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Inverted pyramid of prenatal care – is it enough? Should it be – extended inverted pyramid of prenatal care?

  • Aleksandar Ljubić EMAIL logo
Published/Copyright: April 7, 2017

Abstract

In recent years, the idea of the inverted pyramid of prenatal care and monitoring has emerged, for the purpose of prediction and prevention, early detection and treatment of health disorders of the fetus. Is this enough? If we analyze the period behind us, progress has been made in the field of detection of multiple pregnancies, dating of pregnancy and prenatal detection of chromosomal and structural fetal disorders, as well as a small amount of progress in terms of prediction and prevention of preeclampsia. If these disorders are the consequence of the disturbed or dysfunctional placentation, they are rooted at the time of implantation. This means that the changes that lead to the dysfunctional implantation should be sought in the pre-implantation period, in relation between the embryo and the endometrium. An extended inverted pyramid is necessary to find better results in perinatal medicine. This means that the interventions should be focused on the preconception and peri-implantation periods. The therapy should be on the subcellular and genetic level by applying the latest biotechnological procedures. It is possible that the time is approaching when the listed disorders of a pregnancy will be the indications for the application of a non stimulated in-vitro fertilization (IVF) (without ovary stimulating medication) with the use of new biotechnological achievements.

  1. Author’s statement

  2. Conflict of interest: Authors state no conflict of interest.

  3. Material and methods: Informed consent: Informed consent has been obtained from all individuals included in this study.

  4. Ethical approval: The research related to human subject use has complied with all the relevant national regulations, and institutional policies, and is in accordance with the tenets of the Helsinki Declaration, and has been approved by the authors’ institutional review board or equivalent committee.

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Received: 2016-12-29
Accepted: 2017-03-01
Published Online: 2017-04-07
Published in Print: 2018-09-25

©2018 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Antenatal and prepregnancy care – prevention of perinatal morbidity and mortality
  4. Review article
  5. Fetal interventional procedures and surgeries: a practical approach
  6. Opinion paper
  7. Inverted pyramid of prenatal care – is it enough? Should it be – extended inverted pyramid of prenatal care?
  8. Research articles
  9. Expectant management in di-chorionic pregnancies complicated by discordant anomalous twin
  10. Pregnancy outcomes among patients with recurrent pregnancy loss and uterine anatomic abnormalities
  11. Early postnatal echocardiographic assessment of pulmonary blood flow in newborns with congenital diaphragmatic hernia
  12. Sonographic prediction of small and large for gestational age in breech-presenting fetuses
  13. Comparison of fetal weight distribution improved by paternal height by Spanish standard versus Intergrowth 21st standard
  14. Can early ultrasonography explain the lower miscarriage rates in twin as compared to singleton pregnancies following assisted reproduction?
  15. Pregnancy outcomes among patients with recurrent pregnancy loss and chromosomal aberration (CA) without PGD
  16. Regular research articles
  17. Induction of labor in twin gestation: can we predict success?
  18. Low dose aspirin for preventing fetal growth restriction: a randomised trial
  19. Mid-pregnancy cervical length as a risk factor for cesarean section in women with twin pregnancies
  20. Efficacy of three different regimens in recovery of bowel function following elective cesarean section: a randomized trial
  21. Obstetrical, maternal and neonatal outcomes in pregnancies affected by muscular dystrophy
  22. Fetal brain development in diabetic pregnancies and normal controls
  23. Body composition in preterm infants with intrauterine growth restriction: a cohort study
  24. Commentary
  25. Professionally responsible management of gynecologic cancer in pregnancy when clinical resources are unavoidably limited
  26. Letters to the Editor
  27. Erroneous conclusion due to mis-calculation of data: reply to Rai SE, Sidhu AK, Krishnan RJ. Transfusion-associated necrotizing enterocolitis re-evaluated: a systematic review and meta-analysis. J Perinat Med 2017
  28. Reply to: Letter to the Editor by Stritzke A and Shah PS. Transfusion-associated necrotizing enterocolitis re-evaluated: a systematic review and meta-analysis
  29. Congenital Zika syndrome in non-endemic regions
  30. Reply to: Congenital Zika syndrome in non-endemic regions: A neuroimaging pattern-based approach
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