2. INTRODUCTION
DEFINITION
PD is the science of identifying structural and
functional abnormalities in the developing
fetus through invasive and non-invasive
techniques.
SIGNIFICANCE
About 2-3% of all live born infants have an
abnormality.
These anomalies account for majority of
miscarriages and perinatal deaths.
More than a quarter of all paediatric hospital
admissions result from genetic disorders.
3. OBJECTIVES
Primary objective is to prevent fetal
death
Ensure satisfactory fetal growth and well
being
Identify adverse factors that could affect
fetal well being
Treat or modify any identified risk
Determine the optimal time, mode and
place of delivery
Plan the postnatal management.
4. ETHICAL / LEGAL CONSIDERATIONS
The pregnant woman has an ethical
obligation to accept fetal therapy for a
viable fetus:
◦ If treatment to prevent a serious disease or
handicap would benefit or save the life of the
fetus.
◦ If mortality or injury to the fetus is unlikely.
◦ If mortality or morbidity in the mother is unlikely.
INTRODUCTION
5. Screening tests
Tests that do not provide a diagnosis but
rather identify individuals with risk high
enough to benefit from a definitive
diagnostic test.
Prenatal screening tests should meet
criteria generally accepted for other types of
screening tests:
1. The disease is well defined and serious.
2. Treatment or prevention is available
3. The screening test is cost effective and reliable.
4. The subsequent diagnostic test is reliable.
6.
7. Indications
1. GENERAL RISKS
◦ Maternal age>35yrs
◦ Abnormal MSFAP
◦ Abnormal triple screening
results
3. Certain ethnic groups
◦ Blacks, Indians
◦ Jews
◦ mediterrenean
2. SPECIFIC RISKS
Parents with congenital
abnormality
Previous Hx
Balanced chromosomal
translocation
Mother with X-linked abnormal
gene e.g Duchenne MD
Both parents with same
recessive abnormal gene (e.g.
sickling gene)
Recurrent miscarriages or
stillbirth
Maternal disease e.g. DM
Chronic alcohol or drug
consumption in mother
Maternal rubella infection
Teratogen exposure
Consangunity
10. FETAL SURVEILLANCE
Fetal surveillance encompasses all
measures taken in pregnancy to determine
fetal well being up to the delivery of a healthy
baby.
AIMS:
Identify fetuses at risk of intrauterine death
Identify fetuses at risk of neurologic
impairment and long term disability
Ensure satisfactory fetal growth and
development
Identify factors that could adversely affect
fetal outcome
Proffer solutions to identified risk factors
11. Indications
Routine for all women
Maternal age
Medical disorders in
pregnancy
◦ Hemoglobinopathy
◦ Cyanotic heart disease
◦ Chronic Hypertension
◦ DM
◦ Chronic renal disease
◦ Hyperthyroidism
◦ SLE
◦ Anti-phospholipid
syndrome
PIH
Decreased fetal
movement
Oligo/polyhydramnio
s
IUGR
Post term gestation
Multiple gestation
Rh-isoimmunisation
Premature ROM
Previous
unexplained fetal
demise
Maternal-related Pregnancy-related
12. .
ANTEPARTUM
1. Maternal history &
routine ANC tests
2. Serial SFH
measurements
3. Fetal heart rate counts
4. Fetal movement count
5. Serial USS to detect
IUGR
6. Amniotic fluid index
7. Non stress test
8. Contraction stress test
9. Fetal biophysical profile
10. Modified biophysical
profile (NST+AFI)
11. Fetal doppler studies
INTRAPARTUM
1. Non invasive
◦ Fetal heart rate
count
◦ Liquor colour
◦ Cardiotocograph
2. Invasive
• Internal CTG
• Fetal blood
sampling
• Fetal scalp
electrodes
13. Non stress test
Done on a non-labouring woman
Assesses FHR in response to fetal
movement
Two accelerations i.e. rise in FHR of
15beats/min above base line for at
least 15 seconds before returning to
baseline is expected in 20min
Reported as reactive or non-reactive
14. Contraction stress test
Designed to assess ability of a fetus to
survive stress of labour
Three Contractions in 10min, each lasting
at least 40 sec are stimulated.
Normal fetus respond to hypoxia by
deceleration then immediate acceleration
Contra indicated in situation in which
labour is not desired.
May provoke preterm labour
Results reported as negative, positive or
equivocal.
15. Biophysical profile
VARIABLE NORMAL ABNORMAL
Fetal breathing
movementt.
>1 lasting 30sec in 30
min
Absent or <1
Gross body
movement.
>3 body movt <3
Fetal tone > 1 flexion-extension,
open –close hand
cycle
Absent or slow
NST > 2 acceleration with
fetal movt
<2 acceleration or 1 +
deceleration
Amniotic fluid vol >1 pool of 1*1 None or less than
1*1cm pool
16. Doppler flow velocimetry
Rationale:
Pulsatile flow in umbilical artery is an
of indication feto-maternal status
Decrease in placental function will
result in Increased resistance
Evidenced in fetal diastolic flow
(reduced, absent or reversal)
More reliable than other commonly
used methods
18. Fetomaternal Surveillance in Labour – Use of
partograph
Graphical records of events of labour.
Components of the partograph:
Labour progress
Maternal condition
Fetal condition
Note concept of active Mgt of labour:
Monitoring labour –alert line
-action line
18
19. Fetal Heart Auscultation :Pinard’s Fetal
Stethoscope/Sonicaid
Easy to use, widely available
Suitable for low-risk pregnancies
Should ideally be used before, during, and
after uterine contractions
Drawback –
Cannot be used for continuous fetal
monitoring
Subject to significant inter and intra observer
variations
19
22. Fetal Blood Sampling
Involves collection of fetal scalp (buttock) blood
sample after rupture of fetal membranes
(using an amnioscope) and determination of
fetal pH.
pH<7.2 (first stage) or <7.15 (second stage)
considered indication for immediate delivery.
22