biophysical, biochemical & cytogenic

2. Antenatal fetal assessment

3. Definition:
•"Assessment" means is to "evaluate" .i.e. here we
gather the information of client starts and it
identifies the specific needs of a client by which
better care can be given to the client and her
developing fetus.

4. Aims of antenatal fetal monitoring:
• The primary objective for antenatal assessment is to avoid fetal death
through out pregnancy.
• To ensure satisfactory growth and well being of the fetus.
• To screen out the high risk factors that affect the growth of the fetus.
• Prevent fetal injury and death.
• Improve long-term neurologic outcome through optimal timing of
delivery
• Avoiding unnecessary intervention, such as cesarean delivery or
preterm delivery.

5. Common indications for antepartum fetal monitoring :
• Pregnancy with obstetric complications:
• IUGR, Multiple pregnancy, Polyhydramnios or Oligohydramnios,
Rhesus alloimmunization.
• Pregnancy with medical complications:
• Diabetes mellitus, Hypertension, Epilepsy, Renal or Cardiac disease,
Infection (Tuberculosis), SLE.
• Others:
• maternal age (> 35 years), previous still birth or recurrent abortion,
previous birth of a baby with structural (anencephaly, spina bifida) or
chromosomal (autosomal trisomy) abnormalities.
• Routine antenatal testing.

6. Procedures of antenatal examination
First visit:
History collection, physical examination, recording of the obstetrical
examination for the mother with following test.
Hb estimation
Urine culture
Serological test for syphilis
ABO and Rh typing
PPBS & GTT
Other test in case of unexplained recurrent abortion/still birth

7. At subsequent visit: following clinical parameters are taken in to account
of the satisfactory progress of gestation:
1. Maternal weight gain
2. Blood pressure
3. Assessment of size of uterus & height of fundus
4. Clinical assessment of liquor
5. Oedema of feet
6. Abdominal girth in last trimester

8. Early pregnancy
Foetal
assessment
Biochemical
BiophysicalCytogenic

9. biochemical
Maternal serum alpha foeto protein
It is the onco foeto protein. Produced by yolk sac and foetal liver. The
highest level of the AFP in foetal serum and amniotic fluid reached around 13
weeks and thereafter it decreases. Maternal serum level peak around 32
weeks. Maternal screening access the quantity of the maternal serum protein
level.can be perform any time between 15 7 21 weeks of gestation (17 weeks
is ideal).

12. Elevated at
Wrong gestational age
Open neural tube defect of the foetus
Multiple pregnancy
IUFD
Anterior abdominal wall defects
Renal anomalies

13. Low at
• Down syndrome
• Gestational trophoblastic diseases.

15. Triple test
It is combined test in which includes MSFP, hCG and UE3
(unconjugated oestriol).
It is used for detection of down syndrome. Performed at 15-18 weeks.

16. Condition MSAFP UE3 hCG
Neural tube defect Increased Normal Normal
Trisomy 21 Low Low Increased
Trisomy 18 Low Low Increased
Molar pregnancy Low Low Very high
Multiple gestation Increased Normal Increased
Fetal death Increased Low Low

17. Coomb’s test
The Coomb’s test (also known as Antiglobulin Test or AGT) refers to two
clinical blood tests used in immunohematology which are done to find certain
antibodies that cause autoimmune haemolysis of red blood cells (erythrocytes).
Used to detect presence or absence of the maternal antibodies on fetal red cells.
If there is no antibodies, the blood is retested at 28 and 34 weeks of pregnancy.

18. Types
Direct Coombs Test
The direct Coombs test (also known as the direct antiglobulin test
or DAT) is used to detect if antibodies or complement system factors
have bound to RBC surface antigens in vivo. A blood sample is taken
and the RBCs are washed and then incubated with antihuman globulin.
If this produces agglutination of RBCs, the direct Coombs test is
positive, a visual indication that antibodies are bound to the surface of
red blood cells.

20. Indirect Coombs Test
The indirect Coombs test (also known as the indirect antiglobulin test or
IAT) is used to detect in-vitro antibody-antigen reactions. It is used to detect very
low concentrations of antibodies present in a patient’s plasma/serum prior to a
blood transfusion. In antenatal care, this test is used to screen pregnant women for
antibodies that may cause hemolytic disease of the newborn. The IAT can also be
used for compatibility testing, antibody identification, RBC phenotyping, and
titration studies.

22. Interpretation
If the blood coagulates, it can be concluded that the patient’s red
blood cells have been bound by (his/her own) immunoglobulins. Of
course, this isn’t the normal state of affairs, and implies that the patient
is experiencing an autoimmune haemolysis of his/her red cells.

23. Biophysical
It is a screening test for uteroplacental insufficiency. The fetus biophysical
activities are initiated, modulated and regulated through fetal nervous system.
The fetus CNS is very much sensitive to diminished oxygenation.
Hypoxia → metabolic acidosis → CNS depression → changes in fetal
biophysical activity.

24. It is performed at two stages :
• Antepartum
• Intrapartum
A. Antepartum tests:
1. Fetal movement monitoring
2. The non stress test (NST)
3. The contraction stress test (CST)
4. The biophysical profile
5. Doppler usg of fetal umbilical artery blood flow
B. Intrapartum assessment of fetal well-being:
1. Continuous electronic fetal monitoring:
a. The fetal heart rate (FHR)
b. Uterine activity
2. Fetal scalp blood gas

25. Antepartum tests
1. Fetal movement monitoring
Cardif ‘count 10’ formula:
Daily fetal movement count (DFMC):

27. Factors affecting movement
• Maternal obesity
• Excessive liquor
• Placental site (?)
• Fetal malformations

28. The non stress test (NST):
A test monitors the fetal heart in response to fetal movements in
order to assess the integrity of fetal central nervous system and cardio
vascular system.
NST involves application of the fetal monitor to record the fetal heart
rate.

29. Purposes
 To assess the fetal ability to cope with continuation of a high risk
pregnancy.
 To determine the projected ability of a fetus to withstand the stress of
labour.
 To assess the fetal status in women for whom contraction stress is
contraindicated such as previous CS, placenta previa or preterm.

30. Indication (maternal)
Post dated pregnancy
Rh sensitization
Maternal age 35 or more
Chronic renal disease
Hypertension
Collagen disease
Sickle cell disease
Diabetes
Premature rupture of membrane
History of still birth
Trauma
Vaginal bleeding in 2nd an d3rd
trimester

31. Indications (fetal)
• Decreased fetal movement
• Intrauterine growth retardation
(IUGR)
• Fetal evaluation after amniocentesis
• Oligohydramnios/polyhydramnios

34. Vibroacoustic stimulation
• Introduced by Zimmer et all, 1993.
• Stimulation via an artificial larynx, over the fetal head along with NST
attached & producing vibratory acoustic stimulus of approx 80Hz and 82dB.
• A healthy fetus responds with a sudden movement (Startle Response)
followed by FHR acceleration.

35. The contraction stress test
(CST)
Performed during pregnancy to
verify whether or not the unborn
baby’s heart is strong enough to
withstand labor.

36. Types of CST
 Nipple stimulation test:
 Oxytocin challenge test:
 The contraction stress test (CST)

37. Results
Negative CST(normal): is represented by late or variable decelerations
of the fetal heart rate.
Positive CST is late or variable decelerations of the fetal heart with
50% or more of the contractions in the absence of hyperstimulation of
the uterus.
Equivocal: it contains decelerations but with less than 50% of the
contractions, or the uterine activity shows the hyperstimulation of the
uterus.

38. Fetal cardiotocography (ctg)
Is a technical means of recording (-graphy) the fetal heartbeat (cardio-)
and the uterine contractions (-toco-) during pregnancy, typically in the
third trimester.

39. Recordings are performed by two separate transducers, one for
the measurement of the fetal heart rate and a second one for the uterine
contractions. Each of them may be either external or internal.

40. External fetal monitoring

41. Internal fetal monitoring

42. Interpretation of a CTG tracing requires both qualitative abd quantitative
description:
Uterine activity (contractions)
Baseline fetal heart rate
Baseline FHR variability
Presence of accelerations
Periods or episodic decelerations
Changes or trends of FHR patterns over time.

46. Doppler ultrasonography of fetal umbilical artery blood flow:

47. cytogenic

48. AMNIOCENTESIS

49. Indications
• Neural tube defects (such as spina bifida or anencephaly)
• Blood type of the fetus (which can be important if the mother's blood
contains antibodies that can react with the fetus's red blood cells)
• Genetic disorders in the fetus, such as sickle cell anemia
• Infection in the fetus
• Readiness of the fetus's lungs to live outside the uterus (if done late in
pregnancy)

50. Complications
• Leakage of amniotic fluid
• Injury to the fetus
• Infection
• Miscarriage

51. cordocentesis

52. INDICATIONS
• Rapid Karyotype In Fetuses Detected With Anomalies On USG.
• Fetal Hemolytic Disease
• Suspected Fetal Viral Infection
• Non Immunologic Hydrops Fetalis
• Suspected Fetal Thrombocytopenia
• Twin To Twin Transfusion
• Fetal Heamoglobinopathies

53. RISKS
• BLEEDING FROM PUNCTURE SITE
• VASO VAGAL REFLEX
• FETAL BRADYCARDIA

54. Chorionic Villus Sampling

55. Indications:
•Family history of a genetic disorder
•Wife & husband are carriers for genetic disorders, such as fragile X, Tay
Sachs disease, or cystic fibrosis.
• Prenatal screening tests (blood tests or ultrasound) show that fetus is at
increased risk of having a genetic disorder.

56. Types of procedure
• Transcervical
CVS — In the
transcervical CVS
technique, the
physician inserts a
small tube through
the cervix into the
placenta. This is done
while ultrasound
guides the physician.

57. Transabdominal CVS —
In the transabdominal
CVS technique, the
physician inserts a needle
through the abdomen into
the placenta. This is also
done with ultrasound to
guide the physician

58. Complications
• Bleeding
• Miscarriage

59. FLUORESCENCE IN SITU HYBRIDIZATION

60. • Fluorescence in situ hybridization (FISH) is a cytogenetic technique
that uses fluorescent probes that bind to only those parts of the
chromosome with a high degree of sequence complementarity
• It is used to reveal the location of specific nucleic acid sequences on
chromosomes or in tissues, a crucial step for understanding the
organization, regulation, and function of genes.