Behind its happiness, pregnancy is a period filled with changes and requires regular health monitoring to ensure that the condition of the mother and fetus remains optimal. One of the important examinations recommended in early pregnancy is first-trimester screening.
This examination aims to help detect several conditions that may potentially affect the development of the pregnancy. Through this examination, doctors will obtain important information regarding fetal growth and determine whether further examinations are necessary. Here is an explanation of first-trimester screening!
First-trimester screening is a series of examinations ideally performed at around 10 to 14 weeks of pregnancy, to assess the risk of chromosomal abnormalities or congenital abnormalities in the fetus. During this period, the size of the fetus allows doctors to perform certain measurements that are an important part of risk assessment.
Having the examination at the right time will improve the accuracy of the screening results. Therefore, it is important to come for the examination within this gestational age window so that the examination results are optimal. With early detection, prospective parents have the opportunity to receive appropriate education, planning, and management throughout pregnancy.
During this examination, the doctor will assess several important parameters, including:
The results of all these parameters will be used to estimate the risk of chromosomal abnormalities or congenital abnormalities in the fetus. If the results indicate an increased risk, the doctor may recommend further examinations to obtain more accurate information.
It is important to note that first-trimester screening is not a diagnostic examination, but rather an examination that assesses the level of risk. The screening results cannot confirm whether or not there is an abnormality in the fetus, but they can help determine whether further examinations are necessary.
It is also important to emphasize that first-trimester screening, as with ultrasound examinations during pregnancy, has standards for image acquisition that must be met to optimize the accuracy of the examination. Therefore, it is important to consult with an obstetrician who is specifically trained in this area. Usually, this examination is performed by an obstetrician who is a maternal-fetal medicine consultant.
A visit during the first trimester is not only to ensure that the pregnancy is progressing well and developing according to gestational age; first-trimester screening also has several important purposes, including:
This early detection gives doctors the opportunity to provide prospective parents with a more comprehensive explanation and determine the next examination steps if necessary.
When undergoing a pregnancy examination, the doctor will generally perform a preliminary physical examination of the mother, including an assessment of weight and height, as well as the mother's vital signs, which include blood pressure, heart rate, body temperature, and respiratory rate. In addition, there are several other examinations, including:
The first stage begins with an anamnesis or medical interview. The doctor will gather information regarding:
This information is an important part of calculating the individual risk of chromosomal abnormalities and pregnancy complications.
Ultrasound is a main component of first-trimester screening. In addition to confirming pregnancy development, the doctor will evaluate various parameters that have been proven to have value in estimating the risk of chromosomal abnormalities, including:
a. Nuchal Translucency (NT) Measurement
Nuchal translucency (NT) is the thickness of the fluid located behind the fetal neck. Increased NT thickness is associated with an increased risk of: Down syndrome (trisomy 21), trisomy 18, trisomy 13, congenital heart defects, and several other genetic syndromes. NT measurement must be performed using standardized techniques to ensure accurate results.
b. Nasal Bone Examination
In some fetuses with chromosomal abnormalities, the nasal bone may appear underdeveloped or not visible during a first-trimester ultrasound examination. This parameter is one of the additional assessments in screening for the risk of aneuploidy.
c. Ductus Venosus Blood Flow Examination
The ductus venosus is an important blood vessel that connects the umbilical vein with the fetal circulation. Through Doppler examination, doctors can assess the blood flow pattern in this vessel. An abnormal pattern may be associated with an increased risk of chromosomal abnormalities, impaired cardiac function, or certain structural abnormalities.
d. Tricuspid Valve Blood Flow Examination
Doppler assessment of the tricuspid valve is performed to determine the presence or absence of regurgitation (backflow of blood). Tricuspid regurgitation is found more frequently in fetuses with trisomy or congenital heart abnormalities.
e. Early Fetal Anatomy Evaluation
Although the fetal organs have not yet fully developed, several structures can already be assessed, such as: the head and brain, abdominal wall, spine, limbs, stomach, and bladder. Certain major anatomical abnormalities can even begin to be identified during the first trimester.
In addition to ultrasound examination, first-trimester screening can be complemented by maternal blood tests. One option that may be considered is NIPT (Non-Invasive Prenatal Testing), an examination that analyzes DNA fragments originating from the placenta and circulating in the mother's blood.
NIPT can be performed starting at 10 weeks of pregnancy and is primarily used to assess the risk of several chromosomal abnormalities, such as:
Certain sex chromosome abnormalities, depending on the type of examination used
NIPT has a high detection rate for several chromosomal abnormalities. However, it is important to understand that NIPT is a screening examination, not a diagnostic examination, so a high-risk result cannot yet confirm that the fetus has an abnormality. NIPT results will be assessed comprehensively together with ultrasound results, laboratory examinations, and maternal risk factors.
If an increased risk is identified, the doctor may recommend further examinations, including certain diagnostic examinations, to confirm the condition of the fetus. Meanwhile, mothers with low-risk screening results can generally continue routine pregnancy monitoring according to the doctor's recommendations.
Generally, no special preparation is required for a first-trimester ultrasound examination. However, if the doctor plans certain blood tests, including NIPT, follow the instructions provided by the medical professional. Mothers should also bring the results of previous pregnancy examinations and inform the doctor about their medical history, previous pregnancies, medications currently being taken, and any family history of genetic abnormalities.
First-trimester screening is an important part of pregnancy monitoring to help doctors assess fetal development while also estimating the risk of chromosomal abnormalities, structural abnormalities, and certain pregnancy complications at an early stage. First-trimester ultrasound examinations can be complemented by blood tests such as NIPT, according to the individual needs and risk factors of each mother.
Having the examination at the right time and consulting with a doctor can help prospective parents obtain more comprehensive information about the condition of their pregnancy and determine the next steps in the examination process if necessary. Therefore, do not delay your pregnancy check-ups and consult with an obstetrician and gynecologist to determine the appropriate type and timing of screening.
National Hospital is here to accompany you throughout your pregnancy journey through pregnancy check-up and prenatal screening services supported by experienced medical professionals and adequate facilities. National Hospital also has two maternal-fetal medicine consultants, namely dr. Frans O.H. Prasetyadi, Sp.OG, Subsp.KFM and dr. Maurin Susanna, Sp.OG (K), who can provide consultations and recommend examinations according to your pregnancy condition, including first-trimester screening and supporting examinations such as NIPT when necessary.
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