segunda-feira, 2 de maio de 2011

FMF Courses

NT courses

Theoretical courses in the 11-13 weeks scan, approved by the Fetal Medicine Foundation for the process of certification in the 11-13 weeks scan are organized in the following countries:

* Courses planned in Australia can be viewed by clicking here
* Courses planned in the USA can be viewed by clicking here
* Courses planned in the Netherlands can be viewed by clicking here
* Courses planned for other countries can be seen below

Advance Course in Gynecological Ultrasound

Pelvic tumors - recent developments in ultrasound diagnosis
London, 11th March 2011

Contact: Mary Stanton
email: mary.stanton@imperial.nhs.uk
For more information please click here
Ian Donald Advanced Ultrasound Course

Istanbul, 1st - 2nd December 2011
Contact: Rauf Kınay
E-mail: rauf.kinay@serenas.com.tr
For more information please click here
European School of Perinatal Medicine - Preeclampsia

Istanbul, 3rd - 4th December 2011
Contact: Rauf Kınay
E-mail: rauf.kinay@serenas.com.tr
For more information please click here

Turning the pyramid of prenatal care

In the 19th century pregnancy care was confined to the time of delivery and reserved for the wealthy. In the beginning of the 20th century the high maternal and infant mortality stimulated the establishment of institutions for provision of antenatal care.
In 1929 the Ministry of Health in the UK issued a Memorandum on Antenatal Clinics recommending that women should first be seen at the 16 th week of pregnancy and then 24 and 28 weeks, fortnightly until 36 weeks and then weekly until delivery. No explicit rationale was offered for either the spacing or clinical content of visits yet these guidelines established the pattern of antenatal care that is followed throughout the world until now. old pyramid.jpg

The high concentration of visits in the third-trimester implies that firstly, most complications occur at this late stage of pregnancy and secondly, most adverse outcomes are unpredictable in the first- or even second-trimester.

In the last 20 years it has become apparent that more than 90% of all major aneuploidies can be identified at 11-13 weeks' gestation by a combination of maternal characteristics, ultrasound findings and biochemical testing of maternal blood. It is also becoming increasingly apparent that an integrated first hospital visit at 11-13 weeks combining data from maternal characteristics and history with findings of biophysical and biochemical tests can define the patient-specific risk for a wide spectrum of pregnancy complications, including miscarriage and stillbirth, preeclampsia, gestational diabetes mellitus, preterm delivery, fetal growth restriction and macrosomia.
Early estimation of patient-specific risks for these pregnancy complications would improve pregnancy outcome by shifting antenatal care from a series of routine visits to a more individualized patient and disease-specific approach both in terms of the schedule and content of such visits. A small proportion of women identified as being at high-risk for a variety of pregnancy complications can have close surveillance in specialist clinics. nicolaides pyramid.jpg

The great majority of women would be identified as being at low-risk for pregnancy complications and in this group the number of medical visits can be substantially reduced.

Each visit would have a predefined objective and the findings will generate likelihood ratios that can be used to modify the individual patient and disease-specific estimated risk from the initial assessment at 11-13 weeks. In this respect, the 11-13 weeks assessment is likely to be the basis for a new scientific approach to antenatal care that could reduce maternal and perinatal mortality and morbidity.

This section presents the emerging evidence on the potential value of the 11-13 weeks assessment and sets the basis for a challenge to overturn the 80 years old pyramid of antenatal care.

In each topic there will be a short lecture summarizing the methodology and results, the pdf files of the relevant scientific publications and a risk calculator to estimate the patient-specific chance for a given condition based on the findings at the 11-13 weeks assessment.

For comments and suggestions, please email : jaderjcruz@gmail.com

This new section has been introduced in October 2010 and it has so far been accessed by 22,585 viewers.

Acknowledgments:

* Director: Kypros Nicolaides
* Coordinators: Jader de Jesus Cruz, Ranjit Akolekar

workshop