FEOTAL MEASURE

PRESENTED BY
SANDHYA GUPTA
M.SC.NURSING PREVIOUS YEAR
 INTRODUCTION:-
Majority (80%) of
fetal deaths occur in the antepartum
period. The important causes of deaths
are-
•Chronic fetal hypoxia (IUGR)
•Maternal complications e.g. diabetes,
hypertension, infection
•Fetal congenital malformation and
•Unexplained causes
 AIMS OF ANTENATAL FETAL MONITORING:-

•To ensure satisfactory growth and well

being of the fetus throughout
pregnancy.
•To screen out the high risk factors that
affects the growth of the fetus.
 INDICATIONS:-
•Pregnancy with obstetrics complications- IUGR,
multiple pregnancy, Polyhydramnios or
oligohydramnios.
•Pregnancy with medical complications- Diabetes
mellitus, Hypertension, Epilepsy, Renal or Cardiac
disease, Infection (Tuberculosis).
•Others – Advance maternal age (>35 years),
previous still birth or recurrent abortion, previous birth
of a baby with structural (anencephaly, spina bifida )
or chromosomal (autosomal trisomy) abnormalities.
•Routine antenatal testing.
COMPONENT OF FETAL ASSESSMENT:-

CLINICAL
PARAMETERS

BIOCHEMICAL BIOPHYSICAL
METHODS METHODS
1. CLINICAL PARAMETERS:-
 Crown rump length(CRL),
 Biparietal diameter(BPD),
 Femur length(FL),
 Head circumference(HC),
 Occipitofrontal diameter(OFD),
 Abdominal circumference(AC),
 Humorous length(HL),
 Estimated foetal weight (EFW).
GESTATIONAL SAC (GS) –

•The gestational sac (GS) is a structure that surrounds an

embryo.
•The first pregnancy structure that can see on ultrasound
in early pregnancies.
•The GS encloses not only the embryo, but also the
amniotic fluid, which helps to nourish and protect the
developing baby.
FETAL POLE-

•The fetal pole is a mass of cells before the embryo is

visible. Fetal pole becomes visible somewhere between
five- and a-half and six-and-a-half weeks of gestational
age.
It grows at a rate of about 1 mm a day, starting at the 6th
week of gestational age.
CROWN-RUMP LENGTH (CRL)-

•The CRL measurement is the distance

between the top of the embryo and it’s
rump. The CRL can be measured between
7 to 13 weeks.
BIPARIETAL DIAMETER (BPD)-

•The diameter between the 2 sides of the head.

This is measured after 13 weeks. It increases from
about 2.4 cm at 13 weeks to 9.5 cm at term.
HEAD CIRCUMFERENCE (HC)-

•The head circumference or HC measures the

circumference of the fetus’ head. The HC is
usually done after 13 weeks of the pregnancy.
FEMUR LENGTGH (FL)-

•Measures the longest bone in the body and

reflects the longitudinal growth of the fetus. It
increases from about 1.5 cm at 14 weeks to about
7.8 cm at term. Similar to the BPD, dating using
the FL should be done as early as is feasible
ESTIMATED FEOTAL WEIGHT (EFW)-

•The weight of the fetus at any gestation can

also be estimated with great accuracy using
polynomial equations containing the BPD, FL,
and AC.
2. BIOCHEMICAL TESTS/ METHODS:
HUMAN ESTRIOL,
ACETYL CHOLINE ESTRASE (ACHE),
MATERNAL SERUM ALPHA
FETOPROTIEN,
TRIPLE TEST,
AMNIOCENTHESIS,
CARDOCENTHESIS,
CHORIONIC VILLUS SAMPLING.
HUMAN ESTRIOL:
ESTROGEN- An estrogen test measures the
level of the most important estrogen hormones
in a blood or urine sample. It measures
estradiol, estriol, and estrone.

PURPOSES:-
•Help find fetal birth defects
•Check for estrogen-producing tumors of the
ovaries
•Monitor treatment with fertility medicines.
PROCEDURE:-
Wrap an elastic band around upper arm to stop the
flow of blood. This makes veins below the band
larger so it is easier to put a needle into the vein.
Clean the needle site with alcohol.
Put the needle into the vein. More than one needle
stick may be need.
Attach a tube to the needle to fill it with blood.
Remove the band from your arm when enough
blood is collected.
Put a gauze pad or cotton ball over the needle site
as the needle is removed.
Put pressure on the site and then put on a bandage.
RESULTS-

Estriol in pregnant women-

1st trimester-Less than 38 nanograms/mL

2nd trimester-38-140 ng/mL
3rd trimester-31-460ng/Ml
 ACETYL CHOLINE ESTRASE (ACHE):-

This test measures the amount of an enzyme

called acetylcholine esterase in amniotic fluid.
To help identify unborn babies who have
neural tube defects, including anencephaly,
spina bifida, and heart defects.
INDICATIONS-
Patients on valporic acid anti-seizure
medication,
Insulin dependent diabetic patients,
Previous pregnancy with a NTD,
Ultrasound indications of a NTD or open ventra
PROCEDURE-

A sample of this fluid is collected by a procedure

called an amniocentesis.
RESULTS-
Normal range by method :
Polyacrylamide gel electrophoresis: Negative
AE-2 immunoassay: Negative
Inhibition assay:5.17+_2.63 milliunits/mL
MATERNAL SERUM ALPHA FETOPROTIEN:-

MSAFP is a screening test that examines the

level of alpha-fetoprotein in the mother’s blood
during pregnancy.
•Normally, low levels of AFP can be found in
the blood of a pregnant woman.
PURPOSE-
Check the developing baby (fetus) of a
pregnant woman for brain or spinal problems,
Down syndrome
Find certain cancers, especially cancer of the
RESULTS-
Men and nonpregnant women: 0-40 nanograms/Ml or
micrograms/L
Women 15-18 weeks pregnant: 10-150 nanograms/Ml

High values-
The age (gestational age) of the baby is wrong,
Twins or triplets baby.
Neural tube defect, Abdominal wall defect, Baby not
live.
LOW VALUES-
The age (gestational age) of the baby is wrong.

•TRIPLE TEST:-
•The triple screening measures the amounts of three
substances in a pregnant woman’s blood: alpha-
fetoprotein (AFP), human chorionic gonadotrophin
(hCG), and estriol (Ue3). This is also called the
maternal serum triple, the expanded AFP test, the
AFP plus test, or the multiple marker screening tests.
 Down syndrome
•Spina bifida

•Anencephaly
INDICATIONS-
All pregnant women in the second trimester (between weeks
15 and 22) are tested. Those in the following categories are at
higher risk:
Women over 35 years old
Those taking insulin for treating diabetes, Viral infections.
Women having a family history of birth defects
Exposure to high radiation levels.

PROCEDURE- BLOOD COLLECTION.

RESULTS-
•A “positive” result means that there is a higher-
than-average chance, baby has at birth defect. If
the result is “negative”, or normal, it means that
baby probably doesn’t have a birth defect.
AMNIOCENTESIS:-

Amniocentesis is a prenatal test in which a

small amount of amniotic fluid is removed
from the sac surrounding the fetus for testing.
The sample of amniotic fluid is less than one
ounce.
 INDICATIONS-
Genetic diagnosis:
Down syndrome (trisomy 21)
Patau syndrome (trisomy 13)
Neural Tube Defect
PROCEDURE-
The woman’s abdomen is cleaned with antiseptic.
A fine sterile needle is guided through the woman’s
abdominal wall and the wall of the uterus (womb) into the
amniotic fluid.
The path of the needle is watched by ultrasound.
As the procedure is rapid, a local anesthetic is usually not
necessary.
Most women say that the procedure is no more painful
than any type of injection.
Once the needle is seen to be in the right place, a small
amount (about 20ml) of amniotic fluid is taken out and the
needle is withdrawn.
The amount of amniotic fluid in the uterus returns to
normal within a few hours.
COMPLICATIONS-
Amniocentesis is performed between the
15th and 20th week of pregnancy, performing
this test earlier may result in fetal injury.
Complications of amniocentesis include
preterm labor and delivery.
Chance of infection and miscarriage.
Ethical problem arise when parents decide
for an abortion following the test results
when there is a baby girl in the womb of
mother.
It is expensive process.
CORDOCENTHESIS:-
Cordocenthesis, also sometimes called Percutaneous
Umbilical Cord Blood Sampling (PUBS), is a diagnostic test
which examines blood from the fetus to detect foetal
abnormalities.
INDICATIONS-
High risk of chromosomal disorder
Identification of anomalies during foetal ultrasound, which
may be associated with chromosomal diseases (e.g. Short
femur, hypoplasia of the nasal bone and other).
The presence of the parents of hereditary diseases,
Suspicion of hemophilia.
CONTRAINDICATIONS-
Cervical incompetence (cervical insolvency), with large
myoma nodes (in the projection of the puncture)
PROCEDURE-

An advanced imaging ultrasound determines the location

where the umbilical cord insert into the placenta. The
ultrasound guides a thin needle through the abdomen and
uterine walls to the umbilical cord. The needle is inserted into
the umbilical cord to retrieve a small sample of foetal blood.
RISK AND SIDE EFFECTS TO THE
MOTHER OR BABY-
•Miscarriage
•Other potential side effects includes: Blood loss from
the puncture site, Infection,
•Drop in foetal heart rate
•Premature rupture of membranes
•Contact your healthcare provider if these symptoms
remain or get worse.- fever, chills, and leaking of
amniotic fluid.
COMPLICATIONS-
•Bleeding from the puncture area
•Violation of the functional state of the fetus as
SUMMARY
THANK YOU