Giovanni Centini, a specialist in Obstetrics and Gynecology, is Professor of Prenatal Diagnosis at the University of Siena and has directed the Prenatal Diagnosis section at Santa Maria della Scala for more than 30 years. He is the author of more than 200 national and international publications and co-author of 5 volumes of ultrasound in obstetrics and gynecology.
When is prenatal counseling recommended and what does it consist of?
Before embarking on the path of pregnancy, it is indicated to perform prenatal counseling to be able to cope with an informed gestation. The initial interview covers the prospective parents' family history and lifestyle, to identify any hereditary diseases and provide them with the useful tools for a proper approach to procreation.
Added to this are some blood tests to check the antibody status against certain infectious diseases such as toxoplasma or cytomegalovirus that may affect the course of pregnancy and an ultrasound check aimed at studying the internal genitalia. This concludes with the prescription offolic acid for the prevention of fetal spida bifida or other supplements if needed. This is the time when the couple can address and dissect all the issues or anxieties that often arise at the time of the decision to have a child.
Speaking of prenatal diagnosis, what are the recommended tests?
Ultrasound is now an indispensable instrumental device to assess the physiological growth of the fetus and exclude or unfortunately suspect any structural abnormalities. Customarily, during a physiological pregnancy, there are three planned monitoring checkups to be performed in the three trimesters.
The first check can be performed early, during the 6th-7th week, to check for the presence of the gestational chamber in the uterus, the presence of the embryo, and observation of cardiac activity. Later around the 10th-11th week, dating of the pregnancy can be performed. The first checkup is essential to talk about pregnancy lifestyle and to address, for couples who wish, the issue of diagnosing genetic abnormalities, such as Down syndrome.
For this purpose, one of the best known tests and offered for years in our Region is the Combined Test, which involves a blood draw to dose certain hormones and an ultrasound examination around the 12th week of pregnancy aimed at measuring nuchal translucency. Correct information can be obtained on the fetal DNA test, which offers at present the highest reliability in the field of noninvasive techniques.
In the second trimester, the ultrasound examination called morphologic ultrasound is performed at 20 to 22 weeks and is aimed at fetal growth and the detection of any structural abnormalities of the best for this purpose.
The third-trimester ultrasound examination is performed between weeks 30 and 32 and is primarily aimed at the proper development of the product of conception, fetal presentation, assessment of the amount of amniotic fluid, and also the exclusion of certain late-developing diseases, including renal and intestinal diseases.
In this diagnostic pathway, what role does three-dimensional ultrasound play?
3D/4D echo plays a very important role in gynecology for the study of uterine malformations, which account for about 7% in the general population. In obstetrics, both 3D i.e., static image representation and 4D i.e., moving image (fourth dimension time) are used. 3D/4D echo offers a more accurate diagnostic capability in some specific pathologies.
This examination also has the effect of increasing, in the parents, the affective relationship toward the fetus, because the possibility of "seeing" the body in the first trimester and, later, the face of one's baby, makes concrete what with two-dimensional ultrasound is achieved only by imagination. Moreover, with 3D/4D, the male partner also becomes more aware of the mystery growing in the abdomen of the mother-to-be. To achieve all this, it is advisable to perform the 3-D ultrasound no later than 29 weeks.
