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Antenatal assessment,fetal well being

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biophysial and biochemical examination for fetal well being

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Antenatal assessment,fetal well being

  1. 1. AASSSSEESSSSMMEENNTT OOFF MMAATTEERRNNAALL AANNDD FFEETTAALL WWEELLLL BBEEIINNGG DDUURRIINNGG PPRREEGGNNAANNCCYY PPrreesseenntteedd bbyy:: SShhaalliinnii jjoosshhii MM..SSCC..((NN)) 11sstt yyrr..
  2. 2. DDeeffiinniittiioonn :: ‘‘ Assessment’ means is ‘to evaluate’ i.e. here we gather the information of client status and it identifies the specific needs of a client by which better care can be given to the client and her developing fetus.That means,it is the systematic supervision(examination & advice)of a woman during pregnancy.So,it is the foundation stone for antenatal care.
  3. 3. OOBBJJEECCTTIIVVEESS:: To screen the ‘high risk’ cases. To prevent or to detect and treat at the earilest any complications. To ensure continued medical surveillence and prophylaxis. To educate mother about the physiology of pregnancy and labour by demonstration,charts and diagrams so that fear is removed and psychology is improved.
  4. 4. CCoonnttdd…… To discuss with the couple about the place,time and mode of delivery and care of newborn. To motivate the couple about to the need of family planning. To give appropiate advice to couple seeking MTP.
  5. 5. AASSSSEESSSSMMEENNTT MMaatteerrnnaall MMeeaassuurreess FFeettaall MMeeaassuurreess
  6. 6. MMAATTEERRNNAALL MMEEAASSUURREESS :: History Taking Examination • General • Physical • Obstetrical Radiological Examination
  7. 7. History Taking Vital Statistics  Name: …………………………..  Date of first examination: ……..  Address:…………………………  Age:………………………………  Gravida:Parity…………………..  Duration of marriage: ………….  Religion:…………………………
  8. 8. CCoonnttdd…… • Occupation: …………………………… • Period of Gestation: ………………….. Chief Complaints: ……………………. History Of present illness:……........... History of present pregnancy: ………. Obstetrics History:…………………….. Menstrual history: …………………….. Past medical history: …………………. Past surgical history: …………………..
  9. 9. CCoonnttdd…… Family History Personal History Investigations Hb ABO/Rh HIV/HbsAg/VDRL USG PAP smear Blood sugar Urine analysis
  10. 10. AANNTTEENNAATTAALL EEXXAAMMIINNAATTIIOONN
  11. 11. EExxaammiinnaattiioonn :: General and Physical Examination: • Build:Obese/Avgerage/Thin OBESE
  12. 12. CCoonnttdd……  Nutrition:Good/Average/Poor
  13. 13. CCoonnttdd…… • Height:Short stature is likely to be associated with small pelvis.
  14. 14. CCoonnttdd…… Weight:The total weight gain during the course of singleton pregnancy for a healthy women averges 11 kg(24 Ib) BMI(20-26) is 11 to 16 kg BMI >29 not gain more than 7 kg BMI <19 allowed to gain upto 18 kg
  15. 15. CCoonnttdd…… • Pallor:The sites to be noted are lower conjunctiva,dorsum of tongue and nail beds. EYES TONGUE NAIL BED
  16. 16. CCoonnttdd…… • Jaundice:The sites to be noted are conjunctiva,tongue,skin.
  17. 17. CCoonnttdd…… • Tongue,teeth,gums and tonsils: GLOSSITIS STOMATITIS
  18. 18. CCoonnttdd…… • Neck:Neck veins,thyroid gland or lymph nodes should be inspected. NECK VEINS GOITRE
  19. 19. CCoonnttdd…… • Oedma of legs:The site of oedma are over the medial malleolus and anterior surface of the lower 1/3rd of the Tibia.Pitting oedma and varicosity also should be inspected. Oedma Varicosity
  20. 20. CCoonnttdd…… • Breast Examination:It should be inspected for pregnancy changes.
  21. 21. OObbsstteettrriiccaall EExxaammiinnaattiioonn :: ABDOMINAL EXAMINATION VAGINAL EXAMINATION
  22. 22. AAbbddoommiinnaall EExxaammiinnaattiioonn:: Fundal grip Lateral grip Pelvic grip Pawlik’s grip(3rd Leopold)
  23. 23. CCoonnttdd…… F.H.S. Fundal height
  24. 24. VVaaggiinnaall EExxaammiinnaattiioonn:: It should be done by using the left fingers(thumb & index),the character of vaginal discharge,cervix consistency,cystocele,uterine prolapse,rectocele is to be elicited. Prolapse
  25. 25. CCoonnttdd…… Can be done for taking vaginal swabs for investigations:
  26. 26. RRaaddiioollooggiiccaall EExxaammiinnaattiioonn:: INDICATIONS:(5 Rads)  Diagnosis of pregnancy  Fetal maturity  X-ray Pelvimetry  X-ray chest  Congenital malformation
  27. 27. Absorbed radiation by the fetus in different diagnostic radiation procedures: PPRROOCCEEDDUURREE DDOOSSEE((RRAADDSS)) Abdominal X-Ray 0.263 Pelvic X-Ray 0.5-1.1 Chest X-ray <0.001 Abdominal CT 0.50-1.10 Ventilation lung scan 133 Xe 0.004-0.019
  28. 28. FFEETTAALL MMEEAASSUURREESS
  29. 29. FFEETTAALL MMEEAASSUURREESS:: Clinical(Maneuvers) Biochemical(MSAFP,Triple test,AChE,) Cytogenetic • Amniocentesis • Chorion Villus Sampling(CVS) • Cordocentesis • Fluorescence In Situ Hybridisation(FISH)
  30. 30. CCoonnttdd…… Biophysical • Fetal movement count(DFMC) • Non Stress Test(NST) • Fetal biophysical profile(BPP) • Cardiotocography • Contraction stress test(CST) • Doppler Ultrasound • Vibroacoustic stimulation(VAS)
  31. 31. BBiioopphhyyssiiccaall PPrrooffiillee:: It is the screening test for utero-placental insufficiency.The fetal biophysical activities are initiated,modulated and regulated through fetal nervous system.The fetal CNS is very much sensitive to diminished oxygenation.
  32. 32. CCoonnttdd…… HHyyppooxxiiaa CChhaannggeess iinn ffeettaall BBiioopphhyyssiiccaall pprrooffiillee CCNNSS ddeepprreessssiioonn MMeettaabboolliicc AAcciiddoossiiss
  33. 33. CCoonnttdd……  It is the continuous electronic monitoring of the fetal heart rate along with recording of fetal movements (cardiotocography) is undertaken.  FHR acceleration with fetal movements,which when present,indicates a healthy fetus.  It is used as screening test.  The test is valuable to identify the fetal wellness rather than illness.  Test should be started after 30 weeks and frequency should be twice weekly.
  34. 34. CCoonnttdd…… • Reactive(Reassuring): When two or more acceleration of more than 15 beats per minute above the base line and longer than 15 sec in duration are present in a 20 min observation. • Non-Reactive(Non-Reassuring):Absence of any fetal reactivity.
  35. 35. FFeettaall CCaarrddiioottooccooggrraapphhyy
  36. 36. Fetal movement count(DFMC) • The patient counts the fetal movements every morning,noon and evening. • Three counts each of one hour duration are recommended. • If the no. of kicks are less than 10 in 12 hrs. or 3 in each hour it indicates fetal compromise. • Increased fetal movements associated with maternal hypoglycemia. • Decreased FM cause obesity,smoking,hypoxia, anterior placenta,hydramnios,narcotic drugs.
  37. 37. IInnddiiccaattiioonnss :: • Diagnosis of pregnancy. • Assessment of gestational age. • Diagnosis of multiple pregnancy. • Assessment of IUGR or BPP. • Uterine size either > dates or < dates. • Asessment of liquor volume. • Diagnosis of any abnormality e.g. placenta praevia etc.
  38. 38. CCoonnttdd……
  39. 39. The Nuchal translucency is used to provide a risk assessment for chromosomal abnormality, specifically Trisomies 13, 18 and 21(Downs Syndrome). This is a risk assessment based on age, heritage, history, and a specific ultrasound measurement. The accuracy of this is increased by factoring in the levels of bHCG and PaPP-A in the maternal blood. Nuchal Translucency (11-14 weeks : CRL 45-84mm)
  40. 40. Associated with spina bifida (secondary to cord tethering) “Banana sign”. BANANA SIGN
  41. 41. “Lemon Sign" is inward scalloping of the frontal bones and is associated with "open" spina bifida and the Chiari II malformation
  42. 42. Wks of gestation BPD mm FL mm HC mm AC mm 12 21 8 70 56 13 25 11 84 69 14 28 15 98 81 15 32 18 111 93 16 35 21 124 105 17 39 24 137 117 18 42 27 150 129 19 46 30 162 141 20 49 33 175 152 21 52 36 187 164 22 55 39 198 175
  43. 43. WKS in gestation BPD mm FL mm HC mm AC mm 23 58 42 210 197 25 64 47 232 208 26 67 49 242 219 27 69 52 252 229 28 72 54 262 240 29 74 56 271 250 30 77 59 280 260 31 79 61 288 270 32 82 63 296 280 33 84 65 304 290 34 86 67 311 299
  44. 44. Wks in gestation BPD mm FL mm HC mm AC mm 35 88 68 318 309 36 90 70 324 318 37 92 72 330 327 38 94 73 335 336 39 95 75 340 345 40 97 76 344 354 41 98 78 348 362 42 100 79 351 371
  45. 45. CCoonnttdd…… • IUGR cab be diagnosed accurately with serial measurement of BPD,AC,HC and amniotic fluid volume. • AC is the single measurement which best reflects fetal nutrition. • The avg. increase of BPD beyond 34 wks is 1.7 mm/wk. • When HC/AC ratio is elevated(>1.0) after 34 wks,IUGR is suspected. • A measurement of BPD of 9.8 cm indicates maturity. • Increased fetal nuchal skin thickness(in first trimester)>3 mm by TVS is a strong marker for chromosomal anomalies(trisomy 21,18,13) • CRL(in mm)+6.5=Gestational age in wks.After 12 wks it get decreased. • GS should increase by 1.1 mm in diameter/d.
  46. 46. DDoopppplleerr UUllttrraassoouunndd
  47. 47. CCoonnttdd…… • Doppler velocimetry of umbilical artery is studied in pregnancy with complications. • Used to measure the Peak systolic(S),peak diastolic(D) and mean values. • Pulsatility index(P.I.)=(S-D)/M • S/D & PI decreases with gestational age if it increases shows IUGR,HTN.
  48. 48. MMooddiiffiieedd BBiioopphhyyssiiccaall PPrrooffiillee:: It consists of NST and ultrasonography determined amniotic fluid index(AFI). Modified BPP is considered abnormal (nonreassuring) when the NST is non reactive and/ or the AFI is <5.
  49. 49. Fetal BBiioopphhyyssiiccaall PPrrooffiillee:: ((BBPPPP)) Observation for 30 mins.Normal score =2. Abnormal=0 PPaarraammeetteerrss MMiinniimmaall nnoorrmmaall ccrriitteerriiaa SSccoorree Non Stress Reactive pattern 2 Test(NST) Fetal 1 episode lasting>30 sec 2 Breathing movements Gross body 3 discrete body/limb movements 2 movements Fetal muscle tone Amniotic fluid 1 episode of extension with return 2 flexion 1 pocket measuring 2 cm in 2 2 perpendicular planes
  50. 50. CCoonnttrraaccttiioonn ssttrreessss tteesstt:: • It is based to observe the response of the fetus at risk for uteroplacental insufficiency in relation to uterine contractions. • Test is +ve when late decelerations are present with onset of contractions. • It has high false +ve rate. • NST & BPP should be done when CST is +ve before doing any intervention.
  51. 51. INDICATIONS: Intrauterine growth restriction Postmaturity Hypertensive disorders of pregnancy Diabetes
  52. 52. CCOONNTTRRAAIINNDDIICCAATTIIOONNSS:: Compromised fetus Previous history of Caesarean section Complications likely to produce preterm labour APH
  53. 53. SSUUMMMMAARRIIZZAATTIIOONN:: • Assessment • Maternal measures(H/T,OBS. Grips) • Fetal measures(NST,CST,DFMC,USG)
  54. 54. RREECCAAPPTTUULLIISSAATTIIOONN:: • Assessment of mother History Taking Examination • General • Physical • Obstetrical Radiological Examination
  55. 55. • FFEETTAALL MMEEAASSUURREESS:: Clinical(Maneuvers) Biophysical • Fetal movement count(DFMC) • Non Stress Test(NST) • Fetal biophysical profile(BPP) • Cardiotocography & USG.
  56. 56. BBIIBBLLIIOOGGRRAAPPHHYY:: • Dutta D.C. “TEXTBOOK OF OBSTETRICS” New Central Book Agency (P) LTD 2009 Pp 95-113 • Myles “TEXTBOOK FOR MIDWIVES” Churchill Livingstone 14 edition Pp 251- 272:417-422 • BNS-103 Maternal health Nursing IGNOU Pp 67-70
  57. 57. CCoonnttdd ...... • http:www.hps.org/physiccians/radiology-pregnant- patient-qa.html • http://www.scribd.com/doc/6624348/Bioph ysical-Assessment • http://www.brooksidepress.org/Products/M ilitary_OBYGN/Ultrasound/2ndand3rdTrim esterUltrasoundScanning.html • http://www.ultrasoundpaedia.com/USP2nd trimesterpathologywinner.html
  58. 58. TTHHAANNKK YYOOUU !!!!!!

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