pregnancy test

1. DIAGNOSTIC TEST
IN PREGNANCY

2. DEFINITION OF BIOPHYSICAL PROFILE
A biophysical profile (BPP) is a prenatal ultrasound evaluation of fetal well-being
involving a scoring system,[1]with the score being termed Manning's score.[2] It is often
done when a non-stress test (NST) is non-reactive, or for other obstetrical indications.
The "modified biophysical profile" consists of the NST and amniotic fluid index only.

3. PURPOSE
 The purpose of biophysical profile is a test performed to assess fetal well-being. It is
a tool used near or at term by clinicians to assess the potential risk of fetal
compromise due to fetal hypoxia or acidosis.
 It is use to prevent pregnancy loss and most commonly done when there's an
increased risk of problems that could lead to complications or pregnancy loss.
PROCEDURE
The Biophysical profile has 5 components: 4 ultrasound assessments and an NST. The
NST evaluates fetal heart rate and response to fetal movement. The five discrete
biophysical variables are:
1.Foetal heart rate
2.Foetal breathing

4. 3.Foetal movement
4.Foetal tone
5.Amniotic fluid volume
Parameter Normal (2 points) Abnormal (0 points)
At least two
accelerations in 20
minutes
NST/Reactive
FHR
Less than two accelerations to satisfy the test
in 20 minutes
US: Foetal
breathing
movements
At least one episode
of > 30s or >20s in 30
minutes
None or less than 30s or 20s

5. US: Foetal
activity / gross
body
At least three or
two[3] movements of
the torso or limbs
Less than three or two[3]movements
movements
At least one[3] episode
US: Foetal of active bending and No movements or movements slow and
incomplete
muscle tone straightening of the
limb or trunk
At least one vertical
US: Qualitative pocket > 2 cm in the Largest vertical pocket </= 2 cm, or AFI </= 5
AFV/AFI vertical axis or AFI of
5 cm
cm

6. Biophysical profile of 8 or 10 is generally considered reassuring. A BPP normally is not
performed before the second half of a pregnancy, since fetal movements do not occur in
the first half.
BIOPHYSICAL TEST
1.fetal movement count
2.cardiotocography
3.doppler ultrasound
4.contraction stress test(CST)
5.Non stress test(NST)
6.Vibroacoustic stimulation test
7.Ultrasound
8.Foetal biophysical profile(FBP)
9.Auscultation

7. Fetal Movement Count
Foetal movement count can be done by using two methods:-
 Cardif “count 10” formula:
o The fetal movement starting at 9.A.M, the counting
comes to an end as soon as 10
movements.
o Less than 10 movements- in 12hrs on 2 successive days
o No movements is perceived even after 12hrs in a single
day.
 Daily fetal movement count:
o Three counts each of one hour duration(morning, noon and evening) are
recommended.
o The total counts are multiplied by 4 gives daily (12 hours).
o Kick – is less than 3 in each hour-indicates fetal compromise.
o The count should be performed starting daily at 28 weeks of pregnancy.
o Maternal hypoglycaemia- associated with increased fetal movement.
o Maternal perception of fetal movements may be reduced with fetal sleep.

8. Cardiotocography
Cardiotocography is a technical means of recording the fetal heart rate and the uterine
contractions during pregnancy, typically in the third trimester. The machine used to
perform the monitoring is called the cardiotocography , more commonly known as
electronic fetal monitoring(EFM).
There are Two methods which is used in cardiotocography
o External – continuous tracing of FHR
o Internal – fetal ECG tracing is made by applying a spiral pointed scalp electrode to
the fetal scalp after rupturing the membrane.
o Intra uterine pressure could be simultaneously
measured by passing a catheter inside the uterine cavity.

9. o Advantages – can detect hypoxia
o Drawbacks – trained personnel required .,instruments are expensive.
Doppler Ultrasound Of Umbilical Artery
o Doppler ultrasound is used to assess fetal and uteroplacental blood flow in
pregnancies associated with high risk.
o It is also used to check other blood vessels in the baby.
o It is also used with other tests when the baby is not growing well or in cases in which
the baby is at risk of anaemia, such as rh sensitization.
o In this test a transducer is rolled gently over the abdomen to project sound waves. An
image of the artery that is being examined is shown on a computer screen.
Contraction Stress Test

10. o The contraction stress test helps to see how the fetal heart reacts when the uterus
contracts. In this test, belt with sensors that detect fetal heart rate and uterine
contraction are placed across the abdomen of the mother.
o To make the uterus contract mildly, the investigator asks the mother to rub her
nipples or oxytocin may be given. If the heart rate does not decrease after a
contraction, the result is normal(negative). A decrease in heart rate after more
contractions is a positive result.
Non Stress Test
o The fetal non-stress test is a simple non-invasive test performed in pregnancies over
28 weeks gestation. The test is named as ‘non-stress’ because no stress is placed on
the fetus during the test.
o The test involves attaching one belt to the mother’s abdomen to measure fetal heart
rate and another belt to measure contractions.

11. o The movement, heart rate and reactivity of heart rate to movement is measured for
20-30 minutes
o Continuous electronic monitoring of the fetal heart rate along with recording of fetal
movement.
o Foetal heart rate acceleration with fetal movements, indicates healthy fetus.
Vibroacoustic stimulation test
o It is the a application of a vibratory sound stimulus to the abdomen of a pregnant
women to introduce fetal heart accelerations.
o The presence of FHR accelerations reliably predicts the absence of fetal metabolic
acidaemia.
o It is typically used during a non-stress test.

12. Ultrasound
o A pregnancy ultrasound is a test that uses high-frequency sound waves to evaluate
the growth of the baby, amniotic fluid quantity, placenta, blood flow pattern etc.
o It is a way of examine the baby using sound waves.
o It may be performed by a health care provider or a specially trained technician.
o Women should have at least one ultrasound at 18 weeks and 20 weeks of pregnancy
to help in assessing the gestational age and development of the baby.
Purpose:
-To confirm pregnancy
-To check the fetal heartbeat.
-To determine the gestational age of the baby and estimate a due date.

13. -To check for multiple pregnancies.
-To examine the placenta, uterus, ovaries, and cervix.
-To diagnose an ectopic pregnancy (when the fetus does not attach to the uterus) or
miscarriage.
-To look for any abnormal growth in the fetus.
DEFINITION OF BIOCHEMICAL TEST
Biochemical markers are used to assess maternal, placental and fetal health. They help
to diagnose and monitor maternal conditions such as gestational diabetes and pre-
eclampsia, trophoblastic disease and fetal chromosomal abnormalities such as Down's
syndrome.

14. BIOCHEMICAL TEST
1.Maternal serum alpha fetoprotein(MSAFP)
2.Triple test
3.Acetyl choline esterase (AChE)
4.Amniocentesis
5.Chorionic villous sampling (CVS)
6.Cordocentesis
Maternal Serum Alpha Fetoprotein
o Alpha- fetoprotein (AFP) is found in both fetal serum and also amniotic fluid.
This protein is produced early in gestation by the fetal yolk sac and then in fetal liver

15. o Highest level of AFP in fetal serum and amniotic fluid is reached around 13 weeks
and thereafter it decreases.
o Maternal serum level reaches a peak around 32 weeks.
o MSAFP levels are elevated in following conditions:-
-wrong gestational age
-open neural tube defects
-multiple pregnancy, Rh isoimmunization
-IUFD
-anterior abdominal wall defects
-renal anomalies
o Low level found in trisomy (down’s syndrome) and gestational trophoblastic disease.
o Test is done between 15-20 weeks.
o Elevated MSAFP detects 85% of all neural tube defects.

16. Triple Test
The triple test, also called triple screen, the Kettering test or the Bart's test, is an
investigation performed during pregnancy in the second trimester to classify a patient as
either high-risk or low-risk for chromosomal abnormalities (and neural tube defects).
The triple test measures the following three levels in the maternal serum:
 alpha-fetoprotein (AFP)
 human chorionic gonadotropin (hCG)
 unconjugated estriol (UE3)
The levels may indicate increased risk for certain conditions or may be benign:
AF U hC
P E3 G
Associated conditions

17. lo lo
w w
Trisomy 21(Down
syndrome)
high
low
lo lo
w w
trisomy 18 (Edward's
syndrome)
neural tube
defects (like spina
bifida that may have
associated increased
levels
hig n/
h a
n/a
of acetylcholinesterase
in the amnionic
fluid), omphalocele, ga

18. stroschisis, multiple
gestation (like twins or
triplets), or an
underestimation
of gestational age.
o It is performed at 15-20 weeks although results obtained in the 16th-18th week of
pregnancy are most accurate.
o It gives a risk ratio and for confirmation amniocentesis has to be done.
Acetyl Choline Esterase
o Raised levels (greater than or equal to 4.5 munits/ml) of acetylcholinesterase (AChE)
activity in amniotic fluid at 14--23 weeks of pregnancy were significantly associated
with open fetal neural-tube defect.

19. o Raised specific acetylcholinesterase (AChE) activity in amniotic fluid was
consistently found to be associated with fetal intrauterine death and neural tube
defects, but in just under half of the samples from pregnancies with spina bifida, the
increase was marginal. Elevated AChE levels were occasionally found in fluid
samples contaminated by maternal blood, and in nearly half of the samples which
were a brown or yellow-brown colour but where there was a normal fetus
Amniocentesis
Amniocentesis (also referred to as amniotic fluid test) is a medical procedure[1] used
in prenatal diagnosis of chromosomal abnormalities and fetal infections, and also for sex
determination, in which a small amount of amniotic fluid, which contains fetal tissues,
is sampled from the amniotic sac surrounding a developing fetus, and then the fetal DNA
is examined for genetic abnormalities.
o Amniocentesis is performed when a woman is between 14 and 16 weeks gestation.
o The sample of amniotic fluid (less than one ounce) is removed through a fine needle
inserted into the uterus through the abdomen, under ultrasound guidance.

20. o The fluid is then sent to a laboratory for analysis. Different tests can be performed on a
sample of amniotic fluid, depending on the genetic risk and indication for the test.
o It is performed to look for certain types of birth defects such as Down syndrome.
Chorionic Villous Sampling
o It is performed for prenatal diagnosis of genetic disorders.
o It is carried out trans cervically between 10-12 weeks and transabdominally from 10
weeks to term.
o A few villi are collected from the chorionic frondosum under ultrasonic guidance
with the help of a long malleable polyethylene catheter introduced transcervically
along the extra ovular space.
COMPLICATION:-
o Foetal loss(1-2%)

21. o Oromandibular limb deformities
o Vaginal bleeding are higher
Cordocentesis
o Cordocentesis is also known as percutaneous umbilical blood sampling (PUBS) is a
diagnostic prenatal test in which a sample of the baby's blood is removed from the
umbilical cord for testing.
o Cordocentesis is usually done after week 18 of pregnancy. The test can be used to
detect certain genetic disorders, blood conditions and infections.
o Cordocentesis can also be used to deliver blood transfusions or medication to a baby
through the umbilical cord.
o Use of cordocentesis is decreasing because diagnostic procedures such as
amniocentesis and chorionic villus sampling, which pose a lower risk of fetal loss,
can be used in place of cordocentesis for prenatal diagnosis of disease and

22. cordocentesis might be offered if other prenatal tests don't provide enough or
sufficiently timely diagnostic information.
Procedure:
A 22 gauze spinal needle 13 cm in length is inserted through the maternal abdominal and
uterine wall under real time ultrasound guidance using a curvilinear probe. The needle tip
is progressed carefully and it punctures the umbilical vein approximately 1-2 cm. From
the placenta insertion, generally 0.5 to 2ml of fetal blood is collected. It is performed
under local anaesthetic usually from 18th week gestation.
Cordocentesis carries potentially serious risks, including:
o Foetal Bleeding-Bleeding from the area where the needle is inserted is the
most common complication of cordocentesis. If life-threatening fetal bleeding
occurs, your health care provider might recommend replacement of blood
products to the fetus.

23. o Cord hematoma-A collection of fetal blood within the cord might occur
during or after a cordocentesis. Most babies don't have symptoms when this
occurs. However, a few might develop a low heart rate for a short period of
time. If the hematoma is stable, your health care provider will observe the
baby. If the hematoma is not stable or if your baby's heart rate doesn't
recover, your health care provider will recommend an emergency C-section.
o Slowing of the baby's heart rate.-The baby's heart rate might slow
temporarily after cordocentesis.
o Infection-Rarely, cordocentesis can lead to a uterine or fetal infection.
o Foetal-maternal bleeding-Fetal blood might enter maternal circulation in
about 40 percent of procedures. The amount of bleeding is usually small.
This problem is more common when the placenta lies in the front of the
uterus.
o Pregnancy loss-Cordocentesis carries a higher risk of foetal loss than other
prenatal diagnostic tests, such as chorionic villus sampling and
amniocentesis. The risk is about 1.4 to 1.9 percent for a fetus that appears

24. normal and is being tested for genetic disorders. However, since many
babies are quite ill when the test is done, it's often difficult to determine
whether fetal loss is related to the procedure itself or to the baby's health.