First Trimester Screening Tests

First trimester screening tests • U/S measurement (Nuchal Translucency): - • PAPP-A: - • - - Used in weeks 11 to 13 weeks. Uses the mother’s exact age, weight and correct gestation of pregnancy to provide the risk assessment for babies with Down Syndrome, Trisomy 13 and 18. The program calculates a risk based in these factors and provides an assessment of the possibility of the foetus having these conditions. ✓ Only a risk assessment not a definitive diagnosis. If the result is positive this is usually followed by more invasive techniques: ✓ Chorionic villus sampling (CVS): (weeks 10 -12) ➢ This involves the collection of a sample tissue of chorionic villi from the placenta, which looks for chromosomal abnormalities. ✓ Amniocentesis (weeks 15 to 20) ➢ Use of U/S to locate where the needle is to be placed. ➢ Sample of amnionic fluid. ➢ Fetal cells within the fluid are examined for chromosomal abnormalities, genetic disorders, and certain birth defects. Psychological concerns: - • Produced in pregnancy. Abnormal levels in the maternal blood can be associated with an increased risk of chromosomal abnormalities. Pre-natal screening software program: - • An increase if this in the maternal blood could indicate chromosomal abnormalities. Beta-hCG: - • Thickness of the fluid filled space at the back of the baby’s neck. An increase in measurement may indicate a higher risk of chromosomal abnormalities. Anxiety and stress. Decision making pressure. Impaction of emotional wellbeing. Ethical concerns: - Informed consent. Non-directive counselling: should not pressure on the parents to make a certain decision, especially if they are not comfortable. Reproductive autonomy: social and community norms may influence their decision. Resource allocation. Selective reduction in Multiple Pregnancies • Indications: - • Ethical considerations: - • High risk pregnancy such as preterm labour, preeclampsia, gestational diabetes etc. Fetal health conditions: selective reduction may help with the overall health of the other babies who have no health conditions, or have a lesser risk, and their condition may worsen if the other baby with the poor health condition remains. Space and resources: if carrying multiple pregnancies could add additional unbearable stress on the parents. Wellbeing of the mother. Long term wellbeing. Quality of life for both the parents and the child. This includes emotional suffering and the pain and consequences experiences by the baby. Equity and fairness: such as selectively reducing the foetus due to factors such as gender. Value of human life. Religious beliefs: - Islam: ✓ Sanctity of human life as human life is considered to begin at conception. ✓ Unacceptable unless there it places the mother at danger and there is no treatment or a medical intervention to correct situation. ✓ Some scholars allow before 120 days before the soul is breathed in, if the quality of life of the child may be impacted. But before that it is not allowed as the foetus is considered a human that cannot be killed. - - • Social and cultural beliefs: - • Christianity: ✓ Views vary. ✓ Conservatives believe that human life begins to conception regardless while others believe if there is danger to the mother then it is allowed, others might allow it for whatever reason. Judaism: ✓ Varying beliefs. ✓ Orthodox: do not allow it unless the other is at significant risk of harm. ✓ Conservative and reformed: allow it is there is impact on the wellbeing of the mother and the quality of life of the child and any potential suffering that they may experience. Hinduism: similar views as above. Buddhism: different views with some considering the intention and the reason behind it. Cultural and social norms and pressure. Factors such as family support, financial considerations and the medical resources can impact upon this. Emotional and psychological impacts: - Feelings of grief, guilt and moral dilemmas.