Pre-Pregnancy counseling is an important aspect of prenatal care. A planned pregnancy has an overall better outcome compared to an unplanned one. The goal of the pre-pregnancy consult is to optimize your health, address modiﬁable risk factors and provide education about a healthy pregnancy. Both you and your partner should attend and various screening tests can be performed to assess your risk.
The ﬁrst trimester is an important period of the pregnancy whereby the fetus is developing rapidly. Organ development occurs at this time. An ultrasound scan is usually performed to conﬁrm the pregnancy, ensure that the pregnancy is in the correct location and to accurately date the pregnancy so as to conﬁrm your Estimated Delivery Date (EDD).
The combined First Trimester Screening (cFTS) is recommended by College of Obstetricians & Gynaecologists in Singapore, International Society of Ultrasound in Obstetrics & Gynecology (ISUOG), Fetal Medicine Foundation (FMF) and most countries as an eﬀective way of assessing the risk of a fetus having Down syndrome or other common chromosomal disorders e.g., Trisomy 13 or 18. This test combines a high resolution ultrasound scan with screening of a maternal blood sample, and is done between 11 and 14 weeks of pregnancy. This test is also able to detect early structural anomalies, screen for pre-eclampsia as well as other atypical chromosomal abnormalities.
The Non-Invasive Prenatal Test (NIPT) is the most sensitive screening test for Down syndrome. It is able to detect placental DNA present in the mother’s blood to determine whether there is excessive DNA present to suspect the presence of a Down syndrome. This blood test can be drawn from the mother from 10 weeks onwards. Although NIPT is very sensitive (> 99%) for screening for Down syndrome, it is not so for other birth defects.
The second trimester is the time for you to have a detailed fetal anomaly screening ultrasound to check on the development of the major organs of the fetus. This is a standard ultrasound scan done at 20 weeks of pregnancy using high resolution ultrasound. All women should have this ultrasound done because this is considered the standard of care.
The third trimester is when we monitor the overall growth and well-being of the fetus. Some common pregnancy related medical conditions like gestational diabetes and pre-eclampsia may also develop during this time. It is important to see your doctor regularly to check for these conditions.
3D and 4D ultrasound scans can be performed between 24 to 30 weeks pregnancy. 3D and 4D ultrasounds are not standard tests and are optional. 3D ultrasounds are not as eﬃcient as 2D ultrasounds for the detection of fetal anomalies. However, 3D ultrasound can serve as an adjunct to improve on the accuracy of prenatal diagnosis
Most women will deliver naturally via a normal vaginal delivery. Some women may require a pre-planned caesarean section because of speciﬁc medical conditions like low-lying placenta or breech presentation. Some women may also need a caesarean delivery if there are labour complications like fetal distress or poor progress of labour.
The postnatal period can be deﬁned as the ﬁrst 6-8 weeks after birth. Postnatal care involves helping the women cope with recovery after pregnancy. Care for any post-delivery wounds, care for the new-born and breastfeeding advise are some aspects of postnatal care. Mood changes can also occur around this time and timely interventions may be required to prevent postnatal depression. Postnatal consultation also involves health screening and family planning advise.