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Obstetrical Investigations

Prepared by Mrs. Gauri Manohar M.Sc Nursing Previous Govt. College of Nursing Indore (M.P.)

Radiology in Obstetrics
Radiology, is a medical specialty that employs the use of imaging to both diagnose and treat disease visualised within the human body.

Principles of Radiology in Obstetrics Benefits of radiation must outweigh the risks of the procedure. Minimum radiation dose to be used. Appropriate field shielding should be done. First trimester should preferable be avoided. Benefits and safety of Ultrasonography must be considered as an alternative.

Indications Fetal Maternal

Fetal
Diagnosis of Pregnancy Multiple Pregnancy Malpresentations

Hydramnios
Intrauterine Death of the fetus Congenital malformation of the fetus and neonates and birth injuries Fetal Maturity

Maternal
Patient having cardiopulmonary disease may require X- ray chest during pregnancy and that should be done beyond 12 weeks. X- ray pelvimetry is of limited value in assessing cephalopelvic or fetopelvic disproportion.

Radiation Hazards
Tetratogenecity
Oncogenecity

Genetic Damage
Intra Uterine Death

CT Scan
CT scans may be safely obtained with little or no exposure to the fetus.
Fetal exposed to conventional pelvimetry by computed Tomography is 0.23-1.3 rad

MRI
Of little value for fetal assessment. But it can be used to study maternal anatomy e.g. pelvimetry.

It works on radiofrequency signal emitted by hydrogen protons of tissues.


MRI uses no ionising radiation. It is more accurate and biologically safe.

CAUTION
Radiation during pregnancy can damage the early phase of embryo .
The risk can be minimised by using the 10 day rule. No woman should be exposed to X- ray for a non urgent indication outside 10 days from her last period during reproductive period.

Amniocentesis
Amniocentesis is the deliberate puncture of the amniotic fluid sac per abdomen.

Indications Diagnostic Therapeutic

Diagnostic Early months (14-16 weeks)Antenatal diagnosis of chromosomal and genetic disorder (a) Sex linked disorders, (b) Karyotyping (c) Inborn errors of metabolism (d) Neural tube defects .

Later Months Fetal Maturity Degree of fetal haemolysis in Rh sensitised mother Meconium staining of liquor- An evidence of fetal distress. Amniography or fetography- following instillation of radio-opaque dye in the amniotic fluid cavity.

Therapeutic First Half


(a) Induction of abortion by instillation of chemicals such as hypertonic saline ,urea or prostaglandins. (b) Repeated decompression of the uterus in acute Hydramnios.

Second Half (a) Decompression of uterus in unresponsive case of chronic hydramnios .


(b) To give intrauterine fetal transfusion in severe haemolysis following Rh-isoimmunisation. (c) Amino infusion- Infusion of warm normal saline into the amniotic cavity is done transabdominally or transcervically to increase the volume of amniotic fluid.

Procedure

After emptying the bladder ,the patient remains in dorsal position. The abdominal wall is prepared aseptically and draped. The proposes site of puncture is infiltrated with 1% lignocaine.

Precautions Prior sonographic localisation of placenta is desirable to prevent bloody tap and fetomaternal bleeding. Prophylactic administration of 100 mg of anti-D immunoglobulin in Rh-negative non-immunised mother. Hazards are reduced significantly when it is done under direct ultrasound control compared to blind procedure.

Hazards
A) Maternal complications are Infection. Haemorrhage (placental or uterine injury) Premature rupture of the membranes and premature labour. Maternal isoimmunisation in Rh negative cases.

B)

Fetal Hazards areAbortion(1%) Trauma Feto-maternal Haemorrhage. Oligohydramnios due to leakage of amniotic fluid that may lead to a) Fetal lung hypoplasia and Respiratory distress.

Chorionic Villus Sampling (CVS)


A test done in early pregnancy. The procedure involves inserting a needle into the uterus cavity into the placental site to suck out a very small bit of tissue. This test is done to determine certain genetic disorders like Sickle Cell Anemia, Thalassemia, Downs Syndrome. The risk involved in this procedure is risk of abortion and damage to fetal limb.

Daily Foetal Movement Count (DFMC)


The easiest way is during the evening hours to record the time that has elapsed to feel the baby kick 10 times. The average time taken to feel 10 movements is 21 minutes.
If you have taken 2 hours or more to feel 10 movements, contact your doctor.

Non Stress Test


It is a non- invasive test and carries no risk of the procedure. The duration of the test is approximately 20 minutes. In this test , movements of the baby are monitored along with the heart rate with each movement. The baby needs to be awake during this test. With the movement of the baby, there is a corresponding increase in the heart rate. The NST is done in a high risk pregnancy and is usually done after the 36 th week and repeated weekly.

Ultrasound in Obstetrics
Obstetric ultrasonography is the application of medical ultrasonography to obstetrics, in which sonography is used to visualize the embryo or fetus in its mother's uterus (womb).

Uses of Ultrasonography
Diagnosis and confirmation of early pregnancy. Vaginal bleeding in early pregnancy. Determination of gestational age and assessment of fetal size. Diagnosis of fetal malformation. Placental localization. Multiple pregnancies. Hydramnios and Oligohydramnios. Other areas.

Clinical Tests during Pregnancy Urine Examination Heat and acetic acid test: Dipsticks (Alubstix) Test for Sugar -Benedicts Test and Dipsticks Test for Acetone Clot observation test (Weiner) Peripheral Blood Smear.

Tests for blood Coagulation Disorders-

Cord Blood Samples To get a true picture ,the sample should be taken by opening the Kochers forceps from the placental end of the cord as early as possible .
Samples are taken specially of babies born of Rhnegative mothers. 10 ml of cord blood should be collected in a heparinised tube.

Cervical and Vaginal Cytology


Cervical : Suspected cervix to exclude premalignant or malignant lesion.
Vaginal : Vaginitis to know the specific pathogen

Cardiotocography In medicine (obstetrics), cardiotocography (CTG) is a technical means of recording (-graphy) the fetal heartbeat (cardio-) and the uterine contractions (-toco-) during pregnancy, typically in the third trimester.
The machine used to perform the monitoring is called a cardiotocograph, more commonly known as an electronic fetal monitor (EFM).

Baseline fetal heart rate Abnormal baseline is termed bradycardia when the baseline FHR is less than 110 bpm; it is termed tachycardia when the baseline FHR is greater than160 bpm.

Rubella Test
Done for German Measles-(Rubella). If there is history of exposure to an infected individual, ideally, rubella status should be determined prior to getting pregnant

Blood test for Alpha feto- protein (AFP)


This test can be done on mothers blood (MSAFP or Maternal Serum AFP) around the 14th 16th week of pregnancy. High levels make the doctor suspect defects in the development of spinal cord or brain (neural tube defects) in the baby.

Triple Marker Test


This specialized test may be recommended if you or your doctor is worried that the baby may not have developed normally. It tests a pregnant womans blood around 14 16 weeks for AFP (as above) hCG (human chronic gonadotrophin), and estiol.