BIOPHYSICAL

Ultrasound measurement of nuchal

translucency(NT)

NT- is the fluid filled space between the fetal

skin &the underlying soft tissue at the region
of the fetal neck.

NT >3 mm is abnormal
 BIOCHEMICAL

1. Free β-HCG
Urine pregnancy test- ELISA is sensitive to 10-
15 mIU/ml & is positive in 95% of ectopic
pregnancy.

 A single estimation of β--HCG level either in

the serum or in urine confirms pregnancy but
cannot determine location.
2. PAPP-A (PREGNANCY ASSOCIATED PLASMA
PROTEIN –A)
PAPP-A is secreted by the syncytiotrophoblast.
It act as an immunosuppresant in pregnancy.
 TIME OF TEST
Between 11 weeks & 14 weeks
 VALUES
PAPP-A Reduced
β-HCG Increased in trisomy 21.
NT Measurement increased
 TIME OF TEST
It is done between 15 week & 22 week
 MSAFP(MATERNAL SERUM ALPHA FETO
PROTEIN)
 AFP is the fetal protein.
 It is produced by yolk sac and foetal liver.
 The highest level of the AFP in foetal serum &
amniotic fluid reached arround 13 weeks &
their after it decreases.
 The normal AFP concentration in liquior amnii
at 16 week is about 20 mg/l.
 MSFPA elevated at……
• Wrong gestational age
• Open neural tube defect of the foetus
• Multiple pregnancy
• IUFD( intra uterine foetal death)
• Anterior abdominal wall defects
• Renal anomalies
 MSFPA low at…..
• Trisomies ( down syndrome)
• Gestational trophoblastic disease
 Elevated MSFP detect 85% of all the neural
tube defect.
 Cases with such a high values are considered
for high resolution ultrasound imaging & or
Amniocentasis.
 Very low MSFPA level are associated with
increased rates of miscarriage , still birth &
neonatal death.
 AFP testing is a sequence of test. The first two
are of maternal serum and the final test is of
amniotic fluid.
INTERVENTIONS
 Explain that the level is determined by a
single maternal sample drawn at 15- 18
week of gestation.

 If
the level is elevated & the gestation is
less than 18 weeks, a second sample is
drawn.
 TRIPPLE TEST
It is combined biochemical test which
includes….
 MSAFP
 HCG

 UE3(unconjugated oestriol)

It is used to detection of Down’ syndrome.

 In an affected pregnancy level of MSAFP and
UE3 tend to be low while that the HCG is
high.

 Itis performed at 15-20 weeks. It gives arisk

ratio and for confirmation cvs/amniocentesis
has to be done.
Condition MSFPA UE3 HCG
Neural tube Increased Normal Normal
defect
Trisomy 21 Low Low Increased

Trisomy 18 Low Low Increased

Molar Low Low Very high

pregnancy
Multiple Increased Normal Increased
gestation
Fetal death Increased Low Low
(still birth)
3. QUADRUPLE SCREENING INCLUDES…
 MSAFP
 UNCONJUGATED ESTRADIOL
 DIMERIC INHIBIN-A
 HCG
it detects trisomy 21 in 85% cases with a false
positive rate of 0.9%.
Level of serum analytes in cases with trisomy 21:
 MSFPA- reduced
 uE3- reduced
 INHIBIN – A- elevated
 HCG- increased
 CHORIONIC VILUS SAMPLING
• Performed for prenatal diagnosis of genetic
disorders

• It carried…
 Transcervically between 10-12 week
 Transabdominally 10th week to term
• It provide earlier diagnosis then amniotic
fluid studies.
A few villi are collected from the chorion
froundosum under ultrasonic guidance with
the help of a long malleable polythylene
catheter with a metal obturator introduced
transcervically (TC-CVS) along the
extraovular space. The obturator is then
withdrawl.
 About 15-25 mg villi are aspirated in a 20 ml
syringe creating a negative pressure.
 The tissue are obtained in a tissue culture
media within the syringe.
Trans abdominal(TA-CVS) is done
using a spinal needle (18-20
gauge) under ultrasound
guidance.
 AMNIOCENTASIS
 It is an invasive procedure.
 It is performed between 14-16 weeks of
pregnancy.
 It is the procedure of collection of amniotic
fluid( approximately 10 – 50 ml ) by inserting a
needle through the abdominal wall in to the
amniotic sac.
 Colour of the amniotic fluid is usually in
transparent colour. A yellowish tinge may
suggest the blood incapability and green may
suggest meconium staining.
 ARTICLES AND EQUIPMENT NEEDED
 TPR tray
 Stethoscope
 Sterile gloves
 Dressing tray
 Sterile towels-4
 1 % lignocaine
 Disposable syringes – 5ml, 20 ml
 Cotton swabs
 Antiseptic solutions
 Sterile bottles to collect the specimen
 20-22 gauge spinal needle of 4 inch length
 Adhesive plaster
 After emptying the bladder patient lie in the
dorsal position.
 Abdominal wall is prepared aseptically and
drapped.
 The proposed site of puncture is infiltered with 2
ml of 1% lignocaine.

 The preferred site for blind puncture are

a) In early months - 1/3rd of the way up to the
uterus from symphisis pubis.
b) In later months – Transisthemic suprapubic
approach after lifting the umbilicus behind the
neck of the foetus.
A 18-20 gauze spinal needle about 4 inch in
length is pierced in to the amniotic cavity
under real time sonographic control, with
the stellate is in.
 The stellate is withdrawn and few drops of
the fluid is discarded. About 30 ml of the
fluid is collected in a test tube for a
diagnostic purposes.
 It is performed to determine genetic
disorder, metabolic disorder and foetal lung
maturity.
Maternal Foetal

Infection Abortion

Haemorrhage Trauma

Premature of the mebrane and Foeto maternal Haemorrhge

premature labour

Maternal iso- immunization in Rh Oligohydramnios

others

Fetal lung Hypoplasia

Respiratory distress
 Diagnosis of genetic disorders or
abnormalities.
 Maternal illness, which may affect the
fetus, for example, rubella infection.
 Parents being carries of genetic diesease,
for example, toxoplasmosis.
 Assessment of fetal maturity.
 Determination of the severity of fetal
hemolytic disease( erythroblastosis
fetalis).
 CORDOCENTASIS ( PERCUTENEOUS UMBILICAL
BLOOD SAMPLING)
 A 22 gauze spinal needle, 13 cm length, is
inserted through the maternal abdominal wall
and uterine wall under real –time ultrasound
guidance using a curvilinear probe.
 The needle tip is progressed carefully and it
punctures the umbilical vein approximately 1-2
cm from the placental sepration.
 Umbilical vein is preffered.
 Generally 0.5-2 ml of fetal blood is collected.
 It is performed under local anaesthetic usually
from 18 weeks of gestation.
 Thistechnique is used to screen for
chromosomal abnormalities,
haemoglobinopathies and other
disorder affecting blood or cells.