foetalmeasuresppt-copy-171125134533.pptx

Foetal measures for well being of featus and mother

1. Farkhanda andrabi Msc nursing 1 st year Deptt of obg

2. Review of Topic: Aims Of Fetal Monitoring Introduction Common Indicators Of Antepartum Fetal Monitoring Components Of Fetal Assessment 1. Clinical Parameters 2. Biochemical Methods

3. Fetal measures

4. Introduction :- Majority of (80%) fetal deaths occurs in the ante partum period. The main causes of deaths are :- Fetal hypoxia Maternal complication. Congenital malformation. So it is necessary to avoid fetal and maternal death during pregnancy

5. Aims of Fetal Monitoring:- To ensure satisfactory growth and well being of the fetus throughout pregnancy. To screen out the high risk factors that affects the growth of the fetus.

6. Common indicators of antepartum fetal monitoring:- Pregnancy with obstetric complication:- - IUGR, -Oligohydramnions - Ectopic pregnancy Pregnancy with medical complications:- -Diabetes mellitus, Epilepsy -Renal and cardiac disease, -Infection.

7. CONT… Others:- - Advanced maternal age (>35 years) - Previous still birth, recurrent abortion. - Previous birth of baby with structural or chromosomal abnormalities. Routine antenatal testing

8. Biochemical Methods Biophysical Methods Clinical Parameters COMPONENTS OF FETAL ASSESSMENT

9. 1. Clinical Parameters:- Maternal Weight gain, Blood Pressure, Assessment of size of uterus & height of fundus.

10. 2. Biochemical Methods:- Maternal serum alpha feto protein(MSAFP), Acetyl choline esterage(AchE), Triple test, Amniocentesis, Cordocenthesis, Chorionic villus sampling(CVS).

11. 1.Clinical Parameters

12. 2.Biochemical Methods

13. 1. Maternal alpha-fetoprotein screening (MAFP) :- AFP is a oncofetal protein(Molecular weight 70,000) normally produced by the fetal liver and is present in the fluid surrounding the fetus (amniotic fluid), and crosses the placenta into the mother's blood. Normal values:- 2.5 MOM ( Multiples Of the Median)

14. MSAFP level high indicates :- Wrong gestational age Open Neural Tube Defects(NTDs) Multiple Pregnancy, IUFD e) Renal anomalies

15. MSAFP level Low indicates:- Down’s syndrome Gestational trophoblastic disease Over 80 percent of fetuses affected with Down Syndrome can be detected when both first and second trimester screening are used.

16. Who takes the AFP test ? All pregnant women are usually offered the AFP test. But, your doctor may recommend the test, especially if you: Have a family history of birth defects Age 35 year or older Have diabetes Have taken certain drugs or medication during pregnancy

17. Time of performing test :- 15-18weeks Nursing responsibility :- Explain procedure before performing test. Informed consent should be given prior to testing, and a woman has the right to refuse this test if she chooses.

18. What are the risks and benefits of alpha-fetoprotein screening? Risks Benefits There are no risks of having the actual test performed other than the usual risks of a blood test. Abnormal test results of AFP and other markers may indicate the need for additional testing. Usually an ultrasound is performed to confirm the dates of the pregnancy and to examine the fetal spine and other body parts for defects. An amniocentesis may be needed for accurate diagnosis. The purpose of this screening test is to identify those women in the population who are at increased risk of having a baby with a birth defect, whose pregnancies need additional testing, who otherwise would not have been offered this additional fetal testing.

19. 2. Acetyl choline esterace (AchE) :- Amniotic fluid AchE level is elevated in most cases of open neural tube defects(e.g. Spina bifida,Anecephaly). It has got better diagnostic value than MSAFP Time of performing test :- Between 15 th and 18 th week of gestation.

20. Cont… Procedure: AFP testing is the sequence of tests. The first-two are of maternal serum and the final test of amniotic fluid. An Elevated AFP Level is indicative of significant fetal pathology. A low level of AFP may be associated with Down syndrome. The Normal AFP concentration in liquor amnii at the 16th week is about 20mg/L.

21. 3. Triple test/Triple Screen/Kettering test/Bart’s test, Multiples of the MEDIAN(MoM) :- This test includes the combination of 3 tests: AFP Unconjugated Estriol (UE3) Human Chorionic Gonadotrophin (HCG) Estriol and HCG are two hormones that are present in the mother's blood during pregnancy. Performing Time :- 15-18 weeks.

22. Cont… Procedure: The triple screen test involves drawing blood from the mother. The blood sample is then sent to laboratory for testing. AFP is produced in the yolk sac and fetal liver.

23. AFP UE3 HCG Associated conditions low Low High Down Syndrome low low Low trisomy 18 ( Edward's syndrome )

24. Indication :- Early in pregnancy, used for diagnosis of chromosomal and other fetal problems such as: Down syndrome (trisomy 21) Trisomy 18 Fragile X Rare, inherited metabolic disorders Neural tube defects

25. Later on , it also can be used to detect problems such as: Infection Prediction of lung maturity Meconium stained of liquor Therapeutic :- Induction if abortion Repeated decompression of the uterus in acute hydramnions

26. Nursing responsibility before procedure:- Before procedure take written consent. Explain the purpose of procedure and how it will be done. Emptying the bladder. Provide privacy. Provide supine position with elevated head 20-30degree. (dorsal position). The abdominal wall is prepared aseptically and draped.

27. Cont… Check the vital sign and FHR to obtain base line data. Check USG. Prophylactic administration of 100 mg of anti –D immunoglobuline in Rh negative mother. The proposed site of puncture is infiltered with 2 ml of 1% lignocain.

28. The site of Procedure :- In early month:- 1/3 of the way up the uterus from symphysis pubis. In later month:- suprapubic approach after lifting the presenting part Flanks in between the fetal limb Below the umbilicus behind the neck of the fetus.

29. Time of performing : Amniocentesis is performed between the 15th-20th week of pregnancy; performing this test early can lead to injury to the baby's limbs. Most people do the test during the 18th week of pregnancy.

30. Required equipment Procedure of Amniocenthesis

31. Contraindication :- Acute skin infections Maternal fever Allergies to material used like skin prepration materials, local anesthesia. May be difficulty in patient with multiple pregnancy.

32. Equipment :- Skin prepration material ( betadine) Sterile gloves Tissue transport medium USG unit For transvaginal approach :- Vaginal speculum Sponge stick (may be useful to atraumatically grasp and manipulate the cervix. Small (1.5 mm) aspiration cannula 20 to 30 ml syringe or small biopsy forceps

33. For transabdominal approach :- 20-22 G spinal needles 20 cc syringe Specimen tube with caps Sterile draps 1% lignocaine

34. Procedure:- 1. Transvaginally CVS :-

35. 2. Transabdominally CVS :-

36. Contraindication :- Active vaginal bleeding Infection Multiple gestation HIV infection In transcervical CVS:- cervical stenosis, cervical myomas In transabdominal CVS: - fetal position that block access to placenta

37. Nursing responsibility after procedure :- Complications :- - miscarriage -Infection and amniotic fluid leakage Oligohydramnions mild risk of Limb Reduction Defects associated with CVS, especially if the procedure is carried out in earlier terms (before 12 th week of pregnancy). Fetal loss.

38. Cont… Infection Vaginal bleeding. There is some evidence focus increase risk of pre eclampsia.

39. 6. Cordocenthesis OR Percutaneous umbilical cord blood sampling (PUBS), PUBS provides a means of rapid chromosome analysis and is useful when information cannot be obtained through amniocentesis , CVS , or ultrasound (or if the results of these tests were inconclusive). Time of performance:- 18 weeks of gestation.

40. Summary Aims Of Fetal Monitoring Introduction Common Indicators Of Antepartum Fetal Monitoring Components Of Fetal Assessment 1. Clinical Parameters 2. Biochemical Methods

41. CONCLUSION A fetal biophysical profile is a prenatal test used to check on a baby's well-being. The test combines fetal heart rate monitoring and fetal ultrasound to evaluate a baby's heart rate, breathing, movements, muscle tone and amniotic fluid level.

42. RECAPTULIZATION: 1.Ideal time for performing cvs is -----------------. 2. Time of performance of PUBS-----------------. 3. MSAFP level high indicates -----------------,----------------&-------------------------. 4. Clinical parameters includes----------------------,-----------&---------------------. 5. MSAFP level Low indicates------------------,----------------------&-----------------------  

43. BIBLIOGRAPHY Annamma Jacob, “A Comprehensive Textbook of Midwifery and Gynecological Nursing” Jaypee Brothers Medical Publishers (P) LTD, Third Edition,2012;Page No:125-127