Pre-maternity management throughout pregnancy

Article by Dr. Tran Thi Huyen Trang – Laboratory Department – Share99 Times City International Health Hub

Preetal seizures (TSG) are defined as new oncological hypertension in combination with proteinuria or when proteinuria is not available, TSG is defined as hypertension with the following association: Thrombolysis, renal failure, liverfailure, pulmonaryedema , brain or visual symptoms, oncological oncologically starting after the 20th week of pregnancy.

Every year 10 million women suffer from TSG or have pregnancy-related hypertension disorders, of which about 76,000 die related to TSG and about 500,000 die from TSG each year. Early diagnosis of pre-seizure is extremely important to help doctors manage, care for and have accurate and timely interventions, bringing the best benefits to both mother and baby.

• TSG screening in Q1

Weekly screening 11-14 identified high-risk pregnant women with an algorithm including MAP(Mean arterial pressure), UTPI(Mean uterine artery PI) and PlGF:

• The high-risk group develops TSG before 37 weeks ≥1 /100 (accounting for about 10% of pregnant women). Treatment with aspirin (150 mg/day) before bedtime from 12 to 36 weeks reduces the risk of premature TSG by 60%
• Low-risk group develops TSG before 37 weeks <1/100(chiếm 90% số thai phụ), ít có khả năng hình thành TSG <37 tuần nhưng cần đánh giá lại nguy cơ lúc 22 tuần.
• TSG Management Quarter 2

Use two sFlt-1 and PlGF tests at 20-24 weeks:

• The high-risk group of TSG development before 32 weeks ≥1/100 accounts for about 1% of pregnant women, which should be monitored regularly by measuring bloodpressure , urine tests and ultrasounds that monitor the growth rate of pregnancy between 24-31 weeks.
• Low-risk group develops TSG before 32 weeks <1/300). This group, which accounts > 80% of pregnant women, is less likely to form TSG <36 tuần, nhưng cần đánh giá lại nguy cơ lúc 36 tuần.
• The average risk group (located between the two groups above) <20% trong="" tổng="" số="" thai="" phụ="" và="" có=""> accounts for 90% of these TSG formations between 32-35 weeks, which should be re-evaluated at gestational age of 32 weeks.</20%>

• TSG Management Quarter 3

Use of sFlt-1 and PlGF tests

Week 32:

High-risk group for TSG development before 36 weeks ≥1/100: Accounting for about 3% of pregnant women and about 90% of women in this group forming TSG 32-36 weeks, which should be monitored regularly by measuring blood pressure, urine tests and ultrasound monitoring the growth rate of pregnancy

Low risk group (TSG risk before 36 weeks <1 00).="" chiếm="">80% of pregnant women, <36 tuần, nhưng cần đánh giá lại nguy cơ lúc 36 tuần. less likely to form TSG</1>

Week 36:

High-risk group for TSG development before 40 weeks ≥1/100: accounting for about 20% of pregnant women and about >90% of women in this group form TSG <40 tuần, cần được theo dõi sát

The low-risk group developing TSG before 42 <1 00):="" chiếm="" khoảng="" 40%="" trong="" tổng="" số="" thai="" phụ="">weeks 99.9% of the likelihood of not forming TSG, </1> without any obstetrics and gynecology, can continue monitoring to wait for natural labor.

Average risk group: Accounting for 60% of pregnant women at risk of forming TSG >40 weeks🡪 it is necessary to re-evaluate at 40 weeks to decide the most suitable time for labor.

Support diagnosis and short-term pregnosing using sFlt-1/PlGF ratio from the 20th week of pregnancy for high-risk subjects:

• Pregnant women with suspected TSG signs and symptoms (new CHA, new proteinuria, apotheteritis, headache, visual disturbances, edema, abnormal doppler (≥ 95th percentile), abnormal weight gain,..)
• Pregnant women have been identified as Pre-seizures (based on the classical diagnostic standard CHA and proteinuria)

Diagnosis of TSG at sFLT-1/ PLGF

>= 85 with early TSG (on on-34 weeks)

>= 110 with early TSG (on-on-34 weeks)

Re-tested after 2-4 days for orientation

TSG (Late On-On-On-On-The-Go) to "Suspected TSG":

SFLT-1/ PLGF score >=655 🡪 related to the possibility of having to terminate the pregnancy within 48 hours.

12-week Maternity Care Program:

• This includes double test blood and plgf neovascular factor dosing to screen for 3 Downsyndromes, Edward, Patau for fetuses and 12 weeks pre-production screening for mothers
• Pre-production screening from 20 weeks with sFLT-1 and PLGF test sets

At Share99 International Health Hub, TSG screening tests are carried out on Cobas 8000 system, using the principle of photoefining electrolytization, fully automatic for fast and accurate results, ensuring not to miss pregnant women with TSG to help obstetricians make timely decisions to bring optimal benefits to both mother and baby. These two roche tests have been certified for testing quality by the Organization of Fetal Medicine (FMF) and can apply FMF software to help assess TSG risk with global quality.

At Share99 International Health Hub, there is a full maternity service as a solution to help pregnant mothers feel secure because there is a team of doctors throughout the pregnancy. When choosing a full-service maternity, a pregnant woman can:

• The process of pregnancy is monitored by a team of specialists
• Regular examination, early detection of abnormalities
• Package maternity for the convenience of childbirth
• Infants receive comprehensive care

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