Fetal Measures Presentation
Fetal Measures Presentation
Fetal Measures Presentation
To screen out the high risk factors that affects the growth of fetus .
Others: Advanced maternal age (>35yrs), previous still birth or recurrent abortion,
previous birth of baby with structural or chromosomal abnormalities.
Clinical evaluation of fetal wellbeing: At every antenatal visit, the following clinical
parameters are taken into account for assessment of satisfactory progress of gestation.
1. Maternal weight gain: During second half of pregnancy, the average weight gain is 1 kg a
fortnight. Any excess weight gain may be due to excess fluid retension and could be sign
of pre- eclampsia.
2. Blood pressure: Initial recording of blood pressure prior to 12 weeks helps to differentiate
a pre- existing hypertension from a pregnancy induced hypertension.
3. Assessment of the size of the uterus and height of the fundus: In early weeks, the size of
uterus is of great value in confirming the calculated duration of gestation. The height of
fundus should be documented at each visit.
4. Clinical assessment excess liquor: Should be recorded, as well as scanty liquor in the last
trimester. Evidence scanty liquor may indicate placental insufficiency and the need for
undertaking other placental function test.
5. Documentation of the girth of the abdomen in the last trimester of pregnancy. This is
measured at the lower border of the umbilicus. Normally, the girth increases steadily upto
term. If the girth gradually diminishes beyond term or earlier, it arouses suspicion of
placental insufficiency.
Biochemical measures (early pregnancy): Antenatal assessment of fetal well being in early
pregnancy is primarily designed to detect fetal congenital abnormalities.
AFP is an oncofetal protein, produced by the yolk sac & fetal liver.
Highest levels of AFP in fetal serum & amniotic fluid are reached around 13 weeks &
thereafter it decreases.
MSAFP level is elevated in a number of conditions: wrong gestational age, neural tube
defects(NTDS), IUFD, renal anomalies etc. low levels are found in trisomies (Down’s
syndrome)
Test is done between 15-20 weeks. Elevated MSAFP detects 85% of all neural tube
defects.
Nurse will use a small needle to withdraw blood from a vein, & a laboratory specialist
will analyze the sample.
Triple test:
It is a combined test which includes MSAFP, HCG & UE3 (unconjugated estriol).
In an affected pregnancy, level of MSAFP & UE, tend to be low while that of HCG is
high.
It is performed at 15-18 weeks. The result is considered to be screen positive if the risk
ratio is 1:250 or greater.
Acetyl choline esterase:
Amniotic fluid AChE level is elevated in most cases of open neural tube defects .It has
got better diagnostic value than AFP.
Inhibin A is a dimeric glycoprotein. It is produced by the corpus luteum & the placenta.
Serum level of inhibin A is raised in women carrying a fetus with Down’s syndrome.
Amniocentesis:
“Obtaining a sample of amniotic fluid surrounding the fetus during pregnancy.” It is an invasive
procedure performed under ultrasonographic guidance. The fetal cells obtained in this procedure
are subjected for cytogenic analysis.
Indications:
Hazards:
Complications:
Cordocentesis:
A 22 gauze spinal needle 13cm in length is inserted through the maternal abdominal and uterine
wall under ultrasonic guidance. The needle tip is progressed carefully & it punctures the
umbilical vein approximately 1-2cm from the placental inertion. Generally, 0.5 to 2 ml of fetal
blood is collected. It is performed under local anesthesia usually from 18 weeks gestation.
Risks: - The invasive procedure may lead to abortion, preterm labor & intrauterine fetal death.
Crown- Rump Length smaller than gestational age is associated with the risk of
chromosomal anomalies.
Nuchal translucency at 10 – 14 weeks is associated with many chromosomal
abnormalities( Trisomy).
Absence of nasal bone on USG at 10-12 weeks is associated with fetal Downs
syndrome.
Objectives:
Biophysical tests:
Cardiff technique :Done in the morning, Patient should calculate how long it takes to
have 10 fetal movements.10 movements should be appreciated in 12 hours
Done using the cardiotocometry with the patient in left lateral position. Record for 20
minutes. The base line is 120-160 beats/minute
Reactive:
At least two accelerations from base line of 15 bpm for at least 15 sec within 20 minutes
Non reactive:
Fetal response to induced stress of uterine contraction and relative placental insufficiency
Objective is 3 contractions in 10 minutes. It should not be used in patients at risk of pre
term labour or placenta previa.
Biometry:
Biparietal diameter (BPD)
Abdominal Circumference (AC)
Femur Length (FL)
Head Circumference (HC)
Amniotic fluid
Placental localization
NST
Fetal breathing movements
Gross body movement
Fetal muscle tone
Amniotic fluid