{"id":5739,"date":"2026-03-19T07:15:08","date_gmt":"2026-03-19T07:15:08","guid":{"rendered":"https:\/\/healthcaremagazine.bg\/dr-velislava-veleva-combined-biochemical-screening-is-recommended-for-all-pregnant-women-regardless-of-age\/"},"modified":"2026-05-09T22:03:26","modified_gmt":"2026-05-09T22:03:26","slug":"dr-velislava-veleva-combined-biochemical-screening-is-recommended-for-all-pregnant-women-regardless-of-age","status":"publish","type":"post","link":"https:\/\/healthcaremagazine.bg\/en\/dr-velislava-veleva-combined-biochemical-screening-is-recommended-for-all-pregnant-women-regardless-of-age\/","title":{"rendered":"Dr. Velislava Veleva: Combined biochemical screening is recommended for all pregnant women, regardless of age"},"content":{"rendered":"\n

Dr. Velislava Veleva is a specialist in obstetrics, gynecology, and maternal-fetal medicine with over 8 years of professional experience. Her professional interests are primarily focused on maternal-fetal medicine. Dr. Veleva is a certified specialist in maternal-fetal medicine by the Fetal Medicine Foundation. She actively participates in numerous national and international congresses in obstetrics, gynecology, and maternal-fetal medicine, including the World Congress of Fetal Medicine. Since 2023, she has been a doctoral student at the Faculty of Medicine of Sofia University “St. Kliment Ohridski”. She specialized at MBAL “Serdika” and UMBAL “Lozenets”, and since 2019, she has been part of the team at Oscar Clinic. <\/em><\/p>\n\n

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Dr. Veleva, could you briefly tell us about your professional path and how you decided to focus on maternal-fetal medicine?<\/strong><\/p>\n\n

Dr. Veleva:<\/strong> My professional journey began at MBAL “Serdika”, where I started my residency in obstetrics and gynecology. It was there that I first encountered invasive diagnostic procedures in maternal-fetal medicine, thanks to Dr. Maria Yankova and Dr. Violeta Stratieva. That was when I realized how impressive fetal medicine is and the opportunity it provides to care for the smallest patients even before they are born. I can say it was love at first sight, and since then, I have directed my professional development specifically toward fetal medicine. <\/p>\n\n

What is maternal-fetal medicine and why is it becoming an increasingly important part of modern obstetric practice?<\/strong><\/p>\n\n

Dr.<\/strong> Veleva:<\/strong> Maternal-fetal medicine is a subspecialty of obstetrics focused on the diagnosis and treatment of fetal conditions during intrauterine development. It involves monitoring high-risk pregnancies, tracking fetal growth and development, performing prenatal diagnostics, and applying therapeutic interventions to improve outcomes for both mother and fetus. Fetal medicine is of key importance in modern obstetrics because it transforms pregnancy monitoring from passive observation into active diagnostic and therapeutic medical activity. <\/p>\n\n

What is the role of early prenatal diagnosis in monitoring a pregnancy?<\/strong><\/p>\n\n

Dr.<\/strong> Veleva:<\/strong> Early prenatal diagnosis plays a central role in modern obstetrics, as it allows for the early detection and risk assessment of chromosomal abnormalities, structural defects, and pregnancy-related complications as early as the first trimester.<\/p>\n\n

Dr. Veleva, one of the primary methods for early risk assessment is combined biochemical screening in the first trimester. What does this examination entail? <\/strong><\/p>\n\n

Dr.<\/strong> Veleva:<\/strong> Combined biochemical screening in the first trimester is a screening method for the early assessment of the risk of chromosomal abnormalities, structural defects, heart defects, and pregnancy complications such as preeclampsia, fetal growth restriction, and preterm birth. During this period, early screening for neural tube defects, including spina bifida, is performed. Another important aspect of modern screening is the assessment of placental localization and umbilical cord insertion, which allows for the early identification of risky conditions such as vasa previa. Combined biochemical screening in the first trimester includes ultrasound markers, biochemical indicators (measuring pregnancy-associated plasma protein-A (PAPP-A) and free \u03b2-human chorionic gonadotropin (free \u03b2-hCG) in the mother’s blood), and maternal characteristics, which are analyzed via a statistical algorithm to calculate the individual risk for each pregnancy. The method was developed and standardized in the 1990s by the team of Prof. Kypros Nicolaides and the Fetal Medicine Foundation (London) and has gradually become a core component of modern prenatal diagnosis. <\/p>\n\n

During which period of pregnancy is this screening performed and what tests does it include?<\/strong><\/p>\n\n

Dr.<\/strong> Veleva:<\/strong> The screening is performed between the 11th+0 and 13th+6 gestational week, when the fetal crown-rump length (CRL) is between 45 and 84 mm, which is the optimal period for assessing specific early markers. The primary ultrasound parameter in combined screening is the measurement of nuchal translucency (NT), which is an assessment of the subcutaneous accumulation of fluid in the fetal neck area. Increased NT is associated with an increased risk of chromosomal aneuploidies, most commonly trisomy 21 (Down syndrome), trisomy 18 (Edwards syndrome), and trisomy 13 (Patau syndrome), as well as certain genetic syndromes and congenital heart defects. In addition to NT, the modern algorithm includes other ultrasound markers, such as the presence or absence of the nasal bone, Doppler assessment of the ductus venosus, and the presence of tricuspid regurgitation, which significantly increase the diagnostic accuracy of the screening. <\/p>\n\n

What conditions and chromosomal abnormalities can be assessed through combined screening?<\/strong><\/p>\n\n

Dr.<\/strong> Veleva:<\/strong> Primarily, the risk for the most common chromosomal trisomies, such as Down syndrome (trisomy 21), Edwards syndrome (trisomy 18), and Patau syndrome (trisomy 13), is assessed. Combined biochemical screening in the first trimester is not just about Down syndrome; during this period, an early anatomical assessment of the fetus is performed, which can detect a significant portion of major structural anomalies. Brain structures, the face, heart, abdominal wall, stomach, bladder, and limbs are evaluated. New ultrasound markers also allow for early screening for neural tube defects, including spina bifida. Furthermore, the assessment of placental localization and umbilical cord insertion allows for the early identification of risky conditions such as vasa previa. <\/p>\n\n

For which pregnant women is this type of examination recommended?<\/strong><\/p>\n\n

Dr.<\/strong> Veleva:<\/strong> Combined biochemical screening is recommended for all pregnant women, regardless of age, to assess the risk of chromosomal abnormalities, genetic syndromes, and structural defects. The examination is recommended for both singleton and twin pregnancies. Although offered to all pregnant women, the screening is particularly useful for identifying high-risk pregnancies. It is also recommended for women over 35, although age alone is no longer considered the sole indicator for conducting the screening. <\/p>\n\n

What is the primary goal of combined screening and what follows if an increased risk is identified?<\/strong><\/p>\n\n

Dr.<\/strong> Veleva:<\/strong> The primary goal is the early identification of pregnancies at increased risk for chromosomal abnormalities, genetic syndromes, or structural defects. If the screening result indicates an increased risk, this does not constitute a final diagnosis but rather identifies pregnancies that require further evaluation. Current recommendations from the Fetal Medicine Foundation (FMF), ISUOG, ACOG, and the Society for Maternal-Fetal Medicine (SMFM) suggest the following stepwise approach: The patient should receive detailed counseling explaining the significance of the screening result, the calculated risk, and the options for subsequent diagnosis. For patients with intermediate risk, a non-invasive prenatal test (NIPT) is discussed, which is an examination based on the analysis of cell-free fetal DNA in the mother’s blood.For patients with high risk, greater than 1:150 according to FMF protocols, invasive diagnostic procedures are recommended, including:\u2022 chorionic villus sampling (CVS), usually performed between the 11th and 13th gestational week, or\u2022 amniocentesis, usually performed after the 15th gestational week.These procedures allow for direct chromosomal analysis of fetal cells using methods such as karyotyping, QF-PCR, chromosomal microarray, whole genome sequencing (WGS), or whole exome sequencing (WES), providing a definitive diagnosis.In the presence of pathological ultrasound findings or a high calculated risk, referral to a specialized fetal medicine center for detailed ultrasound evaluation and multidisciplinary consultation is recommended. <\/p>\n\n

How is prenatal screening organized and performed in Bulgaria, and which specialists conduct it?<\/strong><\/p>\n\n

Dr.<\/strong> Veleva:<\/strong> In Bulgaria, pregnancy monitoring is carried out through the “Maternal Healthcare” program, which covers regular check-ups with an obstetrician-gynecologist, standard laboratory tests, and several ultrasound examinations during pregnancy. A normal pregnancy can be monitored by an obstetrician-gynecologist or a general practitioner, while a high-risk one is monitored by an obstetrician-gynecologist. In practice, however, combined biochemical screening in the first trimester is primarily performed by specialists in maternal-fetal medicine. In Bulgaria, combined biochemical screening is mainly conducted in the private sector, in specialized prenatal diagnosis centers. <\/p>\n\n

Dr. Veleva, what are the main challenges regarding access to early prenatal diagnosis in our country?<\/strong><\/p>\n\n

Dr.<\/strong> Veleva:<\/strong> The main challenges include uneven access across different regions, the lack of a sufficiently organized national model, limited awareness among some patients, and sometimes late referral to a specialized center. Early diagnosis is most effective when performed within the correct timeframe and by a well-trained specialist, which requires not only expertise but also good healthcare organization. <\/p>\n\n

Does a national organized program for prenatal screening exist in Bulgaria, and how does its absence affect the system?<\/strong><\/p>\n\n

Dr.<\/strong> <\/span>Veleva:<\/strong> <\/span>Currently, there is no unified, centralized, and fully state-funded national program for organized prenatal screening for all pregnant women in Bulgaria, although the government adopted a “National Plan for the Development of Comprehensive Prenatal and Neonatal Screening until 2027” in September 2025. There is no centralized registry, automated tracking, or unified protocol to ensure that every pregnant woman is informed and screened according to the same standard. At present, screening is primarily conducted through the individual initiative of the pregnant woman and her obstetrician-gynecologist, often on a private basis. There are separate initiatives for partial state funding of biochemical markers used in first-trimester combined screening, but these do not constitute a national organized program and do not guarantee universal coverage for all pregnant women. The lack of a national screening program leads to uneven coverage, differences in the quality of screening, and dependence on the financial capabilities and awareness of the patients. This can result in missing high-risk cases and later diagnosis of chromosomal and structural anomalies. <\/p>\n\n

How does the lack of a central registry affect the tracking of performed tests and healthcare policy?<\/strong><\/p>\n\n

Dr.<\/strong> Veleva:<\/strong> The lack of a unified, centralized electronic registry of pregnancies in Bulgaria creates significant difficulties both in tracking maternal health and in planning healthcare policy. In the absence of such a system, data from examinations performed by different doctors, laboratories, and medical facilities\u2014such as diagnostic-consultative centers, hospitals, or outpatient OB-GYN clinics\u2014are often not exchanged effectively. This makes it difficult to track the overall history of the pregnancy and increases the risk of duplicating or missing important tests. Furthermore, the lack of integrated information hinders the timely identification and monitoring of high-risk pregnant women, especially when a patient changes her attending physician or medical facility. <\/p>\n\n

How does the Bulgarian model of prenatal screening differ from those in other European countries?<\/strong><\/p>\n\n

Dr.<\/strong> Veleva:<\/strong> In many European countries, prenatal screening is organized as a national, standardized program with clearly defined timelines, quality criteria, unified reporting, and centralized tracking of results. An example of this is the National Health Service (NHS) in the United Kingdom, where the first-trimester combined test is part of a national screening program and is offered to all pregnant women following a standardized algorithm. In Bulgaria, the model is more of a mixed one\u2014there is legally regulated pregnancy monitoring, but there is no fully unified national system for prenatal screening with centralized management, registry, and analysis of results. This leads to certain differences in coverage and the organization of screening. At the same time, there are centers and specialists in the country who apply internationally recognized standards, including the Fetal Medicine Foundation protocols for conducting first-trimester combined screening. For example, at OSCAR Clinic, the examination is performed according to these standards, which includes certified measurement of nuchal translucency, the use of validated risk-calculation software, and performance by certified specialists in maternal-fetal medicine. The main difference between the Bulgarian model and those in many Western European countries is that in Bulgaria, the quality of screening often depends on the specific center and the expertise of the specialist, whereas in countries with national programs, equal access, standardized quality, and centralized tracking of results for the entire population are guaranteed.<\/p>\n\n

What is the actual scope of prenatal screening in Bulgaria relative to the number of pregnancies and births?<\/strong><\/p>\n\n

Dr.<\/strong> Veleva:<\/strong> There are no official exact statistics on the total number of all first-trimester screenings (combined screening) performed in Bulgaria annually, as the examination is conducted in state hospitals as well as in numerous private laboratories and OB-GYN centers.However, based on birth rate and prenatal diagnosis data, the following conclusions can be drawn:First-trimester screening (between the 11th and 13th+6 gestational week) is recommended for all pregnant women. Although recommended, not every pregnancy in Bulgaria undergoes this combined screening (ultrasound + blood tests). Some pregnant women only have an ultrasound examination, while others choose more expensive non-invasive prenatal tests (NIPT).With an average of about 50,000\u201360,000 (59,086 in 2020; declining to 48,434 births per year in Bulgaria by 2025), the number of women who actually undergo high-quality first-trimester screening (FMF-certified) is significantly small, around 10\u201315%, although its popularity is growing.The primary examinations are performed in specialized fetal medicine centers (Oscar Clinic, Shterev Medical Center, and others), where several thousand such screenings are conducted annually. <\/p>\n\n

In your opinion, why do not all pregnant women undergo the full combined screening in the first trimester?<\/strong><\/p>\n\n

Dr.<\/strong> Veleva:<\/strong> There are several reasons: insufficient awareness, late detection or late monitoring of the pregnancy, regional differences in access to specialized centers, and sometimes confusion between routine ultrasound and specialized combined screening. For some women, there is also a financial or organizational factor, while for others, there is a mistaken sense that such an examination is unnecessary in the absence of a family history. <\/p>\n\n

To what extent does the awareness of future parents influence their choice to undergo such tests?<\/strong><\/p>\n\n

Dr.<\/strong> Veleva:<\/strong> The awareness of future parents plays a key role in the decision of whether to perform combined biochemical screening in the first trimester. When patients receive clear and reliable information about the purpose of the examination, its capabilities, and its limitations, they are much more likely to choose to take advantage of it. This is because screening allows for an early assessment of the risk of chromosomal abnormalities and certain pregnancy complications, enabling better planning for monitoring and, if necessary, additional diagnostics. At the same time, when information is insufficient or reaches patients too late, some pregnant women miss the optimal timeframe for screening. Therefore, the role of obstetrician-gynecologists and fetal medicine specialists is extremely important\u2014they must inform patients in the early weeks of pregnancy so that future parents can make an informed decision regarding prenatal testing. <\/p>\n\n

What is the role of specialized fetal medicine centers in improving the quality of prenatal care?<\/strong><\/p>\n\n

Dr.<\/strong> Veleva:<\/strong> Specialized maternal-fetal medicine centers play a key role in improving the quality of prenatal care, as they combine professional experience, modern diagnostic equipment, and a multidisciplinary approach to pregnancy monitoring. These centers perform highly specialized examinations, such as fetal morphology, first-trimester combined biochemical screening, and invasive diagnostic procedures, including chorionic villus sampling and amniocentesis. In addition to diagnostic activities, these structures provide a comprehensive assessment of the pregnancy through collaboration between obstetrician-gynecologists, maternal-fetal medicine specialists, medical geneticists, pediatric cardiologists, and other specialists. This multidisciplinary approach allows for more accurate diagnosis, better risk assessment, and timely planning of management during pregnancy, birth, and postnatal care. <\/p>\n\n

How do modern equipment and a multidisciplinary approach change the way pregnancy is monitored today?<\/strong><\/p>\n\n

Dr.<\/strong> Veleva:<\/strong> Modern equipment and a multidisciplinary approach have significantly changed the way pregnancy is monitored in contemporary medicine. Thanks to the development of high-resolution ultrasound, Doppler studies, and modern genetic tests, it is now possible to detect both chromosomal abnormalities and structural fetal malformations much earlier and more precisely. This allows for earlier risk assessment and better planning of pregnancy monitoring. At the same time, the multidisciplinary approach involves collaboration between various specialists\u2014obstetrician-gynecologists, maternal-fetal medicine specialists, medical geneticists, neonatologists, and, if necessary, pediatric cardiologists or other specialists. This joint effort allows for more accurate diagnosis, better interpretation of results, and the most appropriate decision-making for management during pregnancy and after birth. As a result, modern pregnancy monitoring is much more personalized and focused on early diagnosis, prevention, and optimal outcomes for both mother and fetus.<\/p>\n\n

In what way does early screening assist future parents in making informed decisions?<\/strong><\/p>\n\n

Dr.<\/strong> <\/span>Veleva:<\/strong> <\/span>Combined biochemical screening in the first trimester provides future parents with vital information in the early stages of pregnancy. By combining ultrasound markers, biochemical indicators, and maternal factors, the individual risk for chromosomal abnormalities and certain pregnancy complications can be assessed. This early assessment allows parents, together with their doctor, to discuss options for further management\u2014whether an additional non-invasive test like NIPT is necessary, or a diagnostic procedure such as chorionic villus sampling or amniocentesis. In this way, parents gain time and the necessary medical information to make an informed decision regarding the further monitoring of the pregnancy. In this sense, early screening not only aids in early diagnosis but also allows for a calmer and more informed pregnancy journey.<\/p>\n\n

Dr. Veleva, how do you see the future development of fetal medicine and prenatal diagnosis in Bulgaria in the coming years?<\/strong><\/p>\n\n

Dr.<\/strong> Veleva:<\/strong> The future of fetal medicine and prenatal diagnosis in Bulgaria is primarily linked to the broader introduction of modern genetic technologies, the development of specialized fetal medicine centers, and the creation of a better-organized national screening system. In recent years, there has been rapid development in non-invasive genetic tests that analyze cell-free fetal DNA in the mother’s blood, allowing for an earlier and more accurate assessment of the risk of chromosomal abnormalities from around the 10th gestational week. Parallel to this, new genomic technologies are developing, such as chromosomal microarray, exome, and genome sequencing, which expand the possibilities for diagnosing genetic diseases during pregnancy.Another important direction is the development of fetal therapy and intrauterine interventions, as well as highly specialized imaging diagnostics, which allow not only for the detection but also for the treatment of certain conditions even before birth.<\/p>\n","protected":false},"excerpt":{"rendered":"

Dr. Velislava Veleva is a specialist in obstetrics, gynecology, and maternal-fetal medicine with over 8 years of professional experience. Her professional interests are primarily focused on maternal-fetal medicine. Dr. Veleva is a certified specialist in maternal-fetal medicine by the Fetal Medicine Foundation. She actively participates in numerous national and international congresses in obstetrics, gynecology, and […]<\/p>\n","protected":false},"author":2,"featured_media":5740,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jet_sm_ready_style":"","_jet_sm_style":"","_jet_sm_controls_values":"","_jet_sm_fonts_collection":"","_jet_sm_fonts_links":"","footnotes":""},"categories":[97,96],"tags":[],"class_list":["post-5739","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-interviews","category-news"],"yoast_head":"\nDr. Velislava Veleva: Combined biochemical screening is recommended for all pregnant women, regardless of age - Healthcare Magazine - \u0412\u043b\u0438\u044f\u043d\u0438\u0435 \u043e\u0442\u0432\u044a\u0434 \u043d\u043e\u0432\u0438\u043d\u0438\u0442\u0435<\/title>\n<meta name=\"description\" content=\"Dr. Velislava Veleva on the role of maternal-fetal medicine and the importance of early combined screening for timely diagnosis and improved pregnancy monitoring.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/healthcaremagazine.bg\/en\/dr-velislava-veleva-combined-biochemical-screening-is-recommended-for-all-pregnant-women-regardless-of-age\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Dr. Velislava Veleva: Combined biochemical screening is recommended for all pregnant women, regardless of age - 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