The first three months after conception are
the period of formation of body parts of the baby. Hence it is essential to avoid all
medications, radiation and contact with children with viral infections, all of which can
potentially damage the developing baby. During this period a scan should be done by an
experienced ultrasonologist to detect any abnormality in the baby (4 MONTHS).
The second 3 months (II Trimester) should be assessed by doppler flow of placenta, to
grade depletion of placental blood flow, in a growth retarded baby. This prevents
Intrauterine death (IUD). This situation also warrants evaluation for intrauterine
infection and chromosomal anomalies especially if the growth retardation was noticed
earlier.
The last 3 months (III Trimester) is the most dynamic and needs a bare minimum of
cardiotocographic monitoring (CTG) during and prior to labour and delivery. Only if such a
electronic device is used continuously can we be reasonably sure that the timing of
delivery was appropriate and that the baby's brain has not been affected by oxygen
deprivation due to poor timing of birth. In western countries CTG monitoring is used in
all pregnancies. In India it is disheartening to note that only some hospital should use
CTG routinely. It is suggested that all maternity hospital use CTG monitoring.
Biophysical profile is done by ultrasound observation of the baby's posture, heart rate
accelerations etc during a 30 min observation. It is a sensitive test and supplements CTG
monitoring.
Newer modalities of monitoring give specificity in addition to the sensitivity of the
older surveillance techniques. NIRS (Near Infra Red Spectroscopy) and foetal pulse
oximetry detect lack of oxygen supplied to the brain of the baby far ahead of the above
mentioned surveillance techniques, showing abnormalities.
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