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Antenatal care critical in detecting and correcting foetal abnormalities during pregnancy

<div><span style="font-family: helvetica;"><img src="/nairobi/PublishingImages/cord%20around%20the%20neck_body.jpg" alt="" style="margin: 5px;"/></span> </div><div><span style="font-family: helvetica;"><em><strong>Dr Sikolia Wanyonyi, </strong></em><span style="font-size: 11pt; line-height: 107%; font-family: arial, sans-serif;"><em><strong>Consultant Obstetrician Gynaecologist and Foetal 
Medicine Specialist at Aga Khan University Hospital in Nairobi conducting an ultrasound scan.</strong></em></span></span></div><div><span style="font-family: helvetica;">
</span></div><div><span style="font-family: helvetica;">Foetal abnormalities can negatively affect the physical and/or mental development of the child. In some cases, death may occur either in the womb, immediately, after birth or later on in life. Interestingly, up to 90% of foetal anomalies can be detected - even early in pregnancy through use of ultrasound scans, blood tests and amniotic fluid screening where necessary.</span></div><div><br style="font-family: helvetica;"/></div><div><span style="font-family: helvetica;">Once pregnancy is confirmed, a woman should seek antenatal care within the first 2-3 months of pregnancy.  Several prenatal tests are then carried out to determine the presence of infection, or other conditions that may be harmful to the fetus and/or the woman.</span></div><div><br style="font-family: helvetica;"/></div><div><span style="font-family: helvetica;">Besides these tests, the gestational age can be accurately determined in the first trimester. The first trimester scan also offers the opportunity to determine if there is more than one baby and if this is the case, whether they share a placenta or not. Most abnormalities of the brain, spinal cord, abdomen and kidneys can be seen at this stage. In good hands a handful of heart problems could also be picked up.  The anomaly scan done at around 20 weeks thereafter identifies most of the major structural abnormalities. However, it must be remembered that even in the most experienced and good hands, not all anomalies can be seen and this may be picked up either at birth or on autopsy in the event of death. Genetic anomalies if not associated with obvious defects can only be diagnosed through foetal testing and not ultrasound.</span></div><div><br style="font-family: helvetica;"/></div><div><span style="font-family: helvetica;">Birth defects are classified as structural and developmental. Structural defects can affect any part of the body and can either be lethal or compatible with life. They include but not limited to, heart defect, cleft lip, or excessive fluid in the brain, clubfoot and spinal bifida which is the abnormal development of the spinal cord. Advancements in medicine have made it possible to treat and correct these deformities through medications, surgeries and proper home care. </span></div><div><br style="font-family: helvetica;"/></div><div><span style="font-family: helvetica;">Functional or developmental birth defects may not exhibit any obvious anomaly but the baby can as some may be genetic. Examples include; Down syndrome which causes delay in physical and mental development, sickle cell disease where the red blood cells become mis-shapen (crescent shaped) and cystic fibrosis, a condition that damages the lungs and digestive system. These often cause limited intelligence, or development of various body systems.</span></div><div><br style="font-family: helvetica;"/></div><div><span style="font-family: helvetica;">Once an abnormality is identified, parents should be counselled regarding the nature of the deformity and the treatment options available either in pregnancy or after birth. They should also be informed of the special needs or requirement the child may have in future. The parents may choose to carry on with the pregnancy despite the abnormality or opt to terminate it. </span></div><div><br style="font-family: helvetica;"/></div><div><span style="font-family: helvetica;">Some of the risk factors for having a baby with either genetic or structural anomalies include advanced maternal age usually over 40 years, genetic disorders within the family, excessive alcohol consumption, smoking  or drug abuse during pregnancy. Other factors include use of some medications prior to conception or during early pregnancy that are harmful to the developing baby, lack of folic acid supplementation prior to conception, exposure to chemicals, toxins and radiations, viral infections, pre-existing medical conditions such as diabetes or epilepsy among others.</span></div><div><br style="font-family: helvetica;"/></div><div><span style="font-family: helvetica;">Most abnormalities, especially those of the heart can benefit from immediate correction post delivery that could prevent death and result in normal healthy individuals. Some such as spina bifida and can be prevented with use of folic acid prior to conception. While others can be corrected either in the womb or after birth. It is therefore important that women should seek early prenatal screening and testing to detect these abnormalities if any and receive expert opinion on their pregnancies to avoid unnecessary unpleasant surprises at birth. </span></div><div><span style="font-family: helvetica;">
</span></div><div><span style="font-family: helvetica;"><em>By Dr Sikolia Wanyonyi, Consultant Obstetrician Gynaecologist and Foetal Medicine Specialist, and Professor Marleen Temmerman, Chair Department Obstetrics and Gynaecology at Aga Khan University Hospital in Nairobi</em>

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