01 FIRST TRIMESTER SCREEN
One of the most common concerns of parents-to-be is whether the unborn child is going to be affected by chromosomal or birth defects. Birth defects occur in around 3% of babies and chromosomal defects are present in 0.5% of pregnancies. The chance of a pregnancy carrying such a defect can be assessed as early as the first trimester, in the form of the first trimester screening (otherwise known as one-stop clinic for assessment of risk, OSCAR) test. This is a non-invasive assessment, comprising of a blood test for the mother and a scan of the fetus. The resulting risk score will allow the parents-to-be and the obstetrician to plan ahead for the outcome of the pregnancy. All expectant mother are encouraged to have the test done, regardless of age.
02 SECOND TRIMESTER SCREEN
As the pregnancy advances, a detailed ultrasound scan can be performed in the second trimester to check for structural defects within the baby, as well as markers of chromosomal problems. This is commonly performed between 18 to 20 weeks gestation, to allow time for decision making and intervention. However, the limitations of such scans have to be accepted as minor defects may still be missed, despite the best of operators.
03 THIRD TRIMESTER SCREEN
When the pregnancy reaches the third trimester, the focus shifts towards the baby’s growth and planning for deliver. A scan of the growth parameters in the third trimester will allow us to pick up babies that are growing too quickly or too slowly. This will allow parents-to-be and their obstetrician to plan for the delivery (timing and route). Mothers who are at risk of gestational diabetes may also be offered the diabetes test in the third trimester.
Most pregnancies will conclude with a vaginal delivery, while some cases will have a caesarean section planned from the early antenatal period, due to specific conditions that make vaginal delivery inappropriate, such as low-lying placenta, breech presentation, etc. Others may attempt a vaginal delivery, but end up with a caesarean section when labour does not progress or is unsafe to allow further progress. In selected cases, assistance may be offered for vaginal delivery, in the form of forceps or vacuum, only when deemed appropriate by the obstetrician.
05 POSTNATAL CARE
After delivery, the mother’s body undergoes dramatic changes to return to pre-pregnancy state and she has to deal with healing of delivery wounds, breastfeeding, care of the new-born, as well as the swinging hormone levels. The postnatal check-up will allow the obstetrician to assess the health status of the new mother and offer assistance to those in need. Routine gynaecology screening and contraception options will also be discussed.