2. INTRODUCTION
Majority of 80% of fetal deaths occurs in the ante-partum period.
There is progressive decline in maternal death all over the world.
Biochemical markers are used to assess maternal, placental and
fetal health.
3. AIMS OF ANTENATAL FETAL MONITORING
To ensure growth and well being
of fetus.
To screen the high risk factors.
To detect congenital abnormalities
4. INDICATIONS OF FETAL MONITORING
Pregnancy with obstetrics
complications
Pregnancy with medical
complications
7. Maternal Serum Alpha Fe-to Protein
Molecular weight is 70,000
Normal AFP conc. in liquor amnii
is 16th week.
Produced by yolk sac and fetal
liver.
Highest level of AFP in fetal serum
and amniotic fluid is around 13
weeks and later decreases.
Maternal serum levels reaches
peak around 32 weeks.
Normal values: 2.5 MOM.
10. Indication of AFP test
all pregnant women are usually offered the AFP test. But, your doctor may
recommended the test, especially if you:
Have a family history of birth defects
Age 35 year or older
Have diabetes
Have taken certain drugs or medication during pregnancy
12. HUMAN ESTRIOL
Estriol (E3), also spelled oestriol, is a steroid, weak estrogen, and a minor female sex
hormone.
It is one of the three major endogenous estrogens, the others being estradiol and
estrone.
Estriol is produced by the placenta.
It also prepares the mother and baby for labor and breastfeeding.
It promotes the uterus growth and gradually prepares a woman’s body for giving birth.
13. USE IN SCREENING;
Estriol can be measured in maternal blood or urine.
If levels of unconjugated estriol are abnormally low in a pregnant
woman, this may indicate chromosomal or congenital anomalies
like Down syndrome or Edward’s syndrome.
14. AMNIOCENTESIS
It is deliberate puncture of amniotic fluid sac per abdomen.
Amniocentesis is an invasive, diagnostic antenatal test. It involves
taking a sample of amniotic fluid in order to examine fetal cells found
in this fluid.
15. PURPOSES:
Early months:
1. sex-linked disorders
2. inborn errors of metabolism.
3. neural tube defect.
Later months:
1. fetal maturity.
2. degree of fetal hemolysis in rh –
ve mother
3. meconium staining.
4. amniography and fetography.
16. Nursing responsibilities before procedure;
Take written consent.
Explain the purpose of procedure and how it will be done.
Empty the bladder.
Provide privacy.
Provide supine position with elevated head 20-30 degree.
The abdominal wall is prepared aseptically and draped.
17. Cont.
Check the vital sign and FHR to obtain the baseline data.
Check USG.
Prophylactic administration 100mg of anti-D immunoglobulin in Rh-ve
mother.
The proposed site of puncture is infiltered with 2ml of 1% lignocaine.
19. THE SITE OF PROCEDURE:
in early months:1/3 of the way up the uterus from symphysis pubis.
In later months: suprapubic approach after lifting the presenting
part
Flanks in between the fetal limb
Below the umbilicus behind the neck of the fetus.
20. Time of performing:
Amniocentesis is performed between the 15-20th week of
pregnancy.
21. COMPLICATIONS:
A. maternal hazards:
1. infection
2. hemorrhage
3. PROM
4. premature labor.
5. maternal Allo-immunization in Rh – ve cases.
23. ACETYLE CHOLINE ESTERASE:
It is found in nerve tissue and red blood cells.
Amniotic fluid AchE level is elevated (> or = 4.5 m
units/ml) in most cases of open neural tube defects (eg.
Anencephaly, spina bifida)
It has got better diagnostic value than MSAFP
15-18th week of gestation.
24. TRIPLE TEST:
Kettering test or Bart’s test.
It is a combine bio-chemical test includes MSAFP, HCG
and UE3 (unconjugated estriol).
15-18 weeks.
26. CORDOCENTESIS:
Is a diagnostic test that examines blood from the fetus umblical cord to
detect fetal abnormalities.
it provides a means of rapid chromosome analysis and is useful when
information cannot be obtained through amniocentesis, CVS, or
ultrasound.
Performed at 18 weeks or after.
33. CHORIONIC VILLUS SAMPLING:
Chorionic villus sampling is the removal of a small piece of
placental tissue (chorionic villi) from the uterus during early
pregnancy to screen the baby for genetic defects.
34. INDICATIONS:
35 years or greater.
10 to 14 weeks
Detecting genetic disorders.
Abnormal first trimester results
Abnormal ultrasound findings.
36. RISKS:
Bleeding
Infection
Miscarriage
Rh incompatibility in mother
Rupture of membrane.
Amniotic fluid leakage.
Oligohydramnios
Hypoplastic lungs
Limbs problem in fetus.
37. INDICATIONS:
For transvaginal approach:
Vaginal speculum
Sponge stick
Aspiration cannula (1.5mm)
20 to 30 ml syringe or small biopsy forceps
38. Cont.
For trans-abdominal approach:
20-22G spinal needle
20 cc syringe
Specimen tube with caps
Sterile drapes
1% lignocaine
39. CONTRAINDICATION:
Active vaginal bleeding
Infection
Multiple gestation
HIV infection
In transcervical CVS: cervical stenosis and cervical myomas
In transabdominal CVS: fetal position that block access to
placenta.
