{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T20:58:53Z","timestamp":1790629133935,"version":"4.1.0"},"reference-count":76,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosmedicine.org"],"crossmark-restriction":false},"short-container-title":["PLoS Med"],"abstract":"<jats:title>Summary points<\/jats:title>\n                  <jats:p>\n                    <jats:list list-type=\"bullet\">\n                      <jats:list-item>\n                        <jats:p>Traditional antenatal care consists of an accelerating frequency of visits with advancing gestational age, as the bulk of pregnancy complications occur in late pregnancy.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>The \u2018inverted pyramid of care\u2019 concept describes a focus on structured risk assessment in early pregnancy, to facilitate prevention and enhanced surveillance of those at increased risk of maternal, intrinsic fetal, and uteroplacental problems.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Since publication of this concept in 2011, it has become clear that early pregnancy screening may be contingent, with a sub-population identified for re-screening in mid- or late pregnancy.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Maternal conditions (such as pre-eclampsia), intrinsic fetal conditions (such as chromosomal abnormalities) and uteroplacental problems (such as placenta accreta spectrum) can now be predicted or identified at earlier stages.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>This Policy Forum advocates for building risk-stratified care pathways around early prediction, prevention, and personalised surveillance. We provide updated guidance for \u2018inverted\u2019 antenatal care, including optimal screening timepoints and the most accurate methods of screening.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>We also highlight recent advances in diagnostics and treatment that we anticipate will further improve antenatal care in the future, including development and integration of artificial intelligence-assisted technologies.<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list>\n                  <\/jats:p>","DOI":"10.1371\/journal.pmed.1005255","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T20:01:16Z","timestamp":1790625676000},"page":"e1005255","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmed.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["The inverted pyramid of care in modern-day obstetrics"],"prefix":"10.1371","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1355-610X","authenticated-orcid":true,"given":"Laura A.","family":"Magee","sequence":"first","affiliation":[{"name":"King\u2019s College London","place":["London, United Kingdom"],"department":["Department of Women and Children\u2019s Health, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4136-3070","authenticated-orcid":true,"given":"Peter","family":"von Dadelszen","sequence":"additional","affiliation":[{"name":"King\u2019s College London","place":["London, United Kingdom"],"department":["Department of Women and Children\u2019s Health, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kypros H.","family":"Nicolaides","sequence":"additional","affiliation":[{"name":"Fetal Medicine Research Institute, King\u2019s College Hospital","place":["London, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"pmed.1005255.ref001","doi-asserted-by":"crossref","DOI":"10.1093\/acprof:oso\/9780198229971.001.0001","volume-title":"Death in childbirth: An international study of maternal care and maternal mortality, 1800\u20131950","author":"I Loudon","year":"1992"},{"key":"pmed.1005255.ref002","author":"Great Britain Ministry of Health","year":"1929"},{"key":"pmed.1005255.ref003"},{"key":"pmed.1005255.ref004","volume-title":"Birth counts: Statistics of pregnancy and childbirth","author":"A Macfarlane","year":"2000","edition":"2"},{"issue":"3","key":"pmed.1005255.ref005","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1159\/000324320","article-title":"Turning the pyramid of 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