RECENT ANTENATAL INVESTIGATIONS FOR BETTER PREGNANCY OUTCOMES

InternationalJournalofAppliedandNatural Sciences(IJANS)

ISSN(P):2319–4014;ISSN(E):2319–4022

Vol.11,Issue2,Jul–Dec2022;41–44

©IASET

RECENTANTENATALINVESTIGATIONSFORBETTERPREGNANCYOUTCOMES

Dr.KaushikaPremchand

SriSaiKarthikHospital,DuraisamyNagar,Vadakuthu,Neyveli,TamilNadu,India

ABSTRACT

Thisstudyoffersthescientificevidencefortheproceduresfordetectingfoetalchromosomalandstructuralabnormalities duringearlypregnancythatarebeingusedorintheprocessofbeingadopted.Earlyprenataldiagnosiswasexamined fromamedical,safetystandpoint,qualityassurance,healtheconomic,ethical,psychologicalandsocial

KEYWORDS:AntenatalInvestigation,PregnancyOutcomes,BetterPregnancy

ArticleHistory

Received:17Aug2022|Revised:24Aug2022|Accepted:02Sep2022

INTRODUCTION

RecentAntenatalInvestigations

Thecompositionofmaternalserumbiochemistry(biochemicalscreening)aswellasultrasoundnuchaltranslucency measurement,inconjunctionwithmaternalage,isregardedastheclinicallyassessedtechniqueofdeterminingthe likelihoodofafoetushavingDownsyndromeinearlypregnancy(10–14gestationalweeks)andisrecommended.This approachachievesthehighestbalanceamongthepercentileofrecognisedcasesaswellasthenumberofresultsthatare false-positiveinearlypregnancy,especiallyinhigh-risksituations.

AclinicallyestablishedwayofidentifyingthepossibilityoffoetalDownsyndromeinthesecondtrimesteristhe quadrupletest(maternalserumbiochemistrywithfourmarkers),whichprovidesthehighestbalanceamongthepercentileof casesfoundaswellasthenumberofresultsthatarefalse-positive.Thequadrupletest(withfourmarkers,maternalserum biochemistry)isthemostaccuratetechniqueforidentifyingthepossibilityoffoetalDownsyndromeinthesecondtrimester.

ComparedtomaternalagealoneindeterminingthelikelihoodoffoetalDownsyndrome,allofthetechniques analysedinthisreportandevaluatedinclinicalsettingsfordeterminingtheoccurrencesoffoetalDownsyndrome (maternalserumbiochemistryinthe2ndtrimester,nuchaltranslucencymeasurement,aswellasthecumulativetest) providesaproperbalanceamongtheproportionofdetectedcasesandtheproportionoffalse-positiveresults.Theresultis thattheseapproachesmeansminimalchorionicvillussamplingsandamniocentesesperdetectedoccurrenceofDown syndromecomparedtotraditionalprocedureswhencomparedtomaternalagealone.

Intermsoffindinganeuploidiesinchromosomesx,andy,13,18,and21,theQF-PCR(quantitativefluorescent polymerasechainreaction)orFISH(interphasefluorescenceinsituhybridization)testarealmostascorrectas comprehensivekaryotyping.

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WhentheQF-PCRorquickFISHtestresultsarenormalinprenataldiagnosis,thechanceoffoetalchromosomal disordersremainsapossibility.Acomprehensivekaryotypeanalysiswoulddiscoverachromosomalaberrationthatwas leftoutbythequickFISHtestortheQF-PCRinroughly0.9percentofallchorionicvillussamplingsandamniocenteses. Thereare0.4percentofpeoplewithchromosomalabnormalitiesthatareclinicallysignificant(strongscientificevidence).

Accordingtopreliminaryfindings,atypicalultrasoundexamwhenitisdoneat12ratherthanat18weeksof gestation,congenitalabnormalities,includingcardiacissues,arediscoveredinmuchfewerbabies.Thesameistrueevenif the12-weekexaminationcontainsameasureofnuchaltranslucency,aswellasevenifhighernuchaltranslucencyor dependingonnuchaltranslucencyagreaterlikelihoodofchromosomalabnormalitiesisarationaleat18–22gestational weeksforacomprehensivefoetalanatomyevaluation.Whilescientificevidenceisnotsufficienttomakeavalid conclusioninthiscase,manypeoplecontinuetobelieveittobeso.

Aharmfuleffectinthesecondtrimesterofultrasoundexposureonthechild’shearing,eyesight,orgrowthhasnot beendemonstrated-norhasitbeenshowntohaveaninfluenceontheirspeechdevelopment,cognitive,orneurological. Uptothispoint,therehasbeennoevidencetoshowarelationshipamongpaediatricmalignanciesandprenatal ultrasonographyexposure.

Meta-analysisofrandomisedtrialsfoundthattherewasnodifferenceintheprevalenceofachild'spreferencefor onehandovertheother(i.e.,left-handednessornoapparentpreference).Malenon-righthandednesshasbeenfoundtobe associatedwithsuchexposure,accordingtotheresearchers,whoconductedsubpopulationstudiesandtwoSwedish registrystudiestomaketheirdiscovery.Avalidchoicecannotbereachedduetoalackofappropriatescientificdata,on theotherhand.

Amniocentesisandchorionicvilluscollection,whichareintrusiveprocedures,increasethelikelihoodof embryonicloss.Itisestimatedthata1percentagepointincreaseintheprobabilityoffoetallossafter15ormore completedgestationalweeks(lateamniocentesis)isassociatedwithlateamniocentesis,basedonthebestavailabledata. Miscarriagesaccountforthemajorityoftheselosses.

Pregnantladiesprefertogetinformationfromanindividualratherthanagroup.Lettersandbrochuresappearto belesshelpfulthanaudioorvideoinformationintermsofincreasingtheirknowledgeandgraspofthesubjectmatter. However,regardingtransferringinformationtowomenimmediatelybeforeaprenataldiagnosis,themajorityofstudies haveshownshortcomings.Itisimpossibleforthewomentomakeawell-informeddecisionaboutwhetherornotto undergotestingbecausetheylackappropriateunderstanding,particularlyregardingtheaimofthetestingandthepotential consequencesoftheresults.Thesepeoplehaveahardtimecomprehendingthattheultrasoundwithnuchaltranslucency measurementandananalysisofsignsisonlyaprobabilityassessmentandnotthedefinitivediagnosis.

Themajorityofpregnantwomenwanttoknowasmuchastheycanassoonaspossibleandpreferduringthefirst trimesterscreening.

Pregnantwomendonotgrowmoreanxiousasaresultofincreasedinformation.Priortoundergoinganymedical treatments,patientsshouldbegiventhesameinformationtheyneedtominimisetheirstressandanxietylevels.Whena womanand/orherspouseareanticipatingaprenataldiagnosis,waitingforfindings,orlearningthatabnormalitieshave beendiscovered(oraremorelikelytooccur),theyarelikelytoexperienceelevatedanxiety.

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