1500 pregnant mothers hands-on experience: non-invasive or sheep wear? What can elderly pregnant mothers do to be safe?

In 2021

1569 pregnant mothers

At Zhuhai Maternal and Child Prenatal Diagnosis Center

Amniocentesis is performed

According to statistics, these pregnant mothers

One puncture success rate of up to 99.5%

Postoperative miscarriage rate 0%

"The process operation time is short, the pain is not obvious, and the medical staff is also very gentle with themselves, which can soothe their nervousness, and it is not as terrible as they thought before the operation." Ms. Lin, a 40-year-old mother-to-be, said.

In fact, amniocentesis is a very conventional prenatal diagnostic examination, the safety factor is extremely high, although it is an invasive operation, but the wound is very small and almost invisible!

Some pregnant mothers believe that as long as non-invasive DNA testing (NIPT) is done during pregnancy, they can rest easy. This idea needs to be corrected!

1. Not all pregnant women are eligible for the indications for noninvasiveness, especially advanced pregnant women!

2. Noninvasive as a screening method, based on the detection of placental chromosomes rather than fetus, there will also be false positives or false negatives!

Not all fetal chromosomal problems of elderly pregnant women will be found when non-invasive DNA testing, and 10% of pregnant women who are simply elderly in the second trimester will also need to undergo prenatal diagnosis because of the high risk of non-invasive DNA testing, test failure, ultrasound abnormalities, etc., and may miss the best time to test and terminate pregnancy.

3. Although noninvasive DNA testing is a non-traumatic project, its testing has limitations and cannot fully represent the true condition of the fetus!

Sum up

Amniocentesis is necessary!

Amniocentesis is done under the guidance of B ultrasound, which can maximize the avoidance of the fetus, placenta and umbilical cord to extract amniotic fluid, which is a relatively safe examination.

The amniotic fluid extracted under amniocentesis is fetal urine and amniotic epithelial leakage, which contains exfoliated cells, enzymes, hormones and fetal metabolites of the fetal skin.

The assay project can be more comprehensive, including rapid chromosomes, chromosome microarray analysis, chromosome karyotype analysis, chromosome total exogenesis and other genetic tests.

Suitable for gestational age between 18 and 24 weeks, this is a very common prenatal diagnostic test that can be performed on an outpatient basis without hospitalization.

However, since amniocentesis is a traumatic test, there are also certain risks, which are:

1. A very small number of fetuses have transient bradycardia;

2. In very few cases, premature birth or intrauterine death of the fetus occurs, and it is generally believed that the probability of miscarriage of amniocentesis is between 0.25% and 0.5%, and the minimum is only 0.06%, but this risk is not consistently concluded in clinical medical studies;

3. Very rare amniotic infection;

4. Bleeding from umbilical cord and placental injuries may occur.

Risk aversion:

First, because the current amniotic puncture is completed under the guidance of ultrasound, the possibility of damage to the fetus is minimal.

Second, the Prenatal Diagnosis Center of Zhuhai Maternal and Child Health Hospital became the first batch of institutions in Guangdong Province to obtain prenatal diagnosis qualifications in 2008. In the operation of various prenatal diagnostic technologies, there are standardized management processes, and the doctors who operate are all deputy chief physicians and have rich work experience.

According to the "Expert Consensus on The Management of Advanced Women Before Pregnancy, Pregnancy and Childbirth (2019 Latest Edition)" published in the Chinese Journal of Obstetrics and Gynecology, elderly pregnant women carry out health management from the following aspects:

1. Management of the second and third trimesters of pregnancy

The second and third trimesters of pregnancy are important stages of fetal growth and development and the emergence of various abnormal phenomena, combined with the "Pregnancy Health Care Guidelines (2018)" on the pregnancy care of elderly pregnant women have the following precautions:

1. Carefully ask about the pre-pregnancy medical history, focusing on whether there is diabetes, chronic hypertension, obesity, kidney and heart disease, etc., ask about the previous fertility history, whether the pregnancy is conceived for assisted reproductive treatment, the interval between pregnancies, and clarify and record the high risk factors.

2. Evaluate and inform the pregnant woman of advanced age about the risk of pregnancy, including miscarriage, fetal chromosomal abnormalities, fetal malformations, hypertensive disorders during pregnancy, GDM, fetal growth restriction (FGR), preterm birth and stillbirth.

3. Standardize the supplementation of folic acid or multivitamins containing folic acid, timely regulate the supplementation of calcium and iron, and consider appropriate dose increases according to the situation.

4. Elderly pregnant women are the key groups for prenatal screening and prenatal diagnosis. Key inspection items include:

(1) Ultrasound screening during early pregnancy should be performed at 11 to 13 weeks of pregnancy + 6: fetal NT, presence or absence of nasal bone, etc.

(2) Screening of fetal malformations: The second trimester of pregnancy is an important period for screening fetal chromosomal abnormalities and structural malformations, and prenatal screening and prenatal diagnosis should be carried out strictly. Invasive prenatal diagnosis is preferred for advanced pregnant women, and pregnant women should be informed of the need for invasive prenatal diagnosis and the risks of 0.5% to 1.0% miscarriage, infection, amniotic fluid leakage, etc.

Ultrasound screening is recommended at 20 to 24 weeks of gestation and 28 to 30 weeks of pregnancy to exclude fetal structural abnormalities and to understand fetal development, and if necessary, MRI (magnetic resonance imaging) or fetal karyotype analysis and genetic testing.

(3) Oral glucose tolerance test (OGTT) should be performed as soon as possible at the age of 24 weeks of pregnancy to diagnose and manage gestational diabetes mellitus as soon as possible.

(4) Strengthen the monitoring of blood pressure: elderly pregnant women with a family history of hypertension should strengthen management. With the increase of the age of pregnant women, the risk of complications during pregnancy increases, and the monitoring of pregnancy complications should be paid attention to during the second trimester of pregnancy, including: paying attention to the blood pressure, conscious symptoms and urine protein of pregnant women; for elderly pregnant women with hypertensive risk factors, they should be reminded to pay attention to conscious symptoms and monitor blood pressure changes, and seek medical treatment in time if abnormalities occur.

5. Pregnancy Education: Teach elderly pregnant women to self-monitor common complications during pregnancy. If abnormalities such as headache, dizziness, pain in the liver area, nausea, and vomiting occur, you should see a doctor immediately.

Second, the management of the childbirth period

The period of childbirth is a period of high risk for both age-appropriate and advanced-age women. The literature reports an increased risk of maternal mortality and intrauterine fetal death at an advanced age. Strengthening the management of elderly women and reducing complications during motherhood and childbirth are important links to ensure the safety of mothers and children.

Advanced age is not indicative of caesarean section, especially in pregnant women under 40 years of age, and the success and safety of vaginal delivery are not significantly different from those of women of appropriate age.

The indications for caesarean section may be relaxed as appropriate for older pregnant women with a strong willingness to deliver by caesarean section.

Elderly pregnant women with a previous history of caesarean section surgery, who have the intention of vaginal trial delivery, can undergo vaginal trial labor after being assessed to have vaginal trial delivery conditions, fully inform the risks and know the choice.

Third, postpartum management

1. Be wary of postpartum bleeding.

2. Guide breastfeeding and postpartum rehabilitation, establish a good attitude, reduce the incidence of postpartum depression, and if necessary, require psychological specialists to carry out psychological counseling.

3. Strengthen pelvic floor function rehabilitation exercises to improve the quality of life.