Since the end of the twentieth century, the practice of obstetricians has included achievements in several scientific fields, primarily medical genetics. Research in the field of pathophysiology – the science of the mechanisms of work and the interaction of various organs and systems – has clarified a lot for us on how these processes take place in children before birth.
And, finally, the modern examination of the future mother cannot be imagined without the new opportunities open to obstetricians by immunologists and biochemists studying events in the body at the cellular level. With the help of methods developed on the basis of these sciences, obstetricians can now identify problems in the development of an unborn baby in time and help him, as far as possible, overcome them.
So experts call a complex of diagnostic procedures that help to identify serious problems in the development of the future baby. The importance of this task makes prenatal diagnosis mandatory for every expectant mother.
The first stage of this path will be an ultrasound scan, which is done in 11-12 weeks. Now the doctor will be able to see indirect signs of problems.
For example, the expansion of the baby’s neck area or the fuzzy contours of its nasal bone may indicate the presence of chromosomal abnormalities.
The next step is a blood test that determines the level of specific proteins that serve as markers of such disorders in a child (for example, Down syndrome, Edwards syndrome, Turner syndrome). Deviations from their normal values will indicate the risk of problems.
This “double” test (depending on the purpose of the search – a specific violation – it will include the study of two different markers) is advised to pass on to all expectant mothers. And if earlier it was prescribed to women at 15–16 weeks of pregnancy, today the period of diagnosis has significantly shifted. Now it is carried out immediately after the above-mentioned ultrasound (at 11–12 weeks), examining several other proteins, and the reliability of this test is higher.
The ability to reduce the time of diagnosis helps those women for whom the risk of chromosomal abnormalities in a child is high. An early analysis leaves them time to undergo a clarifying study (chorion biopsy – examination of the cells of the child’s future placenta) and, if the fear is confirmed, terminate the pregnancy at a relatively safe time (up to 12 weeks).
Expectant mothers are recommended to take another so-called “triple” test, later – at 15–16 weeks of pregnancy. In addition to chromosomal abnormalities, it will allow to detect some other serious malformations of the child.
Another area of prenatal diagnosis is the study of the genotype of the future baby. It is made, if necessary, if it is known that the child may inherit a problem. In order to obtain material for study, experts take blood from the child’s umbilical cord (experts say cordocentesis) or a piece of tissue from its placenta (chorionic biopsy).
These surgical procedures are quite subtle and have a low, but still existing risk of complications for the development of pregnancy. Today, the future baby’s DNA can also be distinguished from its amniotic fluid, and this manipulation (it is called amniocentesis) is much safer.
Not far off is the opportunity to determine the chromosomal set of the child, including his gender, by the analysis of the mother’s blood already in the first trimester of pregnancy. Work on this is going on both abroad and in Russian genetic laboratories.
The next stage of prenatal diagnosis will be an ultrasound at 20 weeks of pregnancy. Now the doctor will carefully examine all the systems and organs of the child, and the serious problems of the development of the baby will already be noticeable.
During these periods, you can detect a shortage or excess weight, and even the initial signs of problems in the work of supplying the child with nutrients of the placenta (experts say – placental insufficiency).
The occurrence of rhesus conflict during pregnancy – the situation is special. Recall that he can start with the Rh-negative mother with the second, third child, if he inherits the Rh-positive factor of the father or after an incorrectly performed blood transfusion. In this case, the development of the future baby can be threatened with hemolytic disease (when bilirubin is formed in the baby’s blood – the breakdown product of hemoglobin, which has a devastating effect on the body’s work).
And if for the detection of this problem a small, but still surgical manipulation – cordocentesis was required, then today the diagnosis can be made according to the blood flow velocity in the middle cerebral artery of the child. This procedure is performed on the ultrasound machine with a special sensor.
Now an important program is starting to work in the medical institutions of our country. It is about the welfare of future generations of children, and hence their parents (first of all young mothers).
Her goal – to prevent the occurrence of Rh-conflict during pregnancy.
To do this, Rh-negative future mother needs to enter 1 dose of a special drug (it is called anti-rhesus immunoglobulin) after each abortion, and while waiting for the child – at the 28th week (provided that the anti-Rh antibodies in the woman’s blood have not appeared) and next on the 2nd – 3rd day after the birth of the Rh-positive baby. A start has already been made!
This is an ultrasonic method for determining the speed of blood flow in the vessels of the uterus, umbilical cord and brain of a baby, which helps professionals to determine whether the child has enough nutrients for development from the mother. It is usually performed on women at 32 weeks gestation.
And those future moms whose kids are lagging behind in weight and height do this research a little earlier. Future mom’s genotype
This study is prescribed to future mothers if necessary, if there have been serious problems in the history of the development of previous pregnancies, for example, the waiting has been interrupted more than once, the placenta has exfoliated. The tendency to thicken the blood, various violations of the complex process of its clotting, including the formation of distinct clots in it (blood clots), is one of the reasons for the development of many serious problems during pregnancy.
And a detailed study of a woman’s blood coagulation system — a coagulogram — will help detect any abnormalities in advance. Their future mother may inherit or acquire over time.
Today, specialists have the opportunity to determine hereditary thrombophilia (a disease leading to the formation of blood clots) and calculate the degree of risk of its development. If, according to the results of a study of the genotype of the future mother, among the genes involved in the blood coagulation process, more than 2 weakened ones are found, then such a patient will need treatment before pregnancy.
And to continue therapy will need all the time the child is waiting.