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[Prenatal care in at-risk pregnancies]
1Universitäts-Frauenklinik und kantonales Frauenspital Bern.
Systematic development of prenatal care is a significant factor in the reduction of maternal and perinatal morbidity and mortality. Despite impressive advances in prenatal and perinatal care, attempts at prevention for most serious pregnancy complications are limited by the lack of sensitive and specific indicators allowing prediction with any degree of probability. In view of the widening spectrum of methods for the diagnosis of pregnancy complications, the dangers of broad application without a critical benefit/risk analysis must be stressed. Apart from rising costs, the effect on pregnant women in terms of increased anxiety must be borne in mind. For the majority of women the core or prenatal care must remain conventional clinical examination combined with extensive consultation and information. Repeated use of technology such as ultrasound, Doppler, cardiotocography etc. should be limited to pregnancies with high risk of serious complications. Invasive preventive measures such as hospitalization, cerclage or administration of tocolytic drugs also need critical use and should be confined to a limited number of genuine high risk cases.
Systematic development of prenatal care is a significant factor in the reduction of maternal and perinatal morbidity and mortality. Despite impressive advances in prenatal and perinatal care, attempts at prevention for most serious pregnancy complications are limited by the lack of sensitive and specific indicators allowing prediction with any degree of probability. In view of the widening spectrum of methods for the diagnosis of pregnancy complications, the dangers of broad application without a critical benefit/risk analysis must be stressed. Apart from rising costs, the effect on pregnant women in terms of increased anxiety must be borne in mind. For the majority of women the core or prenatal care must remain conventional clinical examination combined with extensive consultation and information. Repeated use of technology such as ultrasound, Doppler, cardiotocography etc. should be limited to pregnancies with high risk of serious complications. Invasive preventive measures such as hospitalization, cerclage or administration of tocolytic drugs also need critical use and should be confined to a limited number of genuine high risk cases.