title: Inverted Pyramid of Care.
abstract: First-trimester pregnancy evaluation using fetal and maternal parameters not only allows for diagnoses to be made early in gestation but can also assess the risk of complications that become clinically evident later in pregnancy. This evaluation makes it possible for pregnancy care to be individualized. In select cases, treatment that reduces the risk of complications can be started early in pregnancy. Even though cell free DNA is a significant advance in diagnosing fetal aneuploidy, the combination of first-trimester ultrasound and maternal serum biochemistries casts a much wider diagnostic net; therefore, the 2 technologies are best used in combination.
authors.affiliation: Center for Maternal-Fetal Medicine, Ultrasound, and Genetics, Fetal Medicine Foundation of USA, Wright State University, Berry Pavilion, 1 Wyoming Street, Dayton, OH 45409, USA. Electronic address: jdsonek@premierhealth.com.
authors.forename: Jiri D
authors.initials: JD
authors.lastname: Sonek
authors.affiliation: Department of Gynecology and Obstetrics, Universitäts-Frauenklinik, Calwerstrasse, Tübingen 772076, Germany.
authors.forename: Karl Oliver
authors.initials: KO
authors.lastname: Kagan
authors.affiliation: Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, 16-20 Windsor Walk, London SE5 8BB, UK.
authors.forename: Kypros H
authors.initials: KH
authors.lastname: Nicolaides
mesh_terms: D000782:Aneuploidy; D025063:Chromosome Disorders / Q000175:diagnosis*; D003362:Cost-Benefit Analysis; D005260:Female; D047109:Fetal Development; D006801:Humans; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011295:Prenatal Care / Q000379:methods* / Q000639:trends; D011296:Prenatal Diagnosis / Q000379:methods* / Q000639:trends; D013997:Time Factors
keywords: Anomalies; Diagnosis; First trimester; Maternal complications; Preeclampsia; Screening