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Lec04 Antenatal Assessment

Lec04 Antenatal Assessment


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King Faisal University College of Applied Medical Sciences Respiratory Care Department MSRT411: Perinatal and Pediatric Respiratory


Antenatal Assessment
Ghazi Alotaibi, PhD, RRT


 What

do we mean by ……. Antenatal Assessment??

 Why

is it important?

Determines the wellbeing of the newborn and chance for survival (mother history)

Maternal History and Risk Factors
 Comprehensive

maternal history and physical examination is important to point out the risk factors.  Risk factors can be related to mother, during pregnancy, during labor and delivery, or after delivery.  Antenatal assessment starts with determination of risk factors.  Better knowledge about risk factors better preparation to care for the patient.

Risk Factors
 What


is considered preterm??  The second greatest cause of morbidity and mortality in neonates.  Previous preterm birth increases the subsequent preterm birth:  1 prior = 15% of subsequent preterm birth.  2 prior = 32% of subsequent preterm birth.

Risk Factors
 Caused


by cervical trauma, previous surgery, or may be congenital.  Usually leads to membrane rupture and premature delivery.  If severe, a suture around the cervical canal is performed.

Risk Factors

Smoking and Alcohol

 In

the US, about 10% of pregnant mothers smoke, drink alcohol or use drugs.  Maternal intake of alcohol leads to fetal growth problems.  Smoking HBCO decreases availability of oxygen to placenta and fetus.

Risk Factors
 Complicates


6-8% of pregnancies in the US.  Hypertension during pregnancy (after W24) is termed: Preeclampsia.  Preeclampsia (High BP, proteinuria, edema)  Can lead to placental abruption, and preterm delivery.

Risk Factors
 Increase

the risk for CV and CNS malformations, and metabolic disturbances.  When appears during pregnancy (Gestational Diabetes Mellitus, GDM).  Treatment: glycemic control.

Risk Factors
Infections Diseases:
 Infections

can be transmitted to fetus.  Early screening and detection of the infection is important.  Complicated by the rupture of the membrane.

Risk Factors

Problems in Placenta, UC, and Fetal Membrane:
rupture : causes 50% of preterm
births in the US.

 premature  UC

: Prolapse, short, single artery (3%)  Placental problems (see lec. # 3)

Antenatal Assessment
 Save

as compared to radiography.  Uses high frequency sound waves.  Hand-held transducer is placed directly over the mother’s abdomen, and reflected waves are recorded on screen image.  Can give valuable information about pregnancy and fetus (see next slide).

Clinical Uses of Ultrasound
      

Identify pregnancy. Determine fetal age. Observe amniotic fluid abnormalities. Detect fetal anomalies. Identify placental abnormalities. Determine fetal position. Examine fetal HR, and RR

Antenatal Assessment
 Is

the procedure of obtaining a sample of amniotic fluid.  Usually performed after W15 (w15-20).  A needle is inserted through the skin and uterine wall to the amniotic sac.  Insertion is guided by Ultrasound.  Sample from amniotic fluid is obtained for analysis.  Very safe procedure (complication rate <1%).

What Info can be obtained by doing Amniocentesis??? 1. Diagnosis of Genetic and Chromosomal Disorders.
Eg. Down, sickle cell. By analyzing cells in the amniotic fluid.

2. Lung Maturity Test.

L/S Ratio:
(>2 indicates lung maturity) Falsely high if sample contaminated.

S/A Ratio:
>70: mature lung

What Info can be obtained by doing Amniocentesis??? 3. Identification of Meconium Staining:
Meconium (greenish, thick) is passed to amniotic fluid due to fetal asphyxia.  If aspirated collapse or hyperinflation.  Common in postterm fetus (40% in >42 wks)

Antenatal Assessment
FETAL HEART RATE (FHR) MONITORING  Heart starts to beat between W16-W20, but beats can be detected as early as W8.  Normal 120-160 bpm.  Becomes very common test.  Use:
To determine fetal distress.
 How?

External transducer/electrodes OR electrode over the fetal scalp.

FHR Monitoring

 

FHR is monitored during uterine contraction. During normal contraction (nonstress test NST, and during contraction stress test CST). NST (positive result) CST (positive result)

FHR rises => 15 beats per No late deceleration of FHR is minute at least 15 s with mother’s seen with each contraction feeling of fetal movement

   

Assessment of fetal well-being suing ultrasound. 8-10 normal 6 : repeat after 24 hrs. 0-4: abnormal, requires careful evaluation and maybe immediate delivery.

Reading Assignment
Factors Czervinske p20-24.
 Antenatal  Risk

Assessment Kent p31-46.

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