor-alpha expression
Inhibits growth :
Downregulating insulin-like growth factor-1 (IGF-1) expression
NO EFFECT ON ESTRADIOL LEVELS
Mifepristone : 5 or 10 mg per day for 1 year
Ulipristal acetate: 5-10mg/day for 13 weeks
Pro apoptotic and anti-proliferative effects on fibroid cells
Role of Stem Cells in Obstetrics and Gynecology PracticeAsha Jain
Role of Stem Cells in Obstetrics and Gynecology Practice
Talk delivered at 4th Biennial International ISCSGCON 2021
on Febuary 13,2021 by Dr. Asha Jain
Thromboprophylaxis in pregnancy and puerperiumManju Puri
This presentation is about thromboprophylaxis in pregnancy and puerperium and describes the risk assessment , indications, drugs to be used, when to start, for how long to continue.
Low dose aspirin is a wonderful drug in the management of cerebrovascular and cardiovascular disease.However ther is lot of controversies about its use in obstetrics largely due to conclusions drawn on trials with flawed methodology, a reader must always view the evidence critically especially when the not harmful interventions are likely to benefit the patient....
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
Selective progesterone receptor modulators (SPRMs)
Stimulates growth :
Up regulating epidermal growth factor (EGF)
Down regulating tumour necrosis factor-alpha expression
Inhibits growth :
Downregulating insulin-like growth factor-1 (IGF-1) expression
NO EFFECT ON ESTRADIOL LEVELS
Mifepristone : 5 or 10 mg per day for 1 year
Ulipristal acetate: 5-10mg/day for 13 weeks
Pro apoptotic and anti-proliferative effects on fibroid cells
Role of Stem Cells in Obstetrics and Gynecology PracticeAsha Jain
Role of Stem Cells in Obstetrics and Gynecology Practice
Talk delivered at 4th Biennial International ISCSGCON 2021
on Febuary 13,2021 by Dr. Asha Jain
Thromboprophylaxis in pregnancy and puerperiumManju Puri
This presentation is about thromboprophylaxis in pregnancy and puerperium and describes the risk assessment , indications, drugs to be used, when to start, for how long to continue.
Low dose aspirin is a wonderful drug in the management of cerebrovascular and cardiovascular disease.However ther is lot of controversies about its use in obstetrics largely due to conclusions drawn on trials with flawed methodology, a reader must always view the evidence critically especially when the not harmful interventions are likely to benefit the patient....
Invited lecture by Dr Sujoy dasgupta in the Annual Conference of the "Academy of Clinical Embryologists" (ACE) held in October 2021 in "Hybrid mode" (Kolkata and Webinar)
Lecture by Dr Sujoy Dasgupta in BOGSCON 2015, the Annual Conference of Bengal Obstetric and Gynaecological Society, held at Hotel Novotel, Kolkata in January, 2015; where he had been invited as FACULTY to deliver his lecture
interest in stem cells is raising in different field of medicine. The question is : is it successful in Gynecology or it is still too early to say that. The present talk may help to explore this .
this presentation highlights the principles of uterine and ovarian transplantation. It explores the past and examines the current status for uterine and ovarian factor infertility.
In cases of Nulliparous prolapse or even patients deserving child bearing uterus preserving surgeries are done.
Recently even for prolapse if women want to preserve uterus for variety of reasons ,with newer minimally invasive methods it is now gaining popularity.Larger studies and longer followup is required.
Embryo implantation in the region of a previous caesarean section scar is a rare but potentially catastrophic complication of a previous cesarean birth.
Recurrent pregnancy loss is a significant redroductive medical problem, influencing 2%–5% of couples. ... Throughout the years, proof based medications, for example, surgical correction of uterine abnormalities or asprin and heparin for antiphospholipid syndrome have improved the results for couples with repetitive pregnancy loss.
Selection of an embryo from a large number of embryos and then placing it to the uterus is known as selective embryo transfer. This fertility preservation process is usually done after the process of IVF cycle and cancels the risks of spontaneous transfer of multiple embryos. Have a look at the detailed description of elective single embryo transfer in the following ppt.
Invited lecture by Dr Sujoy dasgupta in the Annual Conference of the "Academy of Clinical Embryologists" (ACE) held in October 2021 in "Hybrid mode" (Kolkata and Webinar)
Lecture by Dr Sujoy Dasgupta in BOGSCON 2015, the Annual Conference of Bengal Obstetric and Gynaecological Society, held at Hotel Novotel, Kolkata in January, 2015; where he had been invited as FACULTY to deliver his lecture
interest in stem cells is raising in different field of medicine. The question is : is it successful in Gynecology or it is still too early to say that. The present talk may help to explore this .
this presentation highlights the principles of uterine and ovarian transplantation. It explores the past and examines the current status for uterine and ovarian factor infertility.
In cases of Nulliparous prolapse or even patients deserving child bearing uterus preserving surgeries are done.
Recently even for prolapse if women want to preserve uterus for variety of reasons ,with newer minimally invasive methods it is now gaining popularity.Larger studies and longer followup is required.
Embryo implantation in the region of a previous caesarean section scar is a rare but potentially catastrophic complication of a previous cesarean birth.
Recurrent pregnancy loss is a significant redroductive medical problem, influencing 2%–5% of couples. ... Throughout the years, proof based medications, for example, surgical correction of uterine abnormalities or asprin and heparin for antiphospholipid syndrome have improved the results for couples with repetitive pregnancy loss.
Selection of an embryo from a large number of embryos and then placing it to the uterus is known as selective embryo transfer. This fertility preservation process is usually done after the process of IVF cycle and cancels the risks of spontaneous transfer of multiple embryos. Have a look at the detailed description of elective single embryo transfer in the following ppt.
Neonatal and Obstetric Risk Assessment (NORA) Pregnancy Cohort Study in Singa...Premier Publishers
The Neonatal and Obstetric Risk Assessment (NORA) pregnancy cohort study was set up to assess clinical, biochemical and biophysical markers for risk assessment and prediction of the outcomes early in pregnancy. A total of 3271 patients who were in KK Women’s and Children’s Hospital between September 2010 and October 2014 were screened and 1013 patients consented to participate in the study. Women were followed at 18 to 22 weeks, 28 to 32 weeks and 34 weeks and above, till their postnatal discharge from the hospital. Finally, 926 patients remained for studying the outcome. In NORA study, we established locally derived and gestational age-specific reference intervals for the five thyroid hormone parameters. Higher serum progesterone levels at 28–32 weeks of pregnancy were observed in women who had preterm deliveries compared with women with term deliveries in the cohort. We also found that extracellular vesicle (EV) biomarkers enhanced the predictive robustness of an existing pre-eclampsia (PE) biomarker sufficiently to justify PE screening in a low-risk general obstetric population. We plan to further conduct a range of serial assessments from the biosamples which will provide a comprehensive and valuable information of the dynamics of maternal conditions and fetal development during pregnancy.
A COMPARATIVE ANALYSIS OF HEMATOLOGICAL INDICES IN PREGNANT WOMEN AND NON PR...FidelityP
Red blood cell (RBC) indices are individual components of a routine blood test called the complete blood count (CBC). The CBC is used to measure the quantity and physical characteristics of different types of cells found in your blood. Blood consists of RBCs, white blood cells (WBCs), and platelets that are suspended in your plasma. Platelets are cells that enable clot formation. RBCs contain hemoglobin, which carries oxygen throughout your body to all of your tissues and organs. An RBC is pale red and gets its color from hemoglobin. It’s shaped like a doughnut, but it has a thinner area in the middle instead of a hole. Your RBCs are normally all the same color, size, and shape. However, certain conditions can cause variations that impair their ability to function properly. The RBC indices measure the size, shape, and physical characteristics of the RBCs. Your doctor can use RBC indices to help diagnose the cause of anemia. Anemia is a common blood disorder in which you have too few, misshapen, or poorly functional RBCs123
Introduction
Pregnancy is a normal physiological process and any intervention that is offered to the pregnant or expectant mother should have known benefits and should be acceptable to the woman
Screening in pregnancy is the process of surveying a population of women with markers and defined screening cut-off levels, to identify those at higher risk for a particular disorder
All pregnant women, regardless of age, should be offered, through an informed counselling process, the option of a prenatal screening test for the most common clinically significant fetal aneuploidies
Dr Sujoy Dasgupta was invited to deliver a lecture at BOGSCON (The Annual Conference of Bengal Obstetric and Gynaecological Society) held at Kolkata in December 2019
Discover the 5 essential steps for menopause hormone therapy, including benefits, risks, and how to make informed decisions for a smoother transition through menopause.
Learn about the connection between Polycystic Ovary Syndrome (PCOS) and Metabolic Syndrome. Discover symptoms, associated risks, and effective management strategies to improve your health and well-being.
Late onset menopause, or delayed menopause, refers to the cessation of menstrual periods and reproductive function occurring at an older age than the average onset of menopause, which is typically around 51 years old. When menopause occurs after the age of 55, it is considered late onset. This phenomenon is relatively rare, affecting a small percentage of women, and is influenced by various factors including genetics, lifestyle, and environmental factors.
A urinary tract infection (UTI) during pregnancy occurs when bacteria enter the urinary tract, leading to an infection. This condition is relatively common during pregnancy due to hormonal changes that can affect the urinary system, as well as the physical changes that occur as the uterus expands and puts pressure on the bladder. UTIs in pregnancy require prompt attention and treatment to prevent complications for both the mother and the baby
Discover the essential steps and expert advice for optimal pre-conception care. Learn how to enhance your fertility, ensure a healthy pregnancy, and lay the foundation for your baby's lifelong well-being
Explore the intricacies of ovulation induction in intrauterine insemination (IUI) with Dr Laxmi Shrikhande's informative slide share presentation. From understanding the hormonal mechanisms to the latest techniques, this presentation offers insights into optimizing fertility through IUI. Whether you're a clinician seeking to enhance patient outcomes or an individual navigating fertility treatments, this resource provides valuable knowledge for your journey towards conception.
Discover the keys to maintaining optimal health and vitality during midlife with our comprehensive guide to nutrition. Learn about the dietary choices and habits that support physical well-being, cognitive function, and emotional balance as you navigate through this transformative stage of life. From nutrient-rich foods to mindful eating practices, empower yourself to thrive at midlife and beyond.
In this informative presentation, we delve into the complexities of fever during pregnancy. Pregnancy brings about various concerns, and fever can be particularly worrisome. Join us as we discuss the causes, potential risks, and necessary steps to take if you experience fever while pregnant. Our expert provides valuable insights and practical tips to ensure the safety and well-being of both mother and baby. Don't let uncertainty overwhelm you; empower yourself with knowledge about fever in pregnancy and learn what steps to take next. Watch now to gain the guidance you need for a healthy pregnancy journey.
Unlock the secrets to vibrant health and vitality during midlife with our comprehensive guide on nutrition tailored specifically for women. Discover expert advice, science-backed strategies, and practical tips to support hormonal balance, bone health, metabolism, and overall well-being. Whether you're navigating menopause or simply aiming to thrive in your prime years, this SlideShare presentation is your roadmap to achieving optimal nutrition and vitality in midlife
Welcome to "Gestational Diabetes Mellitus (GDM): What Every Obstetrician Should Know"
Overview of the presentation's objectives and key topics to be covered
IVF Pregnancy -Is it different? A presentation by Dr Laxmi Shrikhande the leading IVF specialist in India
IVF (In Vitro Fertilization) pregnancy can be both similar to and different from natural conception in several ways. In IVF, fertilization of the egg occurs outside the body in a laboratory setting, typically involving the extraction of eggs from the ovaries and combining them with sperm in a petri dish. Once fertilization is successful, the resulting embryos are transferred to the uterus for implantation
Uterine Fibroids: Symptoms, Causes, Risk Factors & Treatment uterine fibroids aren't associated with an increased risk of uterine cancer and almost never develop into cancer
A benign tumor of muscular and fibrous tissues, typically developing in the wall of the uterus.
Prevalence varies among studies and countries (4.5-68.6%)
Nearly 20-30% Indian women in reproductive age group have fibroid uterus
At any given time, nearly 15-25 million Indian women have fibroid uterus
Understand fibroids in a better way
Non-Specific Musculoskeletal Pain presented by Dr.Laxmi Shrikhande Consultant –Shrikhande Hospital & Research Centre Pvt Ltd
Nagpur. The leading hospital in Nagpur
This presentation covers the
1)Pain
2)Characteristics
3) Causes
4) Symptoms
You can get the awareness that you were looking for Non Specific Musculoskeletal Pain details
Non-Specific Musculoskeletal Pain presented by Dr.Laxmi Shrikhande Consultant –Shrikhande Hospital & Research Centre Pvt Ltd
Nagpur. The leading hospital in Nagpur
This presentation covers the
1)Pain
2)Characteristics
3) Causes
4) Symptoms
Contraception where have we been and where are we going is a presentation made by Dr.Laxmi Shrikhande who is a Fertility Specialist, Laparoscopic Surgeon & no scar Hysterectomy Specialist and a leading Gynaecologist from Nagpur
Identifying women with GDM is important because appropriate therapy can decrease maternal and fetal morbidity .
Can prevent two generations from developing diabetes in the future.
International Cancer Survivors Day is celebrated during June, placing the spotlight not only on cancer survivors, but also their caregivers.
CANSA has compiled a list of tips and guidelines of support:
https://cansa.org.za/who-cares-for-cancer-patients-caregivers/
Feeding plate for a newborn with Cleft Palate.pptxSatvikaPrasad
A feeding plate is a prosthetic device used for newborns with a cleft palate to assist in feeding and improve nutrition intake. From a prosthodontic perspective, this plate acts as a barrier between the oral and nasal cavities, facilitating effective sucking and swallowing by providing a more normal anatomical structure. It helps to prevent milk from entering the nasal passage, thereby reducing the risk of aspiration and enhancing the infant's ability to feed efficiently. The feeding plate also aids in the development of the oral muscles and can contribute to better growth and weight gain. Its custom fabrication and proper fitting by a prosthodontist are crucial for ensuring comfort and functionality, as well as for minimizing potential complications. Early intervention with a feeding plate can significantly improve the quality of life for both the infant and the parents.
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INFECTION OF THE BRAIN -ENCEPHALITIS ( PPT)blessyjannu21
Neurological system includes brain and spinal cord. It plays an important role in functioning of our body. Encephalitis is the inflammation of the brain. Causes include viral infections, infections from insect bites or an autoimmune reaction that affects the brain. It can be life-threatening or cause long-term complications. Treatment varies, but most people require hospitalization so they can receive intensive treatment, including life support.
About this webinar: This talk will introduce what cancer rehabilitation is, where it fits into the cancer trajectory, and who can benefit from it. In addition, the current landscape of cancer rehabilitation in Canada will be discussed and the need for advocacy to increase access to this essential component of cancer care.
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
Cold Sores: Causes, Treatments, and Prevention Strategies | The Lifesciences ...The Lifesciences Magazine
Cold Sores, medically known as herpes labialis, are caused by the herpes simplex virus (HSV). HSV-1 is primarily responsible for cold sores, although HSV-2 can also contribute in some cases.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
Trauma Outpatient Center is a comprehensive facility dedicated to addressing mental health challenges and providing medication-assisted treatment. We offer a diverse range of services aimed at assisting individuals in overcoming addiction, mental health disorders, and related obstacles. Our team consists of seasoned professionals who are both experienced and compassionate, committed to delivering the highest standard of care to our clients. By utilizing evidence-based treatment methods, we strive to help our clients achieve their goals and lead healthier, more fulfilling lives.
Our mission is to provide a safe and supportive environment where our clients can receive the highest quality of care. We are dedicated to assisting our clients in reaching their objectives and improving their overall well-being. We prioritize our clients' needs and individualize treatment plans to ensure they receive tailored care. Our approach is rooted in evidence-based practices proven effective in treating addiction and mental health disorders.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
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1. • Medical Director-Shrikhande Fertility Clinic, Nagpur
• Chairperson Designate ICOG 2020
• National Corresponding Editor-Journal of OB/GY of India JOGI
• Clinical Secretary National AMWI
• Past Senior Vice President FOGSI
• Founder Patron & President –ISOPARB Vidarbha Chapter
• Received Nagpur Ratan Award at the hands of Union Minister Shri Nitinji Gadkari
• Received Bharat excellence Award for women’s health
• Received Mehroo Dara Hansotia Best Committee Award for her work as Chairperson HIV/AIDS
Committee, FOGSI
• Received appreciation letter from Maharashtra Government for her work in the field of SAVE
THE GIRL CHILD
• Immediate Past President Menopause Society, Nagpur
• Past President Nagpur OB/GY Society 2005-06
• Visited 96 FOGSI Societies as invited faculty
• Delivered 16 orations and 450 guest lectures
• Publications- 20 National & 11 International
• Sensitized 2 lakh boys and girls on Do’s & Don'ts of adolescent health
Dr. Laxmi Shrikhande
Nagpur
MBBS;MD;FICOG;FICMU;FICMC
2. What’s new in Ante Natal Care ?
Dr Laxmi Shrikhande
Nagpur
3. Traditional care
• Pregnancy management typically involves reacting to maternal and fetal
problems only after they develop.
• Because most fetal and maternal complications become apparent late in
pregnancy, it has been traditionally thought that is when the most intensive
surveillance should be implemented.
4. Nicolaides KH. A model for a new pyramid of prenatal care based on the 11 to 13 weeks’
assessment. Prenat Diagn 2011;31:3–6.
5. New shift
• some very important complications that occur later in pregnancy can be
predicted in the first trimester itself.
• Inverted pyramid helps in dividing cases into high risk & low risk in the first
trimester
Nicolaides KH. Turning the pyramid of prenatal care. Fetal Diagn Ther 2011;29: 183–96.
11. Pre-conceptional counseling-Vaccination
• FOGSI recommends vaccination counseling as a part of
pre-pregnancy counseling (unvaccinated women)
• History of occurrence of vaccine preventable diseases,
previous vaccinations administered and allergic reactions
to vaccinations must be recorded.
• Rubella ,Hepatitis B and Varicella vaccination should be
given preferably during postmenstrual period
• Pregnancy should be deferred for 3 months in case of
Rubella vaccine
13. Why Antenatal surveillance ??
1.Triage mothers to High Risk & Low Risk
2.Screen the fetus for
• Chromosomal errors
• Structural Defects
• Growth abnormalities
3.Predict and prevent maternal complications
4.Decide the time and mode of safe delivery
15. CASE
• Mrs. M
• 26 year old
• Overdue by 10days
• UPT positive
• Natural conception
• First antenatal visit
• First Trimester.
How would you proceed. What would you advise?
19. First-trimester screening for fetal aneuploidy
Fetal aneuploidy is a major cause of perinatal morbidity and mortality as well
as long term disabilities.
All diagnostic prenatal tests used to diagnose fetal aneuploidy carry a risk of
miscarriage and are expensive.
Therefore, starting with a screening test that has the highest possible
detection rate and lowest false-positive rate is of critical importance
Akolekar R, Beta J, Picciarelli G, et al. Procedure-related risk of miscarriage following amniocentesis and chorionic villus sampling: a
systematic review and meta-analysis. Ultrasound Obstetrics Gynecol 2015;45:16–26.
20. First-trimester screening for fetal aneuploidy
• Until the advent of cfDNA technology, first-trimester combined screening
(maternal age and history, gestational age, NT measurement, PAPP-A, and
free beta-hCG) performed at 11 to 13 weeks’ gestation was arguably the most
robust screening test for fetal aneuploidy available.
• combined test can identify more than 90% of fetuses with trisomy 21.
• The detection rate of trisomies 18 and 13 is about 95% for the same
Wright D, Syngelaki A, Bradbury I, et al. First-trimester screening for trisomies 21, 18 and 13 by ultrasound and biochemical
testing. Fetal Diagn Ther 2014;35: 118–26.
Kagan KO, Hoopmann M, Abele H, et al. First-trimester combined screening for trisomy 21 with different combinations of
placental growth factor, free b-human chorionic gonadotropin and pregnancy-associated plasma protein-A. Ultrasound
Obstet Gynecol 2012;40:530–5.
21. First-trimester screening for fetal aneuploidy
• The effectiveness of the first-trimester combined screen can be further
augmented by the addition of other fetal markers, such as nasal bone
evaluation and Doppler evaluations of the ductus venosus and blood flow
across the tricuspid valve.
• There is evidence that the effectiveness of first-trimester screening could also
be further enhanced by including additional maternal serum markers, such as
placental growth factor (PlGF) and maternal serum alpha-fetoprotein (AFP).
Maiz N, Wright D, Ferreira AFA, et al. A mixture model of ductus venosus pulsatility index in screening for
aneuploidies at 11–13 weeks’ gestation. Fetal Diagn Ther 2012;31:221–9.
Kagan KO, Staboulidou I, Cruz J, et al. Two-stage first-trimester screening for trisomy 21 by ultrasound assessment
and biochemical testing. Ultrasound Obstetrics Gynecol 2010;36:542–7.
22. First-trimester screening –structural defects
About half of the congenital structural defects can now be diagnosed in the first
trimester because of improvements in ultrasound technology, NT thickening and
the presence of other ultrasound markers can herald the presence of structural
defects, and detailed evaluation of fetal anatomy is becoming widely recognized
as an integral part of the first-trimester ultrasound.
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;122:1160–7. 28.
Van Mieghem T, Hindryckx A, Van Calsteren K. Early fetal anatomy screening: who, what, when and why? Curr Opin Obstet Gynecol
2015;27:143–50.
23. First-Trimester Detection of Open Neural Tube Defects
• Once it was recognized that the appearance of anencephaly is different in the
first trimester from that in the second trimester, early diagnosis of this defect
has become routine.
• However, the diagnosis of open spina bifida has remained a challenge.
• This situation changed when it was recognized that examination and
measurements of structures located in the posterior fossa can provide clues to
the presence of open neural tube defects (ONTDs) even in the first trimester.
Chaoui R, Nicolaides KH. Detecting open spina bifida at the 11-13-week scan by assessing intracranial translucency and the posterior
brain region: mid-sagittal or axial plane? Ultrasound Obstet Gynecol 2011;38:609–12.
24. First-Trimester Detection of Open Neural Tube Defects
In a prospective, multicenter first-trimester screening study including about
15,500 normal fetuses and 11 fetuses with open spina bifida, all affected cases
were identified or at least suspected by a detailed assessment of the posterior
fossa at 11 to 13 weeks’ gestation.
Chen FCK, Gerhardt J, Entezami M, et al. Detection of spina bifida by first trimester screening - results of the
prospective multicenter Berlin it-study. Ultraschall Med 2015. http://dx.doi.org/10.1055/s-0034-13994
25. First-Trimester Detection of Congenital Cardiac Defects
The association between CHDs and NT measurement is well documented.
In a meta analysis that included 20 studies, the detection rate for major CHDs
based on NT measurement alone was estimated at 44% for a 5.5% false-
positive rate.
Doppler evaluation of blood flow across the tricuspid valve and ductus
venosus further improves screening for CHDs.
Chelemen T, Syngelaki A, Maiz N, et al. Contribution of ductus venosus Doppler in first-trimester screening for major cardiac
defects. Fetal Diagn Ther 2011;29: 127–34. 33.
Papatheodorou SI, Evangelou E, Makrydimas G, et al. First-trimester ductus venosus screening for cardiac defects: a meta-
analysis. BJOG 2011;118:1438–45. 34.
Pereira S, Ganapathy R, Syngelaki A, et al. Contribution of fetal tricuspid regurgitation in first-trimester screening for major
cardiac defects. Obstet Gynecol 2011; 117:1384–91.
26. First-trimester estimation of gestational age
• Finally, first-trimester crown-rump length measurement represents the most
accurate method for establishing the gestational age in the general population.
• Accurate gestational age is a critical piece of information that influences
essentially all decisions
Committee opinion no 611: method for estimating due date. Obstet Gynecol 2014;124:863–6
27. First-trimester assessment of multiple gestations
• Perinatal risk of morbidity and mortality is always increased in multiple
gestations. However, the level of risk depends greatly on chorionicity.
• This assessment is best accomplished in the first trimester, as at this time the
ultrasound appearance of a dichorionic/diamniotic dividing membrane is vastly
different from that of a monochorionic/diamniotic membrane.
• This difference becomes more blurred as the pregnancy progresses.
• Estimation of chorionicity in the first trimester allows accurate counseling
regarding the risk of the pregnancy.
Sebire NJ, Snijders RJ, Hughes K, et al. The hidden mortality of monochorionic twin pregnancies. Br J Obstet
Gynaecol 1997;104:1203–7.
Kagan KO, Gazzoni A, Sepulveda-Gonzalez G, et al. Discordance in nuchal translucency thickness in the
prediction of severe twin-to-twin transfusion syndrome. Ultrasound Obstet Gynecol 2007;29:527–32
28. First-trimester prediction of maternal-fetal complications
• Discussion regarding first-trimester screening often focuses on fetal
aneuploidy and structural anomalies.
• However, maternal and fetal complications that are related to abnormal
placentation are much more common than both of these problems combined.
Sharp AN, Alfirevic Z. First trimester screening can predict adverse pregnancy outcomes. Prenat
Diagn 2014;34:660–7.
29. First-trimester prediction of maternal-fetal complications
• Most placental architecture, including placental maternal blood circulation, is
established by the end of the first trimester; no further anatomic modifications
are evident after the fourth month of pregnancy.
• These 2 facts serve to support the 2 following assertions.
• First, the validity of methods used at the end of the first trimester in screening
for placental dysfunction has a sound physiologic basis.
• Second, in order for any treatment to be successful in reducing the risk of
complications related to placental dysfunction, it must be instituted early in
pregnancy.
30. First-trimester prediction of maternal-fetal complications
• The 2 often-interrelated complications of pregnancy that are major causes of
maternal-fetal morbidity and mortality are PE and small-for-gestational-age
(SGA) fetuses.
• A meta-analysis of 9 published studies has shown that the use of low-dose
aspirin (75 mg/d) reduces the risk of PE but only if treatment is initiated before
16 weeks’ gestation.
• This finding was confirmed in a more recent meta-analysis.
Bujold E, Roberge S, Lacasse Y, et al. Prevention of preeclampsia and intrauterine growth restriction with
aspirin started in early pregnancy: a meta-analysis. Obstet Gynecol 2010;116:402–14.
Roberge S, Nicolaides KH, Demers S, et al. Prevention of perinatal death and adverse perinatal outcome
using low-dose aspirin: a meta-analysis. Ultrasound Obstet Gynecol 2013;41:491–9.
31. First-trimester prediction of maternal-fetal complications
• First-trimester screening for these complications can be improved by using additional markers.
• One is the estimation of downstream resistance by measuring the pulsatility index (PI) in the uterine
arteries.
• Second is maternal blood pressure measurement in the late first trimester.
• Third is evaluation of certain placental product levels in maternal serum, such as PAPP-A and PlGF.
• Fetal Medicine Foundation (FMF) algorithm suggests that, detection of early PE (requiring delivery
before 34 weeks’ gestation) would be approximately 90% based only on historical factors, maternal
blood pressure measurement, and uterine artery PI.
• The addition of PAPP-A and PlGF levels increases the detection rates to 96%.
Poon LC, Nicolaides KH. First-trimester maternal factors and biomarker screening for preeclampsia. Prenat Diagn 2014;34:618–27.
Velauthar L, Plana MN, Kalidindi M, et al. First-trimester uterine artery Doppler and adverse pregnancy outcome: a meta-analysis
involving 55,974 women. Ultrasound Obstet Gynecol 2014;43:500–7.
Wright D, Akolekar R, Syngelaki A, et al. A competing risks model in early screening for preeclampsia. Fetal Diagn Ther
2012;32:171–8.
32. Future applications of first-trimester screening protocols
• Screening for SGA without PE has shown some promise.
• The risk is increased with an increase in the uterine PI and maternal mean
arterial pressure.
• Decreased maternal serum PAPP-A, free beta-hCG, PlGF, placental protein
13 (PP13), and A disintegrin and metalloproteinase 12 (ADAM12) also
increase the risk of SGA.
• For a false positive rate of 10%, the combination of these markers along with
maternal characteristics could identify approximately 75% of SGA fetuses
delivering before 37 weeks’ gestation and 45% that deliver at term.
Beta J, Akolekar R, Ventura W, et al. Prediction of spontaneous preterm delivery from maternal factors, obstetric history and placental
perfusion and function at 11-13 weeks. Prenat Diagn 2011;31:75–83.
Nanda S, Akolekar R, Sarquis R, et al. Maternal serum adiponectin at 11 to 13 weeks of gestation in the prediction of macrosomia.
Prenat Diagn 2011;31: 479–83.
Poon LCY, Karagiannis G, Staboulidou I, et al. Reference range of birth weight with gestation and first-trimester prediction of small-for-
gestation neonates. Prenat Diagn 2011;31:58–65
33. Future applications of first-trimester screening protocols
• The fact that risk of spontaneous preterm delivery is associated with cervical
shortening is well established in the second trimester, and the same seems to
hold in the first trimester.
• Cervical length measurement obtained transvaginally and adhering to strict
guidelines in combination with maternal characteristics is likely to be used in
the future to select a high-risk group that may benefit from close follow-up and
possible treatment.
• Preterm delivery prediction does not seem to be improved by the use of either
maternal serum biochemistries or uterine artery PI.
Greco E, Gupta R, Syngelaki A, et al. First-trimester screening for spontaneous preterm delivery with maternal characteristics and
cervical length. Fetal Diagn Ther 2012;31:154–61.
Retzke JD, Sonek JD, Lehmann J, et al. Comparison of three methods of cervical measurement in the first trimester: single-line, two-
line, and tracing. Prenat Diagn 2013;33:262–8.
34. Future applications of first-trimester screening protocols
• First-trimester screening for gestational diabetes mellitus (GDM) is possible using
maternal serum biochemistries.
• Adiponectin and sex hormone–binding globulin are reduced and visfatin is increased
in association with increased risk for GDM.
• Combination of maternal characteristics and biochemical markers can identify about
75% of pregnancies that will develop GDM for a 20% false-positive rate.
• Screening fetal macrosomia/large for gestational age (LGA) using first-trimester
parameters has shown some promise.
• The risk of LGA increases with increased NT measurement, increased levels of
maternal serum free beta-hCG and PAPP-A, and a decreased level of adiponectin.
• For a 10% false-positive rate, the combination of these factors and maternal
characteristics can detect approximately 40% of LGA fetuses.
Ferreira AFA, Rezende JC, Vaikousi E, et al. Maternal serum visfatin at 11-13 weeks of gestation in gestational diabetes
mellitus. Clin Chem 2011;57:609–13.
Thadhani R, Powe CE, Tjoa ML, et al. First-trimester follistatin-like-3 levels in pregnancies complicated by subsequent
gestational diabetes mellitus. Diabetes Care 2010;33:664–9.
35. Screening in the 1st trimester
• Time window: 8 - 14 weeks
• Ultrasound Marker:
• NT
• Biochemical markers:
• PAPP-A
• Fb-hCG
• Marker combination:
• Combined test: NT, PAPP-A, Fb hCG
41. Cervical length screening routine to prevent
preterm labour and for guideline for cx stitch
• Asymptomatic singleton pregnancy a tvs cl <25 mm in second trimester
• Screen at 11-13 weeks and then at 22-24 weeks
Recent evidence says cx stitch does not help and progesterone may be
the only treatment option here.
Routine mcdonald stitch practise should be individualised
42. • MA + NIPT(OPTIONAL)
• Dual Marker
• NT + NB + TR + DV
First
trimester
• Quad Marker
• Genetic Sonogram
Second
trimester
Integrated 1st and 2nd
trimester screening
DR – 97%
FPR – 2.5%
44. Why vaccinate women ???
• Vaccination
before during and after pregnancy
helps protect women from serious infections .
• It can also help in improving the women’s health in
general .
• It is an important preventable measure which should be
adopted rationally
45. Vaccination
• Tetanus Toxoid – ONE DOSE
• Tdap/Triple Vaccine –SECOND DOSE AT
24 WEEKS
• Influenza vaccine 24 weeks onwards
• HepB can be given if not immunised
• Targetted Vaccine in case of travel to
endemic areas
• Post partum – HPV vaccine
48. Antepartum fetal surveillance
• Antepartum fetal surveillance is the assessment of fetal well being in
utero before the onset of labor
• Early detection of fetus at risk so that timely management to prevent
further deterioration
• To find out normal fetuses and avoid unnecessary interventions
49. The Various Methods of Antepartum Fetal Surveillance
1) Clinical assessment by uterine growth
2) Fetal movement count by the mother
3) Ultrasound for fetal growth
4) Non stress test and cardiotocography
5) Vibroacoustic stimulation test
6) Contraction stress test
7) Nipple stimulation test
8) Biophysical profile
9) Modified biophysical profile
10) Doppler studies
11) Fetal lung maturation studies
12) Placental grading
51. Recording
•Every kick / roll is 1 movement
•Count 10 movements everyday
•Should be around 6 in 1 hour
•If < 6 movements in 2 hours
•Call doctor & come for CTG / USG assessment
52. About baby’s movements
An active baby is usually a healthy baby. You
will feel your baby stretch, kick, roll and turn
every day. Some babies are more active than
others. All babies have periods of sleep during
which they are not as active. You will get to
know your baby’s pattern of movements and
when your baby is most active.
You should feel your baby’s movements
throughout the day, each day from 28 weeks of
pregnancy until the baby is born.
When during my pregnancy should I count
my baby’s movements?
Your health care provider may ask you
to count your baby’s movements once
every day.
If you think there is a decrease in your
baby’s movements this is an important sign that
your baby may not be well. Count your baby’s
movements to be sure that you feel at least 6
movements in 2 hours.
Reference:
Society of Obstetricians and Gynaecologists of Canada (2007).
Fetal Health Surveillance : Antepartum and Intrapartum Consensus
Guideline. Journal of Obstetrics and Gynaecology Canada. 29(9).
FETAL MOVEMENT
COUNT CHART
PLEASE BRING THIS CHART WITH YOU EACH
TIME YOU SEE THE DOCTOR/MIDWIFE
IMPORTANT PHONE NUMBERS:
DOCTOR:
MIDWIFE:
HOSPITAL:
DUE DATE:
OTHER INSTRUCTIONS:
For 24-hour nurse advice and health information call
Health Link Alberta:
1-866-408- LINK (5465)– Toll Free
In Calgary call 403-943- LINK (5465)
In Edmonton call 780-408-LINK (5465)
ADDRESS:
NAME:
HS0001-132 (2012/11)
How do I count my baby’s movements?
• Get into a comfortable position – lying on
your side or sitting. Place one or both of your
hands on your abdomen.
• Count each time that you feel your baby
move. If you feel many movements all at
once, count each movement that you feel.
• Write down the date and the time that you
start counting on the fetal movement chart.
• Make a mark on the chart each time your baby
moves.
• Stop counting when you have counted 6
movements.
• Write down the time you stopped counting.
• Do not count for more than 2 hours
What if I don’t feel 6 movements in 2 hours?
Count your baby’s movements once a day. You
should feel 6 or more movements in 2 hours.
If you count fewer than 6 movements in 2 hours
do not wait. Go to the hospital or birthing unit.
Your baby’s heart rate and movements will be
checked using a fetal monitor. This is called a
non-stress test or NST.
If you live too far from a hospital or birthing
unit, immediately contact your health care
provider for advice.
53. FOGSI OLD CHECK LIST OF 2009,MODIFIED IN 2017 AT FOGSI T.O.G.
54. First-Trimester Detection
• Fetal aneuploidies-pt gets time to opt for mTP
• Fetal structural defects-NTD, Cardiac
• Complications in multiple pregnancies -chorinicity
• Exact dating of pregnancy
• Preeclampsia-aspirin
• Gestational diabetes
• Fetal growth restriction
• Preterm delivery-cervical length
• Rh Negative-Fetal anaemia