Fetal measures clinical parameters

Help the medical students to know about the fetal clinical parameters. Very rarely material present in the books. I prepared this for the little bit help from my side.

1. FETAL MEASURES-CLINICAL PARAMETERS SAKSHI RANA MSC NURSING

2. FETAL MEASUREMENT Fetal measurements reflect whether the fetus has grown enough or whether the measurements fall outside the normal range. They also reflect if there are anomalies of the fetus.

3. Contt .. During pregnancy many different ultrasounds measurements can be done. Fetal ultrasound measurements can include: Crown rump length (CRL ), Biparietal diameter (BPD), Femur length (FL ),  

4. Contt .. Head circumference (HC), Occipitofrontal diameter (OFD), Abdominal circumference (AC), Humorous length (HL), Estimated fetal weight (EFW).

5. Gestational sac ( GS)

6. Contt .. The gestational sac (GS) is a structure that surrounds an embryo. The first pregnancy structure that can see on ultrasound in early pregnancies. The GS encloses not only the embryo, but also the amniotic fluid, which helps to nourish and protect the developing baby.

7. Fetal Pole

8. Contt .. The fetal pole is a mass of cells before the embryo is visible . Fetal pole becomes visible somewhere between five-and-a-half and six-and-a-half weeks of gestationa l age.

9. Contt .. It grows at a rate of about 1 mm a day, starting at the 6th week of gestational age. Thus, a simple way to "date" an early pregnancy is to add the length of the fetal pole (in mm) to 6 weeks. Using this method, a fetal pole measuring 5 mm would have a gestational age of 6 weeks and 5 days.

10. Crown-rump length (CRL )

11. Contt .. The CRL measurement is the distance between the top of the embryo and it's rump. The CRL can be measured between 7 to 13 weeks

12. Biparietal diameter (BPD )

13. Contt .. The diameter between the 2 sides of the head. This is measured after 13 weeks. It increases from about 2.4 cm at 13 weeks to about 9.5 cm at term.

14. Head circumference (HC )

15. Contt .. The head circumference or HC measures the circumference of the fetus' head. The HC is usually done after 13 weeks of the pregnancy

16. Femur length (FL )

17. Contt .. Measures the longest bone in the body and reflects the longitudinal growth of the fetus. It increases from about 1.5 cm at 14 weeks to about 7.8 cm at term. Similar to the BPD, dating using the FL should be done as early as is feasible.

18. Abdominal circumference (AC )

19. Contt .. The single most important measurement to make in late pregnancy. It reflects more of fetal size and weight rather than age. Serial measurements are useful in monitoring growth of the fetus. AC measurements should not be used for dating a fetus.

20. Estimated fetal Weight (EFW )

21. Contt .. The weight of the fetus at any gestation can also be estimated with great accuracy using polynomial equations containing the BPD, FL, and AC.

22. BIOCHEMICAL TESTS

23. HUMAN ESTRIOL ESTROGEN: An estrogen test measures the level of the most important estrogen  hormones  in a  blood or urine sample. It measures  estradiol , estriol , and estrone

24. PURPOSES Help find fetal birth defects Check for estrogen-producing tumors of the ovaries Monitor treatment with  fertility  medicines.

25. PROCEDURE

26. Contt .. Wrap an elastic band around upper arm to stop the flow of blood. This makes the veins below the band larger so it is easier to put a needle into the vein. Clean the needle site with alcohol. Put the needle into the vein. More than one needle stick may be needed.

27. Contt .. Attach a tube to the needle to fill it with blood. Remove the band from your arm when enough blood is collected. Put a gauze pad or cotton ball over the needle site as the needle is removed. Put pressure on the site and then put on a bandage.

28. RESULTS Estriol in pregnant women   1st  trimester Less than 38  nanogramsper milliliter ( ng / mL ) 2nd trimester 38-140 ng / mL 3rd trimester 31-460 ng / mL  

29. ACETYL CHOLINE ESTRASE (ACHE) This test measures the amount of an enzyme called acetyl cholinesterase in amniotic fluid. It is used during pregnancy to help identify unborn babies who have neural tube defects, including anencephaly, spina bifida, and heart defects

30. INDICATIONS Patients on valproic acid anti-seizure medication

31. Contt .. Insulin dependent diabetic patients

32. Contt .. Previous pregnancy with a NTD

33. Contt .. Ultrasound indications of a NTD or open ventral wall defect

34. PROCEDURE

35. A sample of this fluid is collected by a procedure called an amniocentesis.

36. RESULTS Normal range by method : Polyacrylamide gel electrophoresis: Negative AE-2 immunoassay: Negative Inhibition assay: 5.17 ± 2.63 milliunits / mL (5.17 ± 2.63 units/L)

37. MATERNAL SERUM ALPHA FETOPROTIEN MSAFP is a screening test that examines the level of alpha-fetoprotein in the mother’s blood during pregnancy. Normally, low levels of AFP can be found in the blood of a pregnant woman. No AFP (or only a very low level) is generally found in the blood of healthy men or healthy, nonpregnant women.

38. PURPOSE The AFP test is done to: Check the developing baby (fetus) of a pregnant woman for brain or spinal problems  Check the developing baby (fetus) of a pregnant woman for Down syndrome. Find certain cancers, especially cancer of the testicles, ovaries, or liver

39. Contt .. Check how well treatment for cancer is working. Check for liver cancer (called hepatoma ) in people who have cirrhosis or chronic hepatitis B.

40. PROCEDURE The health professional drawing blood will: Wrap an elastic band around your upper arm to stop the flow of blood. This makes the veins below the band larger so it is easier to put a needle into the vein. Clean the needle site with alcohol.

41. Contt .. Put the needle into the vein. More than one needle stick may be needed. Attach a tube to the needle to fill it with blood. Remove the band from your arm when enough blood is collected

42. Contt .. Put a gauze pad or cotton ball over the needle site as the needle is removed. Put pressure on the site and then a bandage.

43. RESULTS Alpha-fetoprotein in blood Men and nonpregnant women: 0-40  nanograms per milliliter ( ng / mL ) or micrograms per liter (mcg/L) 2 Women 15-18 weeks pregnant: 10-150 ng / mL or mcg/L 3

44. Contt .. High values In a pregnant woman, high alpha-fetoprotein values can mean: The age (gestational age) of the baby is wrong. The woman is pregnant with more than one baby, such as twins or triplets.

45. Contt .. The baby has a neural tube defect. The baby's intestines or other abdominal organs are outside the body (called an abdominal wall defect or omphalocele ). Surgery after birth will be needed to correct the problem. The baby is not alive.

46. Contt .. Low values In a pregnant woman, a low level of alpha-fetoprotein can mean: The age (gestational age) of the baby is wrong. The baby may have Down syndrome.

47. TRIPLE TEST The triple screening measures the amounts of three substances in a pregnant woman's blood: alpha-fetoprotein (AFP), human chorionic gonadotropin  ( hCG ), and estriol (uE3). This is also called the maternal serum triple, the expanded AFP test, the AFP plus test, or the multiple marker screening test.

48. Contt ..  Down syndrome

49. Contt .. Spina bifida

50. Contt .. Anencephaly

51. INDICATIONS All pregnant women in the second trimester (between weeks 15 and 22) are tested. Those in the following categories are at a higher risk: Women over 35 years old Those taking insulin for treating diabetes Women having a family history of birth defects

52. Contt .. Use of certain medications Exposure to high radiation levels Having complications, viral infections, during pregnancy

53. PROCEDURE

54. Contt .. Wrap an elastic band around your upper arm. This makes the veins below the band larger so it is easier to put a needle into the vein. Clean the needle site with alcohol. Put the needle into the vein. Attach a tube to the needle to fill it with blood.

55. Contt .. Remove the band from your arm when enough blood is collected. Put a gauze pad or cotton ball over the needle site as the needle is removed. Put pressure on the site and then put on a bandage.

56. RESULT A "positive" result means that there is a higher-than-average chance ,baby has a birth defect. If the result is "negative," or normal, it means that baby probably doesn't have a birth defect.

57. AMNIOCENTHESIS

58. Contt .. Amniocentesis is a prenatal test in which a small amount of amniotic fluid is removed from the sac surrounding the fetus for testing. The sample of amniotic fluid is less than one ounce.

59. INDICATIONS Genetic diagnosis Down syndrome ( trisomy 21)

60. Contt .. Patau syndrome ( Trisomy 13)

61. Contt ..

62. Contt .. Edward's syndrome ( Trisomy 18)

63. Contt ..

64. Contt .. Fragile X

65. Contt ..

66. Contt .. Rare, inherited metabolic disorders

67. Contt .. Neural tube defects

68. Contt .. Lung maturity

69. Contt .. Other Amniocentesis can also be used to detect problems such as: Infection, in which amniocentesis can detect a decreased glucose level, a Gram stain showing bacteria or an abnormal differential count of white blood cells. Rh incompatibility Decompression of polyhydramnios

70. PROCEDURE

71. Contt .. The woman’s abdomen is cleaned with antiseptic. A fine sterile needle is guided through the woman’s abdominal wall and the wall of the uterus (womb) into the amniotic fluid. The path of the needle is watched by ultrasound. As the procedure is rapid, a local anaesthetic is usually not necessary.

72. Contt .. Most women say that the procedure is no more painful than any type of injection. Some women feel cramping when the needle enters the uterus or pressure as the fluid is being withdrawn. Once the needle is seen to be in the right place, a small amount (about 20ml) of amniotic fluid is taken out and the needle is withdrawn. The sample of amniotic fluid is sent to the laboratory for testing.

73. Contt .. The amount of amniotic fluid in the uterus returns to normal within a few hours. Occasionally the doctor is unable to obtain enough amniotic fluid on the first attempt. If this happens, another sample may need to be taken.

74. DRAWBACKS Amniocentesis is performed between the 15th and 20th week of pregnancy, performing this test earlier may result in fetal injury. Complications of amniocentesis include preterm labor and delivery. Chance of infection and miscarriage. Ethical problem arise when parents decide for an abortion following the test results when there is a baby girl in the womb of mother. It is expensive process.

75. CORDOCENTHESIS Cordocentesis , also sometimes called Percutaneous Umbilical Cord Blood Sampling (PUBS), is a diagnostic test which examines blood from the fetus to detect fetal abnormalities.

76. INDICATIONS High risk of chromosomal disorders (based on biochemical screening); Identification of anomalies during fetal ultrasound, which may be associated with chromosomal diseases ( eg , short femur, hypoplasia of the nasal bone and other.);

77. Contt .. The presence of the parents of hereditary diseases, if they already have children with congenital developmental disorders; Suspicion of Rhesus-conflict, intrauterine infection; Suspicion of hemophilia;

78. CONTRAINDICATIONS Cordocentesis is contraindicated in infectious processes, with cervical incompetence (cervical insolvency), with large myoma nodes (in the projection of the puncture) and bleeding disorders in pregnant women. Cordocentesis is also impossible to carry out the threat of termination of pregnancy.

79. PROCEDURE

80. Contt .. An advanced imaging ultrasound determines the location where the umbilical cord inserts into the placenta. The ultrasound guides a thin needle through the abdomen and uterine walls to the umbilical cord. The needle is inserted into the umbilical cord to retrieve a small sample of fetal blood. The sample is sent to the laboratory for analysis, and results are usually available within 72 hours.

81. RISK AND SIDE EFFECTS TO THE MOTHER OR BABY Miscarriage Other potential side effects include: Blood loss from the puncture site Infection Drop in fetal heart rate Premature rupture of membranes Contact your healthcare provider if these symptoms remain or get worse.

82. Contt .. You should also contact your healthcare provider if you experience: Fever

83. Contt .. Chills

84. Contt .. Leaking of amniotic fluid

85. COMPLICATIONS Bleeding from the puncture area Violation of the functional state of the fetus as chorioamnionitis Alloimmune cytopenias (the baby)

86. CHORIONIC VILLUS SAMPLING

87. Contt .. Chorionic villus sampling (CVS), sometimes called "chorionic  villous sampling " (as "villous" is the adjectival form of the word " villus "), is a form of prenatal diagnosis to determine chromosomal or genetic disorders in the fetus

88. INDICATIONS Possible reasons for having a CVS can include: Abnormal first trimester screen results Increased  nuchal translucency or other abnormal ultrasound findings Family history of a chromosomal abnormality or other genetic disorder

89. Contt .. Parents are known carriers for a genetic disorder Advanced maternal age (maternal age above 35). AMA is associated with increase risk of Down's syndrome and at age 35, risk is 1:400. Screening tests are usually carried out first before deciding if CVS should be done.

90. PROCEDURE

91. Contt .. There are two ways samples are collected: Transcervical :   An ultrasound guides a thin catheter through the cervix to your placenta. The chorionic villi cells are gently suctioned into the catheter. This is the most common method.

92. Contt .. Transabdominal :  An ultrasound guides a long thin needle through the abdomen to your placenta. The needle draws a sample of tissue and then is removed. This procedure is similar to that of amniocentesis.

93. RISK AND SIDE EFFECTS TO THE MOTHER OR BABY Miscarriage CVS is not recommended for women who: Have an active infection (i.e. STD)

94. Contt .. Are carrying twins

95. Contt .. Have experienced vaginal bleeding during pregnancy

96. Contt .. Transcervical CVS is not recommended for women who: Have uterine fibroids

97. Contt .. Have a tilted uterus which impedes the catheter

98. Contt .. Following the procedure, the mother may experience one or more of the following side effects: Infection

99. Contt .. Spotting

100. Contt .. Cramping and pain at puncture point

101. Contt .. You should also contact to healthcare provider if you experience: Fever

102. Contt .. Chills

103. Contt .. Leaking of amniotic fluid

104. RESULTS Normal: No abnormalities are found in the genetic material of the chorionic villus cells. Abnormal: Abnormalities are found in the genetic material of the chorionic villus cells.

105. THANK YOU