CARE OF THE FETUS Jet Fernandez, RN

LEARNING OUTCOMES:
• Define Antenatal Care.
• Describe the different methods in assessing
the fetal condition during antepartum.
• Identify common discomforts in pregnancy
and associate it to fetal development.
• Identify the functions of the placenta and fetal
membranes.
Antenatal care is the clinical examination, observation, and
follow up of the mother and fetus during pregnancy, for the
purpose of obtaining the best possible health for the mother
and child.
Goals:
• To reduce the rate of the mother and baby death
and abnormality.
• To improve the physical and mental health of the
mother and the baby.
Why is Antenatal Care important?
• To ensure that the pregnant woman
and her baby in the best possible
health.

• To detect any problem early; so the

treatment becomes easier.

• To prepare the mother for labor,

lactation, parenthood, and care of her
baby.
Schedule for Antenatal visits
The first visit should be as early is pregnancy as possible. The
return visits should be:

• Once every month during the first two trimesters (from

week 1–28).
• Once every 2 weeks (from week 28 – 36).
• Once every week after 36th week until delivery
(delivery at week 38–42).
Frequency of Antenatal Appointments

• Nulliparous: 10 appointments in
normal pregnancy at least.
(Nulliparous is a woman who has never given
birth to an infant)

• Parous: 7 appointments in normal

pregnancy at least.
(Parous is a woman who had given birth to an
infant or more before).
Clinical Assessment
• History.
• Physical examination.
• Investigation and
tests.
• Normal discomforts
of pregnancy.
• Diets.
TAKING A HEALTH HISTORY
WHAT QUESTIONS TO ASK?
• Personal history; smoking, drinking, any present diseases.
• Family history; medical history of family, pregnancy loss, down’s
syndrome.
• Medical and surgical history; if she had any problem before
(such as diabetes, hypertension, heart problems, asthma,
hepatitis, etc.), or used any drugs (such as antibiotics,
cortisones…etc.)
• Menstrual history; the last menstrual period (LMP) to calculate
the date of labor.
• Obstetrical history; did the mother gave a birth before.
• History of present pregnancy; if she has any problem in this
pregnancy or used any medication.
• Abdominal and uterus examination: Palpation before 20th
week, and in centimeters after 20th week (number of
week ± 2), after week 36 (number of week ± 3).
• Weight gain: the approximate weight gain during
pregnancy is 12 kg; 2kg in the first 20 weeks and 10 kg in
the remaining 20 weeks (1.5 kg per week until term).
• Pelvic examination (examination of the external female
reproductive system).
• Heart, lung, and breast examination.
• Fetal movement and position, and heart beat.
 Fetal position
• The position of the baby in the uterus is known as the
fetal lie.
• The purpose of finding the fetal lie is to identify whether
there are any danger signs that could make labor and
delivery difficult and put the mother and baby at risk.

Healthy signs
 There is only one baby in the uterus.
 The baby is head down at the time of birth.
 Fetal position
Warning signs

 The baby is feet or bottom down at the time of birth.

 The baby is lying sideways at the time of birth.
 The mother has twins or triplets. There are two
methods for finding the baby’s position — feeling the
mother’s abdomen (palpation), and listening
(auscultation) to where the fetal heartbeat is
strongest. You may need to use both methods to be
sure of the position of the baby.
LEOPOLD’S MANEUVER
 External Cephalic Version
• External cephalic version (ECV), is a procedure used to turn a
fetus from a (breech) position or lying sideways (transverse)
position into a head-down (vertex) position before labor begins.
It is performed using manual manipulation during the 36th – 38 th
week.
• The actual procedure is performed
by an experienced obstetrician
aided by a labor and delivery
nurse.
Fetal heartbeat
• Fetal heart sound is heard
by a Doppler as early as
10th week of pregnancy.

• Fetal heart sound is heard

by Pinard’s fetal
stethoscope after the 20th
week of pregnancy.
• The average fetal heart
rate is between 110 and
160 beats per minute. It
can vary by 5 to 25 beats
per minute.
• One of the main aims of routine antenatal care is to
identify babies who are not thriving in the womb. It
is possible that medical interventions might improve
outcomes for these babies, if they can be identified.
• Doppler ultrasound uses sound waves to detect the
movement of blood in vessels. It is used in
pregnancy to study blood circulation in the baby,
uterus and placenta.

NURSING CONSIDERATIONS:

• Explain to the mother

• Reassure of no discomforts
• Check manufacturer details
• Test device 1st if it is working.
• Remove the conductive gel from the patient’s skin.
• Assist the patient to a comfortable position.
 Fetal movement
• The fetus starts moving at 7th or 8th weeks.

• Mother cannot feel the movement until sometime

between 16th and 22nd weeks.

• The pregnant woman reports at

least 10 movements in 12 hours.
• Most babies move at least 10
times within two hours.
• Absence of fetal movements
precedes intrauterine fetal death
by 48 hours.
 Fetal movement counting
Fetal movement counting is a way to check the health of a
fetus. It’s often called kick counting. It’s done by counting the
number of kicks that the mother feels from the baby in the
uterus in a certain time period.

The mother writes down the number of times she feels the
baby kick or move in one hour. After several days, she may
find the baby usually moves about the same number of times
per hour. This becomes her baseline number.
 Fetal movement counting
CONSIDERATIONS:

• By 20 weeks gestation, most women are able to feel their baby's

movements.
• Movements vary in strength and how often they occur.
• There are different patterns of movement.
• They depend on the baby’s age.
• Most babies tend to be more active in the evening hours.
• This can start as early as the second trimester.
• A baby may be more active about an hour after the mother eats.
This is because of the increase in sugar (glucose) in the mother's
blood.
• Fetal movement normally increases during the day with peak
activity late at night.
Test Purpose
First Trimester (Routine)
Blood type, Rh factor, and Determines risk for
antibody screen maternal-fetal blood
incompatibility
Complete blood count Detects anemia, infection,
(CBC) or cell abnormalities
Hemoglobin or hematocrit Detects anemia
Venereal Disease Research Syphilis screen mandated
Laboratory (VDRL) test or by law
rapid plasma reagin (RPR)
Rubella titer
Tuberculosis test
Hepatitis B screen
Human immunodeficiency virus
(HIV) screen
Determines immunity to rubella
Screening test for exposure to
tuberculosis
Identifies carriers for hepatitis B
(recommended by American
College of Obstetricians and
Gynecologists)
Detects HIV infection; required by
some states (counseling
concerning prevention and risks
should be provided to all prenatal
patients)
Urinalysis and culture
Papanicolaou (Pap) test
Vaginal or cervical culture
First Trimester (If Indicated)
Hemoglobin electrophoresis
Endovaginal ultrasound
Detects infection, renal disease, or
diabetes (recommended by U.S.
Preventive Services Task Force to
screen for asymptomatic
bacteriuria)
Screens for cervical cancer
(recommended if not done within 6
months before conception)
Detects group B streptococci,
bacterial vaginosis, or sexually
transmitted infections (STIs) such
as gonorrhea, chlamydia
Identifies presence of sickle cell
trait or disease in women of African
or Mediterranean descent
Performed when high risk of fetal
loss is suspected
Second Trimester (Routine)
Blood glucose screen: 1 hr after
ingesting 50 g of glucose liquid
Serum alpha-fetoprotein
Ultrasonography
Second Trimester (If Indicated)
Amniocentesis
Routine test done at 24-28 weeks’
gestation to identify gestational
diabetes mellitus; results >135
mg/dL require medical follow-up
Optional routine test to identify
neural tube or chromosomal defect
in fetus
Optional noninvasive routine test to
identify some anomalies and
confirm estimated date of delivery
Performed at a 16-20 weeks’
gestation when high-risk problem is
suspected or if the mother is over
35 years of age
Third Trimester (If Indicated)
Real-time Performed when problem is suspected
ultrasonography Identifies reduced amniotic fluid, which can
result in fetal problem
Identifies excess amniotic fluid, which would
indicate fetal anomaly or maternal problem
Confirms gestational age or cephalopelvic
disproportion
Determines fetal lung maturity
(lecithin/sphingomyelin ratio) with amniocentesis
Confirms presence of anomaly that may require
fetal or neonatal surgery
Cervical fibronectin Determines risk of preterm labor when problem is
assay suspected
Assessment of Fetal Well-being
• High-risk pregnancies are those in which maternal
and fetal outcomes are potentially not as good as in a
normal pregnancy.
• The improved understanding of fetal disorders and
extraordinary technical advances are changing the
management of high-risk pregnancies.
• Newer diagnostic and therapeutic approaches are
being used in the management of complex problems.
• High-risk pregnancy presents one of the most critical
challenges in medical and nursing care.
• Emphasis must be placed on the safe birth of infants
who can develop to their maximum potential
 Prenatal High-Risk Factors Indicating Need
for Special Prenatal Testing
• Maternal condition that increases risk for
uteroplacental insufficiency such as diabetes
mellitus or hypertension
• History of previous stillbirth
• Mother’s age less than 16 or more than 35 years
• Multifetal pregnancy
• Post-term pregnancy
• Decreased fetal movement
• Oligohydramnios
• Intrauterine growth restriction (IUGR)
• History of congenital abnormalities
KARYOTYPING AND CELL ENZYME STUDIES
Karyotyping is the process of pairing and ordering all the chromosomes
of an organism, thus providing a genome-wide snapshot of an individual's
chromosomes.
Karyotypes can reveal changes in chromosome number associated with
aneuploid conditions, such as trisomy 21 (Down syndrome).
Careful analysis of karyotypes can also reveal more subtle structural changes,
such as chromosomal deletions, duplications, translocations, or inversions. In
fact, as medical genetics becomes increasingly integrated with clinical medicine,
karyotypes are becoming a source of diagnostic information for specific birth
defects, genetic disorders, and even cancers.
 Oxytocin injection is used to begin or improve
contractions during labor. Oxytocin also is used to
reduce bleeding after childbirth. It also may be used
along with other medications or procedures to end a
pregnancy. Oxytocin is in a class of medications
called oxytocic hormones.
THE PLACENTA
• Most essential nutrients for the fetus:
• Folate and folic acid (vitamin B); prevent birth defects.
• Calcium and vitamin D; strengthen bones.
• Protein; promote growth and development.
• Omega3 and vitamin B; Brain development.
• Complex Carbohydrates; Energy for the fetus and mother
(Glucose).
• Iron (with water, potassium); prevent anemia.
• Vitamin C; promote wound healing, tooth and bone
development, and metabolic processes.
• Water; carry the nutrition for the fetus and reduce
pregnancy discomforts for the mother.
THANKS FOR
LISTENING!!!