This document summarizes several diagnostic tests used in high-risk pregnancies to determine fetal status, including ultrasonography, fetoscopy, amniocentesis, non-stress testing, biophysical profile, and others. Ultrasonography uses sound waves to detect fetal structures, growth, and abnormalities. Fetoscopy uses a thin scope to visualize the fetus. Amniocentesis extracts amniotic fluid for analysis. Non-stress testing monitors fetal heart rate responses to movement. Biophysical profile combines ultrasound assessment of fetal wellbeing factors into a score. Each test has specific purposes, preparations, risks, implications and interpretations to evaluate fetal health and guide care.

1. Diagnostic test in high risk pregnancy/prenatal determination of fetal status

2. ULTRASONOGRAPHY

4. Number (multiple pregnancy)

5. Position, presentation

6. Abnormalities(structural)

8. Most accurate at 12 to 24 weeks

9. Biparietal diameter of 9.5 cm = mature fetus

10. Detects placental location (placenta previa) or placental abnormality (H mole)

11. An important aid in high risk procedures like the amniocentesis Preparation Advise mother to drink one quart of water 2 hours before the procedure. Instruct NOT TO VOID. In amniocentesis with ultrasound to offer visualization, the mother should void to prevent injuring the distended bladder with needle insertion. Transmission gel is spread over maternal abdomen.

13. Explain that there is no known risk with infrequent and brief exposure to high frequency sound waves.

14. Encourage verbalization of fears and concerns. Explain further that:

15. Procedure is non invasive and safe for mother and fetus.

16. Confinement is not needed

17. No need for dye and here is no X ray irradiation.

19. To collect blood samples from the umbilical cord

21. The doctor will check the fetal heart rate.

23. Your health care provider will determine the best place to make an incision and then examine the baby.

24. After the procedure, fetoscope is removed and the incision will be closed.

26. Excessive bleeding, infection or excessive leakage of the amniotic fluid

27. Preterm rupture which can cause early delivery of the baby

29. Chills or fever

30. Dizziness

33. Major risks

34. Trauma: fetus, placenta , umbilical cord and maternal surface

35. Infection

36. Abortion

38. Prepare for ultrasonography: to locate placenta and to provide visualization to a blind procedure.

39. Ultrasound in amniocentesis: client needs to void.

41. Prepare needle: G20 -22; 3” -6”.

42. Prepare for administration of local anesthesia of abdomen.

44. Observe for side-effects such as :

45. Vaginal discharge

46. Increase uterine /fetal activity

49. Fetal distress: passage of meconium in cephalic presentation( not significant in breech presentation)

50. spina bifida A birth defect (a congenital malformation) in which there is a bony defect in the vertebral column so that part of the spinal cord, which is normally protected within the vertebral column, is exposed. People with spina bifida can suffer from bladder and bowel incontinence, cognitive (learning) problems and limited mobility. Spina bifida is caused by the failure of the neural tube to close during embryonic development. The neural tube is the embryonal structure that gives rise to the brain and spinal cord. The risk of spina bifida varies according to country, ethnic group and socioeconomic status. In the US as a whole, spina bifida occurs in about one in every 1-2,000 births. The risk of spina bifida and other neural tube defects such as anencephaly can be decreased by women taking folic acid supplements before they conceive and during the first months of their pregnancy.

51. Esophageal atresia (EA) is a developmental defect of the upper gastrointestinal tract in which there is a loss of continuity between the upper and lower esophagus. EA can occur with or without tracheoesophageal fistula (TEF), an abnormal connection between the trachea and the esophagus.

52. X-RAY: LATERAL PELVIMETRY Indication for radiography to determine pelvic size and shape: suspected cephalopelvic disproportion (CPD) history of injury/disease of the pelvic and spine previous difficult delivery cases of maternal deformity or limp

53. CHORIONIC VILLI SAMPLY (CVS)

54. CHORIONIC VILLI SAMPLING Chorionic Villi Sampling (CVS) is removal of a small piece of chorionic villi from the uterus to screen the baby for genetics defects. CVS needs abdominal ultrasound to determine the position of the uterus, the size of the gestational sac, and the position of the placenta within the uterus. TWO METHODS OF CVS Transcervical procedure - performed by inserting a thin plastic tube through the vagina and cervix to reach the placenta. Transabdominal procedure - performed by inserting a needle through the abdomen and the uterus and into the placenta. PURPOSE Detecting genetic disorders, used to study DNA, chromosomes and certain signs of disease in the developing baby. It is usually done 10-12 weeks AOG. Test results take about 2 weeks. It does not detect neural tube defects or Rh incompatibility.

56. Genetic counselling

57. Consent

59. Infection

60. Miscarriage

62. Excessive vaginal discharge

65. Helps to diagnose any of the following concerns:

66. Malformation of the fetus

67. Fetal infection (rubella)

69. Infection

70. Drop in fetal heart rate

72. Chills

76. BP is checked first.

77. Explain:

78. Procedure takes 30 to 60 min to finish.

79. Mother needs to activate “mark button” with each fetal movement

80. Does not need hospitalization – ambulatory basis

82. No FHR acceleration with fetal movement

83. Implication of results

84. Normal: high risk pregnancy continues

87. BP is checked priorly and q 15 minutes during the test

88. Explain:

89. Procedure takes 1 to 3 hours to finish

94. 4 – 6 : Suspected chronic asphyxia