|
"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.
|
