OM VERMA ASSOCIATE PROFESSOR GRACIOUS COLLEGE OF NURSING ABHANPUR RAIPUR C.G

2. GRACIOUS COLLEGE OF NURSING
MATERNAL AGE,MATERNAL DRUG THERAPY
PRENATAL TEST AND DIAGNOSIS
PRENATAL TEST AND DIAGNOSIS
PRESENTED BY
OM VERMA
ASSISTANT PROFESSOR

3. INTRODUCTION
Scientific evidences shows that advance age
,especially after the 35 year women's who conceive
are at greater risk of pregnancies complication. Age
of mother has an influence on the pregnancy and
of mother has an influence on the pregnancy and
fetus. Advanced maternal age is defined as any
expectant mother of age 35 years or above by the
time she delivers. Majority of women over the age of
35 years have healthy pregnancies and healthy
babies.

4. MATERNAL AGE:
The age of the mother at the time of delivery. Advanced
maternal age is usually defined as age 35 or more at
delivery. Advanced maternal age predisposes to Down
syndrome (trisomy 21). The risk of having a Down
syndrome (trisomy 21). The risk of having a Down
syndrome baby rises with maternal age.
According to M.J. Simmons

5. RISKS ASSOCIATED WITH HAVING A BABY AFTER 35 YEAR
All pregnancies come with risks; of advanced maternal age:
Preeclampsia.
Gestational diabetes.
Premature birth or low birth weight.
Expecting twins.
Expecting twins.
Miscarriage.
Down syndrome or other genetic disorders.
Cesarean section (c-section).
Stillbirth. - A stillbirth is the death or loss of a baby before or during
delivery

6. Higher risk of genetic abnormalities: As maternal age
increases there is an increased risk of Down's syndrome
and other chromosomal abnormalities. Advanced maternal
age is one of the indications for prenatal testing.
Decreased fertility: In women, fertility begins to decrease
Decreased fertility: In women, fertility begins to decrease
from beginning in their early thirties. The conception is
delayed in women older than 35 years when compared to
those younger than 35

7. Risk of twins: Advanced maternal age is as sociated with higher risk
of having a naturally conceived (without fertility treatment) twin
pregnancy.
Diseases associated with advanced age: As age increases, the risk
of developing diabetes or high blood pressure, during pregnancy
also increases.
also increases.
Gynecological problems : - such as pelvic infection, tubal damage,
endometriosis, fibroids, ovulation problems, etc. tend to increase
with age and interfere with fertility

11. MATERNAL DRUG THERAPY
The use of drugs in pregnant and lactating mothers requires a
great caution as most of the drugs are able to cross placental
barrier in varying degrees and are secreted in the milk. Many
drugs are known to produce adverse effects on the
foetus/infant. Drug therapy during early pregnancy (first
foetus/infant. Drug therapy during early pregnancy (first
trimester) should be avoided as some of the drugs may
produce teratogenic effects in the foetus. Most drugs are
secreted in the breast milk and therefore, may harm the infant.

12. A teratogenic agents is a substance that
interferes with normal fetal development
and causes congenital disabilities. Drugs,
alcohol, chemicals and toxic substances
alcohol, chemicals and toxic substances
are examples of teratogens. Teratogens
can also increase the risk for miscarriage,
preterm labor or stillbirth

13. A few examples of both the harmful and beneficial
effects have been described below –
Harmful Effects of Maternal
Harmful Effects of Maternal
Drug Therapy
Following are a few examples of the drugs which must be
used

14. 1. Anticonvulsants drugs , such as phenytoin and
carbamezapine (prevent epileptic seizures), cause
intrauterine growth retardation, mental deficiency, facial
abnormalities, cardiac defects, cleft lip and palate,
malformed ears and genital defects .
malformed ears and genital defects .
2. Antimigraine drugs, such as methylsergide and
ergotamine, raise the risk of premature delivery.

15. 3. Isotretinoin and etretinate drugs , used to treat chronic
acne and psoriasis, cause chronic malformations during
the stage of organ development.
4. Non-steroidal anti-inflammatory drugs (NSAIDs), such
4. Non-steroidal anti-inflammatory drugs (NSAIDs), such
as aspirin and ibuprofen, interfere with blood clotting and
increase the risk of uncontrolled bleeding. During the end
of pregnancy, their intake may delay the delivery by
decreasing the production of labour inducing hormones

16. 5. Anticoagulant drugs - based on coumarin (for treating
heart disease and stroke) are associated with facial
malformations and mental retardation. Warfarin may cause
hypoplastic nasal structure ( hypoplastic nasal bone may
be caused by nasal bone hypoplasia or delayed
ossification.) and skeletal abnormalities.
ossification.) and skeletal abnormalities.
6. Diazepam drug - has been associated with cleft palate.
7. Tetracyclines drug - are associated with stained teeth (
Extrinsic tooth discoloration )in infants and depressed
skeletal growth. They also cause dental caries

17. 8. Methotrexate drug - causes intrauterine growth
retardation, decreased ossification of skull. prominent
eyes, limb abnormalities and mild developmental delay.
9. Lithium - is associated with congenital heart disease.

18. Drug/Nutritional Therapy of Genetic
Disorders
Following are some of the examples of beneficial
effects of medications and nutrient supplements in
various genetic disorders.
various genetic disorders.
1. Down syndrome - has been associated with an
imbalance in folate metabolism and zinc deficiencies.
Folic acid and zinc supplementation during the
prenatal period has positive effect on Down
syndromes.

19. 2.Mitral valve prolapse (MVP) - is considered to be
an inherited collagen disorder with overlapping
features similar to Marfan's syndrome (An inherited
disorder that affects connective tissue.Marfan
syndrome affects the heart, eyes, blood vessels and
bones.)
bones.)
. Most of people with MVP are magnesium deficient.
MVP symptoms are reduced or manintain by
magnesium supplementation.

20. 3. cystic fibrosis - patients can be treated
nutritionally using high protein high caloric diets,
pancreatic enzymes, and fat soluble vitamins.
4. Many cases of homocystinuria ( It means the
body can't process the amino acid methionine. This
body can't process the amino acid methionine. This
causes a harmful build-up of substances in the blood
and urine.) a connective tissue disorder showing
Marfan syndrome like symptoms and dislocated
lenses, are treatable through nutritional therapy

21. 5. Folic acid deficiency - caused by genes produces
neural tube defects and cleft palates. These defects
can be prevented by folic acid supplementation
before conception and during early pregnancy.
therapy .
6. Wilson's disease,- an inherited disorder having
excess copper accumulation in the body, can 1
treated successfully by zinc supplementation that
reduces copper levels.

22. 7. Blue sclera, a symptom of wide variety of
connective tissue disorders - including
Ehler- Danlos syndrome, osteogenesis
Marfan syndrome, has been linked to iron
deficiency in many cases.
deficiency in many cases.
8. Sulphocysteinuria (sulphite oxidase
deficiency causing dislocated lenses)
responds well to a low sulphur diet.

23. 9. Cerebral palsy (CP) incidences,
usually associated with very low birth
weight babies, have been shown to
decrease when their mothers are
decrease when their mothers are
treated with magnesium sulphate
soon before giving birth.

25. PRENATAL TESTING
AND
AND
DIAGNOSIS

27. Prenatal testing consists of prenatal
screening and prenatal diagnosis, which
are aspects of prenatal care that focus on
detecting problems with the pregnancy as
detecting problems with the pregnancy as
early as possible. Purpose: detecting
problems with the pregnancy

31. Chorionic villus sampling
Fetal echocardiograms

32. AMNIOCENTESIS
It is a prenatal testing procedure usually performed
during the second or third trimester of pregnancy. It
can diagnose certain chromosomal conditions (such
as Down syndrome) or genetic conditions (such as
as Down syndrome) or genetic conditions (such as
cystic fibrosis). During amniocentesis, your healthcare
provider uses a thin needle to remove a small amount
of amniotic fluid from the sac surrounding the fetus.
This fluid sample then gets tested in a laboratory.

34. CORDOCENTESIS
it is an invasive prenatal procedure. It can
obtain a sample of blood from a
fetus's umbilical cord to detect blood disorders,
fetus's umbilical cord to detect blood disorders,
infections and genetic mutations. It can also be
used to deliver medications or blood
transfusions to a fetus.

35. CHORIONIC VILLUS SAMPLING (CVS),
OR CHORIONIC VILLUS BIOPSY,
It is a prenatal test that involves taking a
sample of tissue from the placenta to
sample of tissue from the placenta to
test for chromosomal abnormalities and
certain other genetic problems.

36. FETAL TISSUE BIOPSY
Invasive procedure to obtain fetal
tissue such as skin, muscle, or liver.
tissue such as skin, muscle, or liver.
Use. Diagnosis of specific inherited
disorders when gene mutation

37. COELOCENTESIS,
which involves aspiration of fluid from the extraembryonic
coelom, can be per- formed between 6 and 12 weeks'
gestation . During a culdocentesis a long thin needle is inserted
gestation . During a culdocentesis a long thin needle is inserted
through the vaginal wall just below the uterus and a sample is
taken of the fluid within the abdominal cavity. Culdocentesis
is a procedure that checks for abnormal fluid in the space just
behind the vagina

38. NON- INVASIVE
NON- INVASIVE
PROCEDURE

41. CELL-FREE DNA SCREENING
it is a test that can determine if a woman has
a higher chance of having a fetus with Down
syndrome (trisomy 21), trisomy 18, trisomy 13
syndrome (trisomy 21), trisomy 18, trisomy 13
or an abnormality in the sex chromosomes (X
and Y chromosomes). With this test, a sample
of the woman's blood is taken after 10 weeks
of pregnancy.

42. TRIPLE SCREENING TEST
Screening are usually performed beetween
16 and 18 week gestation
it is a blood test that measures three things
called alpha-fetoprotein, human chorionic
called alpha-fetoprotein, human chorionic
gonadotropin and unconjugated estriol. The results of
the blood test can help doctor see if baby may be at
higher risk for certain birth defects.

43. FETAL ECHOCARDIOGRAM
A fetal echocardiogram (also called a fetal
echo) uses sound waves to create pictures of
echo) uses sound waves to create pictures of
an unborn baby's heart. This painless
ultrasound test shows the structure of the
heart and how well it's working.

44. FETAL ECHOCARDIOGRAM
A fetal echocardiogram (also called a fetal
echo) uses sound waves to create pictures of
echo) uses sound waves to create pictures of
an unborn baby's heart. This painless
ultrasound test shows the structure of the
heart and how well it's working.