foetal measure

1. Presented by:
Jyoti Kumari
M.Sc nsg 1st year

2.  Introduction
 Aims of Foetal Monitoring
 Terminologies
 Common Indicators of Antepartum Foetal
Monitoring
 Components of Foetal Monitoring
I. Clinical Parameters
II. Biochemical methods

3.  Majority (80%) of fetal deaths occur in the
ante partum period.
The main causes of death are:-
• Fetal hypoxia
• Maternal complication
• Congenital Malformation
• Unexplained cause

4.  There is a progressive decline in maternal deaths
all over the world. Currently more interest is
focused to evaluate the foetal health. The primary
objective of antenatal foetal assessment is to
avoid foetal death. As such simultaneously with
good maternal care during pregnancy & labour, the
foetal health in uteri should be supervised with
equal vigilance.

5.  To ensure satisfactory growth and well being
of the foetus throughout pregnancy.
 To screen out the high risk factors that affects
the growth of the foetus.

6. Abortion:-
• Expulsion or extraction from its mother of
an embryo or foetus weight less than
500gm or when it is not capable of
independent survival.
Multiple pregnancy:-
• When more than one foetus simultaneously
develops in the uterus.

7. Polyhydramnios:-
• Liquor amnii exceeds 2000ml
Oligohydramnios:-
• Liquior amnii lessthan 200ml.
Preterm labour:-
• Labour start before 37 completed weeks.

8.  Pregnancy with obstetric complication:-
• IUGR
• Oligohydramnions
• Ectopic pregnancy
 Pregnancy with medical complications:-
• Diabetes mellitus, Epilepsy
• Renal and cardiac disease,
• Infection.

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

11.  Maternal weight gain,
 Blood Pressure
 Assessment of size of uterus & height of
fundus.

12.  Maternal serum alpha feto protein(MSAFP)
 Acetyl choline esterage (AchE)
 Triple test
 Amniocentesis
 Cordocenthesis
 Chorionic villus sampling(CVS)

13.  US IMAGING
 Foetal Movement Count
 Ultra Sonography
 Cardiotocography
 Cardiotomography
 Non Stress Test (NST)
 Contraction stress Test (CST)
 Amnioscopy
 foetoscopy

15. • In second half of pregnancy: average
weight gain is 1kg/fortnight
• Excess weight gain: could be 1st sign of pre-
eclampsia.
• If weight gain less than normal, stationary
or falling: look for IUGR

16. • Initial recording of BP prior to 12 weeks helps to
differentiate pre-existing chronic hypertension
from pregnancy induced hypertension.
• Hypertension, pre-existing or pregnancy induced
may impair fetal growth.

17. • Top of fundus is measured from superior
border of symphysis pubis ( bladder should be
empty) using a tape.
• After 24 weeks of pregnancy, distance
measured in cm normally corresponds to
periods of gestation in weeks.

20. • 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 crosse the placenta into the mother’s
blood.
• Normal value:- 2.5 MOM (multiples of
median)

21. a) Wrong gestational age
b) Open Neural Tube Defect (NTDs)
c) Multiple Pregnancy,
d) IUFD
e) Renal anomalies

22.  Down’s syndrome
 Gestational trophoblastic disease
 Over 80% of fetuses affected with Down
Syndrome can be detected when both first and
second trimester screening are used.

23.  all pregnant women are usually offered the
AFP test. But, doctor may recommend the
test if..
o Have a family history of birth defects
o Age 35 year or older
o Have diabetes
o Have taken certain drugs or medication
during pregnancy

24.  15-18 weeks

25. procedure
 Explain procedure before performing test.
 Informed consent should be given prior to
testing, and a women has the right to refuse
this test if she chooses.

26. • Amniotic fluid AchE level is elevated in most
cases of open neural tube defect (e.g. Spina
bifida, Anecephaly)
• It has got better diagnostic value than MSAFP
 Time of performing test:-
Between 15th & 18th week of gestation.

27. • AFP testing is the sequences 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.

28.  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 mother’s blood during pregnancy.
 Performing time:- 15-18weeks.

29. • The triple screen test involves drawing blood
from the mother.
• The blood sample is then sent to laboratory for
testing.
• AFP is produced is the yolk sac and fetal liver.

30.  Amniocentesis is an invasive, diagnostic
antenatal test. It involves taking a sample of
amniotic fluid in order to examine fetal cells
found in this fluids.
 Because it carries a slightly increased risk of
miscarriage amniocentesis is usually reserved
for those women considered at higher risk of
carrying a fetus with a chromosomal
abnormality.

32. An ultrasound is used as a guide to
determine a safe location for the needle to
enter the amniotic sac, so the fluid may be
safely removed. A sample of amniotic fluid is
collected through the needle.
The procedure takes about 45 minutes,
although the collection of fluid takes less
than five minutes.

33. Early in pregnancy, used for diagnosis of
chromosomal and other fetal problems such
as:-
 Down syndrome
 Trisomy 8
 Fragile X
 rare, inherited metabolic disorder
 Neural tube defects

34. 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 uterus in acute
hydramnions

35.  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.

36.  Check the vital sign and FHR to obtain base
line data.
 Check USG
 Prophylactic administration of 100mg of anti-
D immunoglobulin in Rh negative mother.
 The proposed site of puncture is in filtered
with 2ml of 1% lignocaine.

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

38.  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 the 18th week of
pregnancy.

39.  Acute skin infection
 Maternal fever
 Allergies to material used like skin prepration
materials, local anesthesia.
 May be difficulty in patient with multiple
pregnancy

40.  CVS is usually carried out between the
11th and 14th weeks of pregnancy,
although it’s sometimes performed later
than this if necessary.
 It usually used in the management of
Rhesus iso immunization and in some
cases to solve the problem of mozaicism.
 Disadvantage is in higher risk of abortion
(2-3%) and abnormalities if carried before
the 9 week of gestation.

41. Indications:
Skin prepration material (betadine)
Sterile gloves
Tissue transport medium
USG unit

42.  Vaginal speculum
 Sponge holder ( may be useful to
atraumatically grasp and manipulate the
cervix.
 Small (1.5mm) aspiration cannula
 20-30 ml syringe or small biopsy forceps

43.  20-22G spinal needles
 20cc syringe
 Specimen tube with caps
 Sterile drapes
 1% lignocaine

44. 1. Transvaginally CVS:- a tube or small
forceps are inserted through the cervix (
the neck of the womb)

45. 2.Transabdominal CVS:- a needle is
inserted through abdominal.

46.  Active vaginal bleeding
 Infection
 Multiple gestation
 HIV infection

47.  Cervical stenosis
 Cervical myomas
in transabdominal CVS
o Fetal position that block access to placenta

48. Complication:-
• Miscarriage
• Infection and Amniotic fluid leakage
• Oligohydramnions
• Fetal loss
• Infection
• Vaginal bleeding
• Increase risk of pre eclampsia.

50. Cordocentesis provides a means of rapid
chromosome analysis and is useful when
information cannot be obtain through
amniocentesis, CVS, or USG ( or if results of
these tests were inconclusive).
Time of performance:-
18 week of gestation.

51.  Malformation of fetus.
 Fetal infection ( i.e. toxoplasmosis or rubella)
 Fetal platelet count in maternal circulation.
 Fetal anemia.
 Isoimmunisation.

52.  Blood loss from the puncture site
 Infection
 Drop in fetal heart rate
 Premature rupture of membranes
 Fever
 Chills
 Leaking of amniotic fluid

53.  Aims of Fetal monitoring
 Introduction
 Terminologies
 Common Indicators Of Antepartum Fetal
Monitoring
 Components of Fetal Assessment
i. Clinical Parameters
ii. Biochemical Methods

54.  Annamma Jacob, “A Comprehensive Textbook
of Midwifery and Gynecological Nursing”
Jaypee Brothers Medical Publishers (P) LTD,
Third Edition, 2012.
page no: 125-127
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