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Physicians should recommend folic acid supplementation to all women as early as possible, preferably before conception, to reduce the risk of neural tube defects.

Administration of Rh(D) immune globulin markedly decreases the risk of alloimmunization in an Rh D-negative woman carrying an Rh D-positive fetus.

At 35 years of age, the risk of Down syndrome (one per 338 births) is similar to that of fetal loss due to amniocentesis.29 It is common to offer invasive testing to women 35 years and older without first performing screening tests; however, screening tests can be used for risk stratification to help a woman decide if she wants invasive testing.611 Options for aneuploidy screening include nuchal translucency testing with serum testing (nine to 11 weeks' gestation) and later serum testing alone (15 to 19 weeks' gestation).

There are a variety of combinations of such tests, and results are generally reported as the risk of aneuploidy.

Ultrasonography can accurately date the pregnancy, evaluate for multiple gestation, and reduce the likelihood of unnecessary labor induction for postterm pregnancy.2021 Pregnancy dating should be confirmed with auscultation of fetal heart tones between 10 and 12 weeks, and with fetal quickening between 16 and 18 weeks in women who have been pregnant before or between 18 and 19 weeks in first pregnancies. communities to offer a single ultrasound examination at 18 to 20 weeks' gestation, even if dating confirmation is not needed.11 This is the optimal time for fetal anatomic screening,23 although the sensitivity of ultrasonography for structural anomalies is poor (overall sensitivity from 11 studies = 24.1%, range = 13.5% to 85.7%).6(D) immune globulin should also be administered if the risk of fetal-to-maternal transfusion is increased (e.g., with chorionic villus sampling, amniocentesis, external cephalic version, abdominal trauma, or bleeding in the second or third trimester).

Correct dating of the pregnancy is critical to prevent unnecessary inductions and to allow for accurate treatment of preterm labor.Periodontal disease is associated with increased risk of preterm birth, and an oral examination is often included in the first prenatal visit.However, treatment does not change outcomes.15Pregnant women should be counseled about proper diet, as well as folic acid supplementation.All screening tests have a positive rate of approximately 5% (most of which are false positives) and a detection rate of 69% to 87%.6Adapted with permission from Chitayat D, Langlois S, Wilson RD; Genetics Committee of the Society of Obstetricians and Gynaecologists of Canada; Prenatal Diagnosis Committee of the Canadian College of Medical Geneticists.Prenatal screening for fetal aneuploidy in singleton pregnancies Adapted with permission from Chitayat D, Langlois S, Wilson RD; Genetics Committee of the Society of Obstetricians and Gynaecologists of Canada; Prenatal Diagnosis Committee of the Canadian College of Medical Geneticists.

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