The Italian Higher Institute of Health (ISS) has published a long-awaited update to the national guidelines for the care of physiological pregnancy.
Ultrasound in the First Trimester
The guidelines unequivocally recommend performing an ultrasound examination in the first trimester of pregnancy. This aims to confirm gestational age, assess fetal viability, the number of fetuses, and early detection of any abnormalities. It is a key element of standard care.
Limiting Ultrasound in the Third Trimester
The document advises against routinely performing ultrasound examinations in the third trimester for a physiological pregnancy that is progressing without complications. The decision for a possible examination should be made individually, based on clinical assessment, and not as a standard procedure for everyone.
Rationalization of Tests and Procedures
The main goal of the update is to promote rational and evidence-based use of diagnostics. The guidelines aim to prevent excessive and medically unjustified performance of tests that do not provide benefits in a normal pregnancy course, while generating costs and anxiety.
Prenatal Care Schedule
The guidelines precisely define the calendar of control visits, laboratory tests (e.g., blood count, infection screening), and measurements of basic parameters, such as blood pressure and weight gain, tailored to each trimester of pregnancy.
The Italian Higher Institute of Health has published a long-awaited update to the national guidelines for the care of physiological pregnancy. The document, which replaces previous recommendations, aims to unify and rationalize medical practices across the country, promoting care based on strong scientific evidence. The main message is a move away from excessive and often medically unjustified diagnostics towards targeted, purposeful interventions. The central, and most discussed, change is the position on ultrasound examinations. The guidelines unequivocally recommend performing an ultrasound in the first trimester of pregnancy. This examination is considered crucial for confirming pregnancy viability, precisely determining gestational age, identifying multiple pregnancies, and early assessment of fetal anatomy. Conversely, in the third trimester, for a normal, uncomplicated pregnancy, routine ultrasound is not recommended. The decision for a possible examination in late pregnancy should stem from specific clinical indications, such as suspected fetal growth restriction or abnormalities in position, and not be a standard procedure for every patient. This change aims to prevent the so-called 'medicalization' of a normal pregnancy and the unnecessary generation of costs and stress for expectant parents. Beyond the issue of ultrasound, the guidelines detail the prenatal care schedule. They define the recommended frequency of check-up visits with a gynecologist or midwife in each trimester. They precisely indicate which laboratory tests – such as blood count, urinalysis, tests for gestational diabetes, viral infections (HIV, HCV), or Rh incompatibility – and when they should be performed. They also emphasize the importance of regular monitoring of basic parameters, such as the pregnant woman's blood pressure and weight gain. The entire document is based on a systematic review of the latest international scientific research and aims to provide safe, effective, and humane care while optimizing the use of healthcare system resources. The guideline update is an important step towards standardizing obstetric care in Italy and sets new standards that could influence clinical practice across the country.