ASSESSMENT OF MATERNAL AND FETAL

WELLBEING
PRESENTED
BY
MARIA
 INTRODUCTION
During gestation period, the foetus
undergo various physiological
development which require medical
attention to prevent complication at
birth.
Cooperation among all members of
the health team is essential in
identifying signs & symptoms of
problems that might occur during
pregnancy & thus find early
solution.
CONCEPT OF ANTENATAL
FETAL MONITORING
• Assuring satisfactory growth & well being of the
fetes as well as the mother all throughout the
pregnancy.
• Screening out the high risk cases & the adverse
maternal & for intrauterine factors which may affect
the healthy growth of the fetus.Extra care is to be
taken in these cases to achieve an ultimate perinatal
foetal outcome.
• Detecting early in pregnancy those congenital
abnormalities or in born metabolic disorders which
are not compatible with life or may be eliminated by
early termination of pregnancy.
DEFINITION OF ASSESSEMENT
Assessment means is ‘To evaluate’ that
is here we gather the information of
client status & it identifies the specific
needs of a client by which better care
can be given to the client & her
developing foetus.
That means, it is the systematic
supervision (examination & advice) of a
woman during pregnancy so it is the
foundation stone for antenatal care.
 OBJECTIVES OF ANTENATAL
ASSESSMENT
 To screen the high risk cases.
 To prevent or to detect & treat at the earliest any complication.
 To ensure continued medical surveillance & prophylaxis.
 To educate mother about the physiology of pregnancy &
labour by demonstration, charts & diagrams so that fear is
removed & psychology is improved.
 To discuss with the couple about the place ,time & mode of
delivery & care of new-born.
 To motivate the couple about the need of family planning.
 To give appropriate advice to couple seeking MTP.
 MATERNAL MEASURES
1) History taking
2) Examination---
 General
 Physical
 Obstetrical
3) Radiological Examination
 HISTORY TAKING
1)Vital statistics
 Name…….
 Date of first examination………
 Address…………
 Age…….
 Gravida: parity……
 Duration of marriage…….
 Religion…….
 Obstetric score…….
 Blood group…….
 Occupation…….
 Period of gestation…..
 Chief complaints……..
 History of present illness……
 Contd..
• History of present pregnancy……
• Domestic history…….
• Menstrual history……..
• Past medical history……
• Past surgical history……….
2) Family history
3) Personal history
4) Investigation
 INVESTIGATION
 Haemoglobin
 ABO/ Rh
 HIV/HbAg/VDRL
 Ultrasonography
 PAP smear
 Blood Sugar
 Urine analysis
 ANTENATAL EXAMINATION

 General & physical examination

 Build: Obese/Average/Thin
 Nutrition: Good/ Average/ Poor
 Height: Short stature is likely to be associated with small
pelvis.
 Weight: The total weight gain during the course of singleton
pregnancy for a healthy women average 11 Kg (24lb)
BMI(20-26) is 11 to 16 Kg
BMI > 29 not gain more than 7 Kg
BMI < 19 allowed to gain upto 18 Kg
 Contd….
 Pallor : The sites to be noted are conjunctiva, dorsum of
tongue & nail beds.
 Jaundice : The sites to be noted are conjunctiva , tongue, teeth,
gums & tonsils.
 Neck: Neck veins, thyroid gland or lymph nodes should be
inspected.
 Oedema of legs : The sites of oedema are over the medical
malleolus & anterior surface of the lower 1/3rd of the tibia.
Pitting oedema & varicosity also should be inspected.
Breast examination
• Flat (nipples does not protrude with stimulation)

• Retracted ( nipples pulls back slightly)

• Inverted( nipples pulls inward when compressed)
OBSTETRICAL
EXAMINATION

VAGINAL ABDOMINAL
 Abdominal examination
 Inspection –
• Size
• Shape
• Contour
• Flank
• Skin
• Bladder
• Foetal movements
• Fundal grip
• Pelvic grip
• Pawilk grip
• Lateral grip
1.Fundal grip
2.Pelvic grip
3.Pawilk grip
4.Lateral grip
 Contd…
 Investigation
1. First visit –Hb,Blood group, Rubella, Hepatitis B&C & HIV
Screening.
2. 10-12 week –Chorionic villous sampling.
3. 15-18 week – USG, serum AFP/ triple test, amniocentesis.
4. 28 week – Hb,TC/DC, ferritin,GTT, & Low vaginal swab to
exclude group B streptococcus.
5. 36 week- Hb
 Vaginal examination
• It should be done by using the left fingers ( thumb & index )
the character of vaginal discharge, cervix consistency,
cystocele, uterine prolapse, rectocele is to be elected.
Radiological examination
• Indication (5 Rads)
o Diagnosis of pregnancy
o Foetal maturity
o X –Ray of pelvimetery
o X- Ray of chest
o Congenital malformation
ANTENATAL SCHEDULE

5-10Wk 16 Wk. 18 Wk. 20 Wk.

Booking Amniocentesis Blood Test Ultrasound

24 Wk. 28 Wk. 32 Wk. 34 Wk.

Follow-up USG Follow-up Follow-up

36 Wk. 37 Wk. 38 Wk. 40 Wk.

Follow-up Follow-up Vaginal Delivery

examination
 IMMUNISATION SCHEDULE
1st dose –as early
as pregnancy
detect.

2nd dose-at 3rd month

of pregnancy
FETAL MONITORING
 AIMS OF FETAL MONITORING

Assess the fetal health & well being that are at risk due to:-
Pre existing maternal condition.

Pregnancy related complication

Timely delivery prevent fetal harm

Decrease perinatal morbidity

 FETAL MEASURES

CLINICAL
MONITORING

BIOPHYSICAL

MONITORING

BIOCHEMICAL
MONITORING
 CLINICAL MONITORING
1. Maternal weight gain-
• 2nd trimester average weight gain – 1 kg / fortnight(2 weeks )
• Excess-1st sign of preeclampsia
• Less/ stationary –IUGR

2. Blood pressure

3.Assessment of size of the uterus amniotic fluid distribution

4.Edema of the feet

5.Abdominal girth
6.Assessment of symphsis fundal height –after
24 weeks – corresponds to GA
 BIOCHEMICAL

1. CYTOGENETIC
• Amniocentesis

• Chorionic Villus Sampling(CVS)

• Cordocentesis
• Fluorescence in situ hybridisation (FISH)- it is used to assess
how many copies of chromosomes or smaller piece of DNA is
in a cell.
 BIOPHYSICAL
• Fetal movement count
• Non stress test(NST)
• Fetal biophysical profile – it is a prenatal test used to check on
a baby well being . The test combines fetal heart rate
monitoring and fetal ultrasound to evaluate a baby’s heart
rate , breathing movement ,muscles tone & amniotic fluid.
• Cardiotocography
• Contraction stress test(CST)
• Doppler ultrasound – it is uses sound waves to detect the
movement of blood in vessels.to study the blood circulation in
the baby ,uterus and placenta .
 BIOCHEMICAL
Maternal serum alpha fetoprotein(MSAFP)
• AFP is protein produced by yolk sac and fetal liver & is
present in the mothers blood
• When MSAFP is elevated one must suspect of :-
1. A open neural tube defect
2. Multiple pregnancy
3.IUFD ( intra uterine fetal death)
4.Wrong gestational age
5. Anterior abdominal wall defects
6. Renal abnormalities
7.Low levels are found in down syndrome
• Test is done between 15-20 weeks.
 BIOCHEMICAL

Triple test
• It is combined biochemical test which includes MSAFP, hCG
& UE3 (unconjugated oestriol).

• It is used for detection of Down’s syndrome

• It is affected pregnancy level of MSAFP & UE3 tend to be low

while that of hCG is high .

• It is performed at 15-18 weeks.

• Confirmation to be done by amniocentesis.

 BIOCHEMICAL
Acetylcholine esterase
• (AChE) Amniotic fluid Ache level is elevated in most cases of
open neural tube defect. It has got better diagnostic value than
AFP.
• Acetylcholinesterase(AChE) is an enzyme that hydrolyzes
the neurotransmitter acetylcholine. In a fetus with an open
neural tube defect, AChE leaks directly into the amniotic fluid
from fetal CSF, causing unexpectedly high levels of amniotic
fluid AChE.
•
 Inhibin A

• It is a dimeric glycoprotein . It is produced by the corpus

luteum & the placenta . Serum level of inhibin A is raised in
women carrying a fetus with Down syndrome.
• The inhibin A test is done to measure the amount of this
hormone in a pregnant woman's blood to see if the baby
may have Down syndrome. Inhibin A is made by the placenta
during pregnancy. The level of inhibin A in the blood is used
in a maternal serum quadruple screening test.
 Amniocentesis
• Aspiration of amnotic fluid from the pregnant uterus for
examination .
• Typically scheduled between the 14th and 16th weeks of
pregnancy .
• An ultrasound is done to determine the position of the fetus &
the location of a pocket of amniotic fluid & the placenta .
• Alpha fetoprotein increasesd levels of AFP : open body defect,
such as anencephaly ,myelomeningocele, or omphalocele.
• Decreased level of AFP : chromosomal defects such as Down
syndrome .
• Bilirubin Determination : if a blood in compatibility is
suspected.
 BIOCHEMICAL

AMNIOCENTESIS
• Aspiration of amniotic fluid from the pregnant uterus for
examination .
• Typically scheduled between the 14th & 16th weks of
pregnancy.
• An ultrasound is done to determine the position of the fetus 7
the location of a pocket of amniotic fluid & the placenta.
 Chorionic villus sampling
• CVS is performed for prenatal diagnosis of genetic disorder .
• It is carried out transcervicaly between 10-12 weeks
• A few villi are collected from the chorion frondosum under
ultrasound guidance .
• While it provides earlierdiagnosis than amniotic fluid
studeises ,complication like fetal loss (1-2% ) ,oromandibular
limb deformities or vaginal bleeding are higher .
 Cordocentesis
• This technique is used to take a sample of fetal blood during
pregnancy in order to screen for chromosomal abnormalites &
other disorder affecting blood or cells.
• It is performed under local anasthetic usally after 18 weeks
gestation .
• Risk : the invasive procedure may lead to abortion , preterm
labour & intrauterine fetal death . Theses may be due to
bleeding , cord haematoma formation , infection or preterm
rupture of membrane.
 Conti…
• Risk : the invasive procedure may lead to abortion , preterm
labour & intrauterine fetal death . Theses may be due to
bleeding , cord haematoma formation , infection or preterm
rupture of membrane.
 DFMC
• The healthy fetus moves with a degree of consistency , or at
least 10 times a day .
• In contrast a fetus not receiving enough nutrients becaues of
placenta insufficiency has greatly decreasesd movements .
• Based on this , asking a woman to observe & record the
number of movements the fetus is making offers a gross
assessment of fetal well being .
• Cardif count 10 formula
• Mother perceive 88% of the fetal movements detected by
doppler imaging
 Conti….
• Loss of fetal movements is commonly followed by
disappearance of FHR within next 24 hours
 Non – stress test
• It is continues electronic monitoring of the fetal heart rate
along with recording of fetal movements cardiotocography is
undertaken.
• FHR acceleration with fetal movements which when present ,
indicate a healthy fetus
• It is used as screening test.
• The test should be started after 30 weeks & frequency should
be twice weekly.
 SUMMARIZATION
• Introduction to antenatal assessment
• Concept of antenatal fetal monitoring
• Objectives of antenatal assessment
• Maternal measure-
 History taking
 Investigation
 Antenatal examination – general & physical examination

 Obstetrical examination – vaginal & abdominal

 Radiological examination
 SUMMARIZATION
• Aims of fetal wellbeing
• Measures of fetal wellbeing
 Clinical measures
 Biochemical measures
 Biophysical measures
 Evaluation
1.Q How many types of obstetric
examination?
2.Q What are the aims of fetal
Monitoring?
3.Q AChE test is used to detect
which disorder
 BIBLIOGRAPHY
• Dutta D.C, Text book og o