Fetal Antenatal Assessment

 Evaluation of the baby throughout pregnancy.  Importance: 1. What is the appropriate time to deliver the baby with no harm and mood of delivery. 2. To decide delivery mood. 3. To pick up complications early and to limit and prevent them. 4. To determine if the baby needs special care during labor, delivery or after delivery. 5. To evaluate baby’s growth. 6. To rule out congenital anomalies 7. To make sure the baby is healthy

Fetal Antenatal Assessment & Fetal Wellbeing; Assessment  Evaluate the baby; are there any anomalies, assess his growth … Fetal Wellbeing  part of the fetal assessment; all the tools assuring the baby is growing and is in a good condition.

 Fetal Antenatal Assessment  US plays a major role. 1. Fetal Anomaly/Abnormality 2. Fetal Growth 3. Fetal Wellbeing 4. Fetal Maturity

1. Fetal Anomaly/Abnormality

 By history;  Any previous babies with anomalies?  Any family history of anomalies?  Investigations:  Chemical tests Alpha-phetoprotien (increase in spinal tube defect; spina bifida, hydrocephalus) BHCG  US 22 -24 weeks (anomaly scan) Baby size is complete Amniotic fluid reasonable  Prenatal Diagnosis Procedures:  Amniocentesis: Amniotic fluid sample Check for anomalies; chromosomal, genetic  Chorionic Villus: Placental tissue sample  Feto-scope: Not used anymore  Cordocentesis: Fetal blood sample Prenatal diagnosis 2. Fetal Growth

 Indication: If I suspect maternal or fetal risk. High-risk patients;  Previous IUGR  Previous IUFD  Diabetic  Multiple pregnancies  Hypertensive  Preeclampsia  Methods:  US  most reliable EED 1st trimester US  Fundal high from symphysis pubis Not accurate in many cases; multiple pregnancies, poly or oligohyramnions, fibroid or any other mass in the uterus … 13 weeks  at the pelvis 22 weeks  at the umbilicus 36 weeks  xiphoid of the sternum Each finger = TWO weeks Each CM = ONE month  Biochemical Tests: Maternal blood sample . Placental hormones and enzymes; Estradiol, Human placental lactogen Increase gestational age  increase hormones If it increases in normal level  placenta is functioning well and baby is growing. If decreasing  insufficient placenta Not used anymore

3. Fetal Wellbeing All the tools assuring that the baby is growing and is in a good condition.  US  1) Fetal growth 2) Biophysical profile  tone & movement Fetal movement 2/2 1st to be lost Amniotic Fluid Index 2/2, normal 8 - 18 Fetal Tone 2/2 (Limb movement) Breathing 2/2 last to be lost 3) Doppler flow Middle Cerebral Artery Increase gestational age  Increase resistance Placental insufficiency  Decrease resistance from early Umbilical Cord Increase gestational age  decrease resistance Placental insufficiency  increase resistance from early  CTG  monitor fetal heart during labor Reactive, 30 minutes, no deceleration, good variability.  Fetal movement by the mother Multi feels it earlier than the primy Normally  10 movements/day Not how many times did he move but how many movements in total. Not by strength, by number No oxygen (hypoxia)  no movement  Biochemical Tests.

4. Fetal Maturity

 The baby is ready to come out or not 1) Gestational Age  LMP US  CRL Maternal Fundal High Amniocentesis; LS ration > 2, secreted by lung Lecithin–sphingomyelin Keratinized cells Creatinine baby level Surfactant X-Ray  (ossification) not used now Liquor examination

Biophysical Test (Better) Biochemical Test Direct Indirect Fetal kick used as screening CTG (non invasive)