The inverted pyramid of care in modern-day obstetrics
by Laura A. Magee, Peter von Dadelszen, Kypros H. Nicolaides Summary points Traditional antenatal care consists of an accelerating frequency of visits with advancing gestational age, as the bulk of pregnancy complications occur in late pregnancy. The ‘inverted pyramid of care’ concept describes a focus on structured risk assessment in early pregnancy, to facilitate prevention and enhanced…
Traditional antenatal care has long involved increasing visit frequency as pregnancies progress, as most complications arise in the later stages. However, a 2011 concept known as the 'inverted pyramid of care' proposes a different approach. This model focuses on early risk assessment to enable prevention and improved monitoring of those with increased chances of maternal, fetal, or uteroplacental issues.
Since its inception, it has become evident that screening in early pregnancy might be insufficient for some individuals. A subset requires re-screening during the middle or latter stages. Conditions in categories such as maternal (e.g., pre-eclampsia), intrinsic fetal (e.g., chromosomal abnormalities), and uteroplacental (e.g., placenta accreta spectrum) can now be predicted or detected earlier.
This policy forum advocates for constructing risk-stratified care pathways centered around early prediction, prevention, and tailored surveillance. The authors provide updated guidance on screening intervals and most precise screening methods. The text also underscores recent diagnostic and treatment advancements anticipated to further enhance antenatal care. These include emerging artificial intelligence-assisted technologies.
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