Sunday, 30 August 2015

Pregnancy: the first and second screening


There is a fairly widespread view that the US adversely affects the nervous system of the child, irritates him - during the examination kids often try to hide from the unit, cover your head handles. Therefore, children, moms are doing regular ultrasound during pregnancy, more anxious compared to babies, mothers who abandoned ultrasound diagnostics. Is it really?

According to doctors, ultrasound can not cause any harm to the baby perfectly - modern equipment is safe. Therefore, official medicine insists that the US were absolutely all pregnant women. After all, the timely holding of diagnosis allows, firstly, to see the full picture of the course of pregnancy, and secondly, if necessary, correct the problem or another.

Ultrasound examination is carried out at least three times during pregnancy (first trimester 11-13 week, in the second - by 18-21 in the third - 30-32 week), but if necessary, the doctor may recommend that it be held more frequently.

Particularly important are considered to be data obtained from the first ultrasound prenatal screening (11-13 weeks gestation). In this period during the study:

It is determined by the number of embryos in the womb, their viability;
It puts more accurate gestational age;
gross malformations are excluded;
is determined by the thickness of the nuchal translucency - RTA (ie measured by the amount of subcutaneous fluid at the back of the neck of the child - normal RTA should not exceed 2.7 mm);
investigate presence or absence of the nasal bone.
For example, in children with Down syndrome, the liquid content much higher than normal, and the nasal bone is often not visualized.

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"Against" № 2: blood chemistry gives unreliable results

Many mothers believe that it is impossible for one to do the analysis in any way reliable conclusions - too many factors can affect the result. And in part they are right. However, the need to closely examine the process of analysis to understand the basis on which the doctor concludes.

Biochemical analysis is performed in order to determine blood levels of specific placental proteins. During the first screening is done "double test" (that is determined by the level of two proteins)

Papp (pregnancy associated plasma protein or associated with pregnancy plasma protein A);
free beta subunit of hCG (human chorionic gonadotropin).
Changes in the level of these proteins indicates a risk of a variety of chromosomal and non-chromosomal some violations. However, the identification of high risk is not yet evidence that a baby is something wrong. These figures are only a pretext for more careful monitoring of pregnancy and child development. As a rule, if the result of the screening of the first trimester increased the risk for some indicators, the expectant mother wait for a second offer of screening. In case of serious deviations from the performance standards the woman sent for consultation to a geneticist.

Pregnancy: the first and second screening - we assess the risks

Conduct a second screening accounts for 18-21 weeks of pregnancy. This study includes a "triple" or "quadruple test". There is still, as in the first trimester - the woman again losing blood. Only in this case the results of the analysis are used to determine not two, but three (or, respectively, four) parameters:

free beta subunit of hCG;
free estriol;
in the case of quadruple test - also inhibin A.
As in the first screening, interpretation of results is based on the deviation from the average performance standards for various criteria. All calculations are carried out with the help of a special computer program, and then carefully analyzed by your doctor. In addition, when analyzing the results takes into account a number of individual parameters (race, presence of chronic diseases, number of fruits, weight, bad habits, etc.), as these factors may affect the value of the parameters studied.

In order to get the most reliable results, be sure to correlate data from studies of first and second trimester of the complex.

If the studies I and II trimester detected any abnormalities in fetal development, women can offer rescreening or go immediately to the right to consult a geneticist. If necessary, he may appoint additional analyzes to more specific diagnoses (such as amniocentesis, chorionic villus sampling). However, due to the fact that these studies were not safe and can cause various complications of pregnancy (risk of miscarriage, development group or rhesus conflict, infection of the fetus, and others.) They are administered only in the case of high-risk disease. However, such complications are not so often - in 12% of cases. And, of course, all of the studies are made only with the consent of the expectant mother.

Thus, the first two arguments "against", from the standpoint of scientific medicine, are not convincing, and soon they should be reformulated as follows: prenatal screening is safe for the mother and her baby, and all the conclusions made by the physician, taking into account a whole range of individual factors.

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"Against" № 3: "I have a good inheritance - I do not need screenings"

Some mothers do not see sense screened - all relatives are healthy, what could be the problem? Indeed, there are some groups of women who first advised to undergo a study to identify possible pathologies in the development of the child. It is women over 35-40 years (since after that age the risk of abnormalities in the baby increases several times), and future mothers with certain diseases (eg, diabetes). Of course, risk group and those mothers whose families already have children or relatives with genetic diseases. However, most doctors (and not only in Russia but also in many countries of Europe and America) is of the opinion that the need to take prenatal screening for all women, especially if the first pregnancy.

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"Against" № 4: "I'm afraid to hear bad diagnosis"

This is perhaps one of the strongest arguments "against" passing screenings. Mother Cares is very frightening probably heard something bad about the development of the baby. In addition, concerned and medical errors - sometimes give false-positive screenings or false-negative result. There are cases when the mother said that the child has Down's syndrome is suspected, and later was born a healthy baby. Of course, to be sure, such news much impact on the emotional state of the mother. Following the detention of pregnancy a woman spends the remainder in constant experiences, and it's also quite unprofitable for the baby's health.

But do not forget that the results of prenatal screening in any way does not serve as a basis for diagnosis. They only define the likely risks. Therefore, even a positive result of screening does not "sentence" to the child. This is just an excuse to get professional advice of the doctor-genetics.

Pregnancy: the first and second screening - we assess the risks

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"Against" № 5: Identify potential possible deviations in the development of the child can not be corrected

It is true - there is no way to cure or correct chromosomal abnormalities. Therefore, impressionable and vulnerable mothers and women who are determined under all circumstances to retain existing pregnancy may be caused screenings passed only another reason to experience. Perhaps, indeed, the best way to handle this is the rejection of research that my mother could quietly wait for the birth of the baby.

And still ...
undoubted advantage is the possibility of prenatal screening at a rather early stage of pregnancy to obtain information about child development, go to a consultation with genetics, pass, if need be, all the additional inspections. After having the data, the expectant mother may have consciously make a decision on the further development or abortion.
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The main argument "against": poor health of the future mother at the time of the study

Anyone, even a slight rise in body temperature, cold (ARI ARI), any other viral and infectious diseases, and even stress are unequivocal contraindication for screening. For each of these factors can distort the data analysis. That is why, before I go to donate blood, the expectant mother must necessarily be examined by a gynecologist - the doctor will evaluate its overall condition.

To date, prenatal screening is not strictly necessary, but most doctors believe in the necessity of this research. The right decision is up to the pregnant woman, so that, after weighing all the "pros" and "cons", every woman makes a choice - someone important to monitor the situation and to obtain all possible information as soon as possible, and someone to manage a much calmer mandatory minimum surveys, just enjoy the pregnancy and hope for the best.


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