原田 文¹, 室月 淳^{1, 2}

Aya HARADA¹, Jun MUROTSUKI^{1, 2}

¹宮城県立こども病院産科, ²東北大学大学院医学系研究科先進成育医学講座胎児医学分野

¹Department of Maternal Fetal Medicine, Miyagi Children’s Hospital, ²Department of Advanced Developmental Medicine, Tohoku University Graduate School of Medicine

キーワード :

First trimester screening（FTS）was first introduced at Kings College Hospital in 1992. Detecting fetuses carrying the high risk of aneuploidy consists of three factors, maternal age, biochemical and ultrasound markers. Conventional FTS focused on achieving maximum detection rate by measuring NT and other additional markers and detecting fetal anomalies relevant to aneuploidy. Implementation of NIPT in 2012 had impact on the way how the FTS is. NIPT had a solid advantage on both detection and false positive rate compared to the combined test. However, first trimester scan was still considered as necessary as it had been previously. First trimester anomaly scan is one of the important reasons. Majority of fetal anomaly has been able to detect during first trimester and detecting fetal anomaly has a direct influence on the subsequent management. “Turning the pyramid of prenatal care” is a concept proposed by Kypros Nicolaides to classify the risk of developing pregnancy complication in later gestation at the timing of 11-13 weeks gestation and to arrange the individual management accordingly. Broadly, first trimester screening embraces the screening for PIH, SGA, preterm birth and so on, which is another augment for performing the first trimester scan. Harris Birthright Centre at Kings College Hospital has been tackling with data collection for the establishment of this concept as a leading clinical research centre.
Harris Birthright Centre is a tertiary institution in south London, accepting both low risk and high risk patient and performing FTS for these women. Being a clinical research centre as well as a training centre for fetal medicine specialist, there are emulate clues in dairy practice. From two year experience at Kings College Hospital, this presentation aims to introduce the management of clinic, the follow-up system of women with any abnormal result of FTS and the quality control of sonographer. The challenges which FTS in Japan faces will be also discussed.