"The prime aim of antenatal care is to look after maternal and foetal well being," said Dr. Shama Munim, Consultant Obstetrician and Gynaecologist at Aga Khan University Hospital (AKUH). She was giving a presentation on "Identifications of Problems in Pregnancy" at the monthly 'Signs, Symptoms and Care' a public health awareness programme held on June 1, 2002.
"Despite adequate antenatal care, in some cases the outcome of pregnancy does not meet the expectations of the parents or family. The leading causes of prenatal mortality are congenital abnormalities and pre-term delivery. Apart from producing varying degrees of physical disability, these conditions also result in some form of neurodevelopment delay," informed Dr. Shama Munim.
Dr. Munim stressed, "congenital abnormalities can be broadly classified into chromosomal or structural abnormalities or rarely a part of some genetic syndrome. Major structural malformations account for 20-30% of death of babies either during pregnancy or soon after birth. The vast majority of these malformations occur in pregnancies of low risk women. Women above 35 years of age and those with a previous abnormal baby are at increase risk of having abnormalities".
"Similarly, delivery before 34 weeks of gestation also increases the risk of physical and neurological handicap. Looking after such children not only emotionally and physically devastating but is also a burden on the finances of the family," added Dr. Shama.
Screening of both congenital malformations and pre-term delivery has revolutionized in the last few years. Previously it was offered at 16 weeks in the form of a blood test called Triple test. More recently this is done at 12 weeks of pregnancy, by measuring the fluid behind the baby's neck by the ultrasound scan. This gives the risk of having a baby with Down's syndrome. In the high-risk group, the diagnosis of chromosomal defects can be made by tests like amniocentesis or chorion villus biopsy. The basic principle of such a test is to insert a needle in the water around the baby or in the placenta and test for chromosomes.
Structural abnormalities can be diagnosed by doing ultrasound as early as 12 weeks or later on at 20th week. These abnormalities can be very mild ones where nothing has to be done during pregnancy. The other type may be where an added investigation or treatment may be required during pregnancy. Finally, the structural defect may be so severe that it may be lethal or can result in neurodevelopment delay. In such cases, further management options can be discussed.
Dr. Shama Munim concluded by saying, "screening for pre-term delivery is performed between 18-23 weeks. Here cervix (neck of the uterus) is measured and risk for delivery before 34 weeks is given. In the high-risk group a suture is put around the neck of the uterus (cerclage) Hence it improves the prenatal outcome by prolonging the pregnancy".
The speaker and panellists, which included Dr. Rahat Qureshi and Dr. Zafar Nazir, participated in the question and answer session at the end of the programme.
