Fetal Diagnostic Examination

Amniotic Fluid Analysis

This is the analysis of the fluid placed in an amber or a foil-covered test tube which was aspirated from the amniotic cavity of a pregnant woman. y A 10 ml syringe is used to attach to a 20G spinal needle with a stylet inserted into the amniotic cavity after the stylet is withdrawn Purpose: To detect fetal abnormalities, particularly chromosomal and neural tube defects To detect hemolytic disease of the neonate.
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Chorionic Villi Sampling Prenatal test for quick detection of fetal chromosomal and biochemical disorders. y Performed during the 1st trimester. y Fingerlike projections that surround the embryonic membrane and eventually gives rise to the placenta. Purpose: To analyze for fetal abnormalities
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Contraction Stress Test

Measures fetal heart rate in response to uterine contractions. y Usually, the heart rate of a healthy fetus wont slow down when contractions begin and after they end. y Generally occurs weekly under delivery. Purpose To measure fetal heart rate in response to contractions.
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Estrogen (Serum estrone, estradiol, and estriol) estrone, estradiol, estriol) In relation to the fetus, it is secreted by ovarian follicular cells during the first half of the menstrual cycle and by the corpus luteum during the luteal phase and during pregnancy. Purpose To determine fetal well-being
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Human placental lactogen

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A polypeptide hormone also known as human chorionic somatomammotropin that displays lactogenic and somatotropic (growth hormone) properties in a pregnant woman. In combination with prolactin, hPL prepares breast for lactation. Indirectly provides energy for maternal metabolism and fetal nutrition. Facilitates protein synthesis and mobilization essential to fetal growth. Secretion is autonomous, beginning at about 5 weeks gestation and declining rapidly after delivery. This radioimmunoassay measures plasma hPL levels, which are roughly proportional to placental mass. Assays must be necessary in high-risk pregnancies and suspected placental tissue dysfunction. Because values vary widely during the latter half of pregnancy, serial determinations over several days provide the most reliable test results.

Purpose y To assess placental function and fetal wellbeing. y To aid diagnosis of hydatidiform mole and choriocarcinoma. y To aid in the diagnosis and monitor treatment of nontrophoblastic tumors that ectopically secrete hPL

FetalFetal-maternal erythrocyte distribution

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Measures the number of fetal RBCs in the maternal circulation. Some transfer of RBCs fromt\ the fetal to the maternal circulation occurs during most spontaneous or electrive abortions and most normal deliveries. Usually, the amount of blood transferred is minimal and has no clinical significance. Transfer of significant amounts of blood from an Rhpositive fetus to an Rh-negative mother can result in maternal immunization to the D antigen and the development of anti-D antibodies in the maternal circulation. During a subsequent pregnancy, the maternal immunization subjects an Rh-positive fetus to potentially fatal hemolysis and erythroblastosis.

Purpose y To detect and measure fetal-maternal blood transfer y To determine the amount of Rh0(D) immune globulin needed to prevent maternal immunization to the antigen.

Internal Fetal Monitoring

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Invasive procedure that involves attaching an electrode to the fetal heart rate (FHR). A catheter introduced into the uterine cavity measures the frequency and pressure of uterine contraction. Performed only during labor, after the membranes have ruptured and the cervix has dilated 3 cm, with the fetal head lower than the 2 station and only if external monitoring provides inadequate data. Provides more accurate information about fetal health than external monitoring and is especially useful in determining whether cesarean delivery is necessary. Carries minimal risks to the patient (perforated uterus and intrauterine infection) and fetus (scalp abscess and hematoma).

Purpose y To monitor FHR, especially beat-to-beat variability (short-term variability). y To measure the frequency and pressure of uterine contraction to assess the progress of labor. y To evaluate intrapartum fetal health. y To supplementary or replace external fetal monitoring.

Ultrasonography Pelvis
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Transmit high frequency sound wave into the interior pelvic region, resultant echoes are converted to electrical impulses, amplified by a transducer, and displayed on a monitor. A-mode technique records only distances between interfaces. B-mode (brightness modulation) technique creates a todimensional image. Gray-scale technique represents organ texture in shades of gray on a screen. Real-time imaging creates instant images of the tissues in motion, similar to fluoroscopic examination. Selected views may be photographed for later examination and kept as a permanent record of the test. Often used to evaluate symptoms that suggest pelvic disease, to confirm a tentative diagnosis, and to determine fetal growth during pregnancy.

Purpose y To detect foreign bodies and distinguished between cysts and solid masses or tumor. y To measure organ size. y To evaluate the fetal viability, position, gestational age, and growth rate. y To detect multiple pregnancy y To confirm fetal abnormalities y To confirm maternal abnormalities

External Fetal Monitoring

Electronic transducer and a cardio tachometer amplify and record fetal heart rates while a pressure sensitive transducer record uterine contraction. y Record the baseline FHR, periodic fluctuation in the baseline FHR, and beat to beat heart rate viability. y Also used during other test of fetal health, notably the non stress test and the contraction stress test
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Purpose y To measure FHR and frequency of the uterine contraction. y To evaluate antepartum and intrapartum fetal health during stress and non stress situation y To detect fetal distress. y To determined the necessity for internal fetal monitoring.

Fetal hemoglobin
Fetal hemoglobin (HbF) is a normal hemoglobin produced in the red blood cells of a fetus and in smaller amounts in infants. y Constitutes 50% -90% of the hemoglobin level in a neonate; the remaining hemoglobin level consists of HbA1 and HbA2 (the hemoglobin level in adults) y Normally, the body stops making HbF during the firsts years of life and begins to make HbA. y If change-over doesnt occur and HbF continues to constitute more than 5% of the hemoglobin level after age 6 months, an abnormality maybe present, particularly thalassemia. Purpose To diagnose thalassemia
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Human chorionic gonadotropin, urine gonadotropin,

Qualitative analysis of urine levels of human chorionic gonadotropin (small age CG) detects pregnancy as early as 14 days after ovulation. y Production of hCG, a glycoprotein that prevents the generations of the corpus luteum at the end of a normal menstrual cycle, begins after conception y During the first trimester, hCG levels rise steadily and rapidly, peaking around 10 weeks gestation, subsequently tapering off to less than 10% of peak levels. y Most common method of evaluating hCG in urine is hemagglutination inhibition. y Provides qualitative and quantitative information. y Qualitative urine test is easier and less expensive than the serum hCG test (beta-subunit assay); therefore, its a more common test for detecting pregnancy. Purpose y To detect and confirm pregnancy. y To aid in the diagnosis of hydatidiform mole or hCG-secreting tumors, threatened abortion, or dead fetus.
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Transvaginal ultrasound
Imaging technique using high frequency sound waves to produce images of the pelvic structures. y Allows evaluation of pelvic anatomy and diagnosis of pregnancy at an earlier gestational age. y Eliminates the need for a full bladder and circumvents difficulties encounter with obese patients. y Also known as endovaginal ultrasound Purpose y To established early pregnancy with fetal heart motion as early as the 5th to 6th week of gestation. y To identify ectopic pregnancy. y To monitor follicular growth during infertility treatment. y To evaluate abnormal pregnancy. y To visualize retained products of conception. y To diagnose fetal abnormalities, placental location, and cervical length. y To evaluate adnexal pathology, such as tubo-ovarian abscess, hydrosalpinx, and ovarian masses. y To evaluate the uterine lining5
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Alpha Fetoprotein screening

Done every 16-18 wks y A liver protein of the fetus y requirements: y Ultrasound- to assess if leakage passes the spine and vien y Screenning assess the quantity of the fetal serum proteins Purpose folic acid deficiency donw syndrome
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Biophysical profile
The best test, to assess five biophysical variables in determining fetal well being. Perform 30 min time frame. y Amniotic fluid volume y Fetal body movement y Fetal breathing y Fetal heart rate reactivity y Fetal muscle tone
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Fern test
Is a microscopic slide test to determine the presence of amniotic fluid y + crystallization ruptured bulk (Bow) y +amniotic fluid crystals Shake Test (foam Stability Test) Presence of bubbles and foam Increase in bubbles lungs wouldnt colapse due to increase surfantant present
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