CAMAGÜEY.- If a Program is known and recognized by the population within the National Public Health System, it is undoubtedly that of Maternal and Child Care (PAMI). In order to maintain its results, it needs a whole gear so technology does not escape. For that reason I came to Dr. Amaralis Trull Martínez, Second Degree specialist in Imaging and Assistant Professor of the Provincial Center of Medical Genetics, assigned to the Ana Betancourt maternal and child hospital in this city, a whole authority within this branch of Medicine .

She started the dialogue like this: “All pregnant women in the province pass through here, only when there is a suspicion of some kind of malformation in the fetus, those with previous problems of this type, those who inherit some detectable diseases such as certain heart disease polycystic kidneys ... that is, with some genetic risk, even those women who took different medications, were exposed to radiation, has given them fever ...

- Are there any ultrasounds conceived in the protocols?

- There is the first quarter, known as integral in that period, because other investigations have been incorporated. We obtain genetic markers in search of chromosomopathies (mutations or chromosomal aberrations), such as Down Syndrome, and malformations that appear at that time; we also do the cervicometry, which is based on a transvaginal ultrasound study and allows the evaluation of the characteristics of the maternal uterine cervix (neck), with the objective of establishing the risk of premature delivery; and we also incorporate the doppler of the uterine arteries, always in search of fetal wellbeing, because if any difficulty is detected, adequate follow-up is offered. These are more sophisticated ultrasound studies.

- If the pregnant woman has some of the above mentioned or not, and does not come here, can she be unprotected?

-No. In the municipality of Camagüey there are nine areas of Health and in five of these there are ultrasound equipment with trained personnel, and in which the equipment is not available they are facilitated to access; in addition, in each municipality one is installed for that purpose, it means that if in any case a minimum suspicion of anomaly is brought to light, it is sent here to be reviewed and take the necessary measures.

—Does another check of this kind continue?

—In the second trimester, between 21 and 24 weeks of gestation. The purpose is to find malformations of that period and that we did not see in the previous one, for example, heart disease, central and digestive nervous system malformations. At 28 weeks the third ultrasound is performed and then at 33 weeks, which is when the geneticist discharges or follows the patient, and if it continues, the appointment to evaluate it according to their interests as many times as necessary.

—So they end up with this kind of consultation?

-No. We have fetal echocardiography, for which cardiologists come twice a week, behind the suspicions announced in the areas of Health, and also with a history of congenital cardiovascular malformations, if they suffer from it, or are diabetic, or if they exceed 37 years of age, to whom amniocentesis is done, which is a common prenatal test in which a small sample of the amniotic fluid that surrounds the fetus is extracted for analysis, and who are benefited if they bring a fetus with Syndrome Down or another marker tested positive.

—Then does she go to the geneticist and what happens?"

— It always depends on the results. We follow it or not depending on what the exams show.

- If an obstacle is ruled without solution at the province level?

— It is sent to the capital of the country.

- If a condition compatible or not compatible with life is detected in the fetus, what do you determine?

—The pregnant woman, her partner and the family are taken to a multidisciplinary consultation with a psychologist, there they are oriented by the pros and cons.

— To decide to continue the pregnancy or not?

-The decision is respected, of course, if it continues its course all the specialists involved are imposed on what the prognosis is and if there are no surprises, but it acts according to the required case, and if you do not want it, pregnancy is interrupted. Only those involved determine, that is their right to choose. We have a program so that when the time of delivery arrives everything is ready.

“After delivery we follow the baby for as long as necessary and all the attention is given, depending on the condition. We attend it periodically until one year of age, and if it disappears we will discharge him. There are cases that we consult with nephrologists and urologists due to certain ailments and hydronephrosis (dilatation of the renal collecting system) depending on their degree of complexity.

“If the disease that the fetus brings is incompatible with life and the mother and family decide to continue, they are accompanied until the end, they are never left alone, and if they interrupt the pregnancy the Health system has instituted that it be corroborated with pathological anatomy and that family is informed about the result, even if they are oriented, they should continue in the Genetics consultation to follow the counseling and avoid or anticipate any repetition in this regard ”.

— An advice to avoid congenital malformations?

—Women and men should take folic acid because it avoids malformations of the central nervous system and cardiovascular diseases, and something vital is to assist your doctor in the slightest suspicion of pregnancy, late uptake is a problem, hinders and prevents detection in time of important events at each stage of that state, then the solutions are complicated. Here we see up to 30 women in a work session.

"Our doors are open to those who need it, whether they come or not with a referral of their primary health care."

Translated by Linet Acuña Quilez