The Value of Early Pregnancy Assessment Clinic in the Improvement of Quality of Antenatal Care
Chanya Pitaksakpong, MD¹, Uravee Limpivest, MD¹, Komsun Suwannarurk, MD¹, Nop Khongthon, MD², Yanwadee Chitkoolsamphan³, Densak Pongrojpaw, MD¹
Affiliation : ¹ Department of Obstetrics and Gynecology, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand; ² Department of Clinical Epidemiology, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand; ³ Medical student, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
Objective: To determine the prevalence of abnormal and complicated pregnancies detected at the first visit of first trimester women attending the early pregnancy assessment clinic (EPAC), to compare the need for gestational age (GA) re-dating between clinically precise and imprecise groups, and to evaluate the prevalence and factors influencing acceptance of prenatal screening (PNS) or diagnosis (PND).
Materials and Methods: A retrospective cohort study was conducted at the EPAC, Maternal Fetal Medicine (MFM) Unit, Thammasat University Hospital (TUH), between July 4 and September 30, 2025. Women with a positive urine pregnancy test (UPT) and GA of less than 14 weeks were included. Data were retrieved from the hospital database. Abnormal and complicated pregnancies were assessed. GA re-dating was analyzed between clinically precise and imprecise groups. Acceptance of PNS or PND was also evaluated.
Results: One thousand six hundred sixty-five pregnant women were enrolled (986 in the clinically precise group and 679 in the imprecise group). Ultrasonography (USG) identified 110 abnormal and complicated pregnancies (6.6%), most commonly early embryonic death, followed by twins, anembryonic pregnancy, and ectopic pregnancy. After excluding early pregnancy failures, 1,578 women remained. Clinically precise women were 1.7 times more likely not to require GA re-dating (p<0.05). For PNS or PND analysis, 1,577 women were included (triplet pregnancy excluded), of whom 864 (54.8%) accepted testing. Acceptance was significantly associated with advanced maternal age (AMA), Thai nationality, and Buddhist religion. Non-invasive prenatal screening (NIPS) was the most frequently chosen test.
Conclusion: EPAC enabled early USG detection of abnormal and complicated pregnancies, with early embryonic death being most common. Clinically precise women required significantly less GA re-dating than women in the imprecise group. Only half accepted PNS or PND after counseling, influenced by AMA, Thai nationality, and Buddhist religion, with NIPS most frequently selected.
Received 1 December 2025 | Revised 29 January 2026 | Accepted 30 January 2026
DOI: 10.35755/jmedassocthai.2026.5.03901
Keywords : Early pregnancy assessment clinic; Quality of antenatal care; Prenatal screening; Prenatal diagnosis
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