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 Vol. 10 No. 11, November 2009
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NeoReviews Vol.10 No.11 2009 e538
© 2009 American Academy of Pediatrics

Comprehensive First-trimester Prenatal Assessment

Jena Miller, MD*
Christopher Harman, MD*

* Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland, Baltimore, Md

Comprehensive first-trimester pregnancy evaluation is a work in progress. The evolution of screening strategies has distilled a combination of maternal factors, early pregnancy analytes in maternal serum, and fetal sonographic parameters into carefully derived risk assessment algorithms. This integrated approach, almost continually supplemented by new information derived from large population-based studies, individualizes assessment to each mother-placenta-fetus triad. Early and accurate, this assessment potentiates informed decision-making and prenatal management. Invasive testing can be limited to those at high risk, decreasing procedure-related losses of unaffected fetuses. Advance warning of preeclampsia and other placenta-based disorders allows stratification of care and opens new windows to prevention therapy. Viewing of anomalies, even complex congenital heart disease, using the steadily advancing three- and four-dimensional capabilities now available, allows prenatal diagnosis and intrauterine surgical management. Comprehensive risk assessment in early pregnancy is transforming prenatal care.

Abbreviations: AFP: alpha-fetoprotein • CRL: crown-rump length • CVS: chorionic villus sampling • DSR: Down syndrome risk • FGR: fetal growth restriction • hCG: human chorionic gonadotropin • NB: nasal bone • NT: nuchal translucency • PP-13: plasma protein 13 • PAPP-A: pregnancy-associated plasma protein A • TR: tricuspid regurgitation • TXA2: thromboxane A2


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Copyright © 2009 by the American Academy of Pediatrics.