Fetal Antenatal Assessment

Fetal Antenatal Assessment

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

  1. 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

  1. 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.

  1. 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)
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