Last Updated on November 6, 2023 by Jasmine KeLa
Explore the Crucial First Trimester Screening: A comprehensive guide shedding light on the pivotal tests and assessments ensuring maternal-fetal health. Discover the significance, procedures, and vital insights into the initial phase of pregnancy care for a wholesome and secure journey.
A closer look at the pregnancy
Pregnancy period extends from conception to the onset of labor. During the first trimester, care of the mother (client) and the fetus focuses on health maintenance and the prevention of complications. Nursing care during the normal antepartum period includes taking a thorough maternal history, performing a complete physical examination, and educating the client about antepartum health.
The Prenatal Care
It is very essential to the overall health of the neonate and the mother. The common considered elements
of prenatal care include assessing the patient, performing prenatal testing, providing nutritional care, and minimizing the discomforts of pregnancy. However, that isn’t where prenatal care ends – or, should we say, where it begins.
The pregnancy first trimester assessment of the fetus prenatally uses direct and indirect monitoring techniques. Common tests include fetal heart rate (FHR) monitoring, ultrasonography, fetal activity determination, CVS, fetoscopy, Non-stress test and prepartum contraction stress test. Most of these screening tests are done to mother at 1st trimester.
Fetal Heart Rate
You can obtain the FHR by placing a fetoscope or Doppler stethoscope on the mother’s abdomen and counting fetal heartbeats. Simultaneously palpating the mother’s pulse helps you to avoid confusion between maternal and fetal heartbeats.
A fetoscope can detect fetal heartbeats as early as 20 weeks of gestation. The Doppler ultrasound stethoscope, a more sensitive instrument, can detect fetal heartbeats as early as 10 weeks of gestation and remains useful tool throughout labor.
Fetal Activity Determination
The activity of the fetus (kick counts) determines its condition in utero. Daily evaluation of movement
provides an inexpensive, noninvasive way of assessing fetal well-being. Decreased activity in previous active fetus may reflect a disturbance in placental function.
As early as 7 weeks of gestation, the embryo can produce spontaneous movements; however, these movements don’t become apparent to the mother until sometime between the 14th and 26th weeks (but generally between 18 and 22 weeks). The first noticeable movement of the fetus by the mother is called quickening. The acknowledgement of fetal movements may be delayed if the due date is miscalculated or if the mother does not recognize the sensation.
During pregnancy, the mother is monitored routinely for potential problems. Some problems may be detected by a simple urine test. The urine specimen should be obtained from the patient during her regularly scheduled visit using a clean-catch technique. The specimen is examined for bacteriuria (bacteria in the urine) as well as protein, glucose, and ketones. Urinalysis can detect such problems as infection or diabetes before the mother shows any signs.
Maternal Serum Assays
Serum assays – including estrogens, human placental lactogen (hPL), and hCG – are used in addition to urinalysis to monitor the pregnant mother for problems.
This is a procedure done during the first trimester in which fetoscope – a telescope-like instrument with lights and lenses – is inserted into the amniotic sac, where it can view and photograph the fetus. This procedure makes it possible to diagnose, through blood and tissue sampling, several blood and skin diseases that amniocentesis can’t detect. Fetoscopy is a relatively risky procedure and, because other safer techniques are becoming available to detect the same disorders, it isn’t widely used.
During 1st trimester, blood studies are ordered to assess the mother’s health, screen for maternal condition that may endanger the fetus, detect, and monitor the fetal well-being. Initial studies include blood typing, a complete blood count (CBC) with differential, antibody screening tests, and a serologic test for syphilis and gonorrhea. Other tests may be performed to assess the Alpha Fetoprotein (AFP) levels, blood glucose, and other chemicals, if indicated.
The AFP testing – sometimes called the MSAFP test or maternal serum AFP test – is usually used to
detect neural tube defects. AFP is a protein that is secreted by the fetal liver and excreted in the mother’s blood. When testing by immunoassay, AFP value is (less than 15 ng/ml) for non-pregnant women.
Performed by a specially trained nurse, a prepartum NST evaluates fetal well-being by measuring the fetal heart response to fetal movements. Such movements produce transient accelerations in the heart rate of a healthy fetus. Usually ordered during the third trimester of pregnancy, this non-invasive screening test used indirect electronic monitoring to record FHR and the duration of the uterine contraction. It is indicated for suspected fetal distress or placental insufficiency associated with maternal conditions.
Contraction Stress Test
The prepartum CST evaluates respiratory function of the placenta and indicates whether the fetus will be able to withstand the stress of labor. Performed by a specially trained nurse, this test uses indirect electronic monitoring to measure fetal heart response to spontaneous or oxytocin-induced uterine contractions. The CST is indicated when the NST fails to produce reactive results.
Contraindicates to the CST include the flowing maternal conditions:
- Preterm labor or preterm membrane rupture;
- Multiple pregnancy;
- Previous vertical cesarean delivery;
- Abruption placentae.
Navigating the initial phase of pregnancy, known as the “First Trimester,” is a crucial period that necessitates comprehensive care and vigilant monitoring for both the expectant mother and the developing fetus. This phase marks the genesis of a journey brimming with vitality, anticipation, and the solemn responsibility of ensuring maternal and fetal well-being.
First Trimester Screening stands as a cornerstone in the continuum of prenatal care. It encompasses a meticulous assessment employing various methodologies to monitor the health of both the mother and the nascent life she carries. This screening entails a multifaceted approach that includes antepartum care, prenatal testing, and a range of diagnostic procedures designed to ensure the optimal health of both the expectant mother and the developing fetus.
The early stages of pregnancy bring forth a series of vital checks aimed at maintaining the health and comfort of the expectant mother. These checks involve the judicious assessment of maternal health through maternal history, thorough physical examinations, and the critical analysis of urinalysis results. Maternal well-being is further monitored through serum assays, encompassing various markers such as estrogens, hPL, and hCG, all contributing to a comprehensive evaluation of the mother’s health status.
Amidst these assessments, the focus remains not solely on maternal health but equally on the welfare of the budding life. Fetal monitoring techniques including fetal heart rate monitoring, fetal activity determination, and AFP screening serve as invaluable tools in gauging the well-being of the developing fetus. Techniques such as the Nonstress Test (NST) and the Contraction Stress Test (CST) play pivotal roles in observing fetal responses to movements and stress, ensuring a thorough evaluation of fetal health.
However, the significance of the First Trimester Screening is not confined solely to these testing and monitoring protocols. It encompasses an all-encompassing approach towards the holistic health of both mother and child. The inclusion of prenatal care services further extends to addressing nutritional needs, alleviating pregnancy discomforts, and providing holistic support for the overall health of the expectant mother and the anticipated arrival.
The diagnostic procedures conducted during the first trimester, such as fetoscopy procedures and blood studies, play a significant role in assessing not only the well-being of the fetus but also in detecting potential maternal conditions that might pose risks to the unborn child.
In essence, the First Trimester Screening encapsulates a symphony of care – an intricate interplay of assessments, tests, and monitoring strategies amalgamated to foster the optimal health of both the expectant mother and the burgeoning life within. It serves as a critical cornerstone not only for the identification of potential risks but equally for the early detection and management of any probable complications that might arise during the course of pregnancy.
In the grand tapestry of pregnancy care, the First Trimester Screening stands as an essential pillar, weaving together the threads of meticulous assessments, diagnostic procedures, and vigilant monitoring into a fabric that ensures the well-being of both mother and child. The knowledge gleaned from these assessments, coupled with the appropriate interventions, creates a nurturing environment for the miraculous journey of birth, underscoring the paramount importance of this critical phase in the continuum of maternal and fetal health.
FAQ For First Trimester Screening
- FAQ 1: What is First Trimester Screening, and why is it important in pregnancy care? Answer: First Trimester Screening involves a series of tests and assessments conducted within the initial stages of pregnancy. It’s vital as it allows early detection of potential risks or complications for both the mother and the developing fetus. These screenings aim to ensure optimal maternal health and monitor the well-being of the growing baby.
- FAQ 2: What diagnostic procedures are included in the First Trimester Screening? Answer: Diagnostic procedures commonly encompass various assessments such as maternal history evaluations, physical examinations, fetal heart rate monitoring, maternal serum assays, urinary analyses, and even procedures like fetoscopy. These tests aid in assessing both maternal health and the condition of the developing fetus.
- FAQ 3: How do Fetal Heart Rate and Activity Determination play a role in First Trimester Screening? Answer: Fetal Heart Rate monitoring involves non-invasive techniques using tools like fetoscopes or Doppler stethoscopes to ascertain the fetus’s heart rate, ensuring its normalcy. Fetal activity determination, often referred to as “kick counts,” assesses the movement and vitality of the growing baby, offering insight into its well-being within the uterus.
- FAQ 4: What complications or conditions can First Trimester Screening help to detect? Answer: The screenings conducted during the first trimester are instrumental in identifying a spectrum of issues. They can detect conditions such as genetic abnormalities, neural tube defects, placental insufficiency, maternal infections, and metabolic disorders that may impact the health of both the mother and the fetus.
- FAQ 5: Are First Trimester Screenings safe for the mother and the developing fetus? Answer: Generally, these screenings are safe and non-invasive. However, each test or procedure entails minimal risks, and it’s essential to discuss these with healthcare providers. The potential benefits of early detection and intervention typically outweigh the minimal associated risks, thereby ensuring a healthier outcome for both mother and baby.
American College of Obstetricians and Gynecologists (ACOG). (2022, July). Prenatal testing. Retrieved from https://www.acog.org/advocacy/policy-priorities/non-invasive-prenatal-testing/current-acog-guidance LINK
American Pregnancy Association. (2023, October 5). First trimester screening. Retrieved from https://americanpregnancy.org/prenatal-testing/prenatal-tests/
March of Dimes. (2023, September 27). First trimester screening. Retrieved from https://www.marchofdimes.org/report-card
Mayo Clinic. (2023, August 31). Prenatal tests. Retrieved from https://www.mayocliniclabs.com/test-info/prenatal/index.html
National Institutes of Health (NIH). (2022, December 22). First trimester screening. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK470559/