Presentation on theme: "Assessment of Fetal Growth & Development"— Presentation transcript:
1 Assessment of Fetal Growth & Development Module B – Part I
2 Objectives List three maternal-fetal risk factors. Differentiate between the various ways to assess fetal growth, development, and status.Differentiate between the various abnormal heart rate patterns.Describe the significance of meconium in the amniotic fluid.
3 Antenatal Assessment Antenatal = Prenatal Includes Maternal HistoryEvaluation of Maternal-Fetal Risk FactorsPhysical AssessmentIntrapartum MonitoringHigh Risk ConditionsMaternal mortality: 6 of 100,000 birthsPerinatal mortality: 17 of 1,000 births
4 Maternal History & Risk Factors Preterm BirthBirth before 37 weeks is the greatest cause of neonatal morbidity and mortality.8% of births.Smaller the infant, greater the risk.Consequence of:Preterm laborPreterm rupture of membranesFetal or maternal distressPrior preterm births1 prior preterm birth: 15% risk of subsequent2 prior preterm births: 32% riskUterine Malformation and Incompetent Cervix
5 Maternal History & Risk Factors Toxic Habits in PregnancyPresent in 10% of pregnanciesSmokingCO & Nicotine decrease fetal oxygen delivery.Correlation between cigarette smoking & low birth weight.Associated with:Premature membrane rupturePlacental disordersSIDSAlcohol UseTeratogenicFetal Alcohol Syndrome
6 Maternal History & Risk Factors Toxic Habits in PregnancyIllicit Drug UseCocaine is a potent vasoconstrictor:Reduced maternal coronary blood flow.Reduced placental blood flow.Opiates and Amphetamine use are shown to result in depressed neonatal function & withdrawal symptoms.Poor NutritionPresence of DiabetesLack of Prenatal Care
7 Maternal History & Risk Factors Multiple BirthsMaternal InfectionGroup B StreptococcusHerpes Simplex VirusHIV & Hepatitis BAbnormalities of the Placenta, Umbilical Cord & Fetal MembranesSee BelowDisorders of Amniotic Fluid LevelsMode of DeliveryToxemia
8 Toxemia Complicates 6 to 8% of deliveries 2nd only to pulmonary embolism as cause of maternal death.Preeclampsia –A blood pressure greater than 140/90 mm Hg.A rise in blood pressure greater than 30 mm Hg systolic or 15 mm Hg diastolic during pregnancy.ProteinuriaEdema of face & handsPressures over 150/100 mm Hg is considered severe preeclampsia.If not treated can lead to Eclampsia.
9 ToxemiaEclampsia – Occurrence of 1 or more convulsive seizures not attributed to other cerebral conditions, during pregnancy.Occurs in 1 of 200 preeclamptic patients.Coma.Seen between 20 weeks and term.May be fatal if untreated.Can occur post-delivery.
10 NEONATAL ASPHYXIACombination of hypoxia, hypercapnia and acidosis leads to neonatal asphyxia.Asphyxia leads to irreversible damage to the brain and vital organs.Asphyxia can occur in utero or during the delivery.GOAL SHOULD BE TO IDENTIFY AND PREVENT ASPHYXIA.
11 Causes of Neonatal Asphyxia Maternal hypoxia or asphyxia.Decreased placental blood flow.Anemia of the fetus.Drugs taken by the mother or given to the mother.
12 Assessment of the Fetus UltrasonographyAmniocentesisFetal Biophysical ProfileNonstress/Contraction Stress TestingFetal Heart Rate MonitoringFetal Blood Scalp Blood Analysis
13 UltrasonographyUses high frequency sound waves to locate and visualize organs and tissues.Placental placement.Amniotic fluid volume.Assess fetal growth.
14 AmniocentesisAmniocentesis is obtaining a sample of amniotic fluid for testing purposesinch 20 – 22 gauge needleGuided by ultrasoundCan be performed at 15 weeks but more commonly during the 2nd & 3rd trimesterComplications are infection, trauma and hemorrhage
15 Amniocentesis L/S ratio PG (Phosphatidylglycerol) Alpha Fetoprotein (AFP)Sign of skin ruptureCytology of cellsCreatinineBilirubinDetection of meconiumFetal fecal matter
16 Biophysical Tests of Fetal Well-Being A prenatal “APGAR” scoreScore of 0 (abnormal) or 2 (normal) on 5 variables:Fetal Breathing (1 breath in 30 seconds) - UFetal Movement (3 movements in 30 minutes) - UFetal Limb Tone (1 extension/flexion in 30 minutes) - UReactive Fetal Heart Rate (2 reactive episodes [acceleration of FHR >15 bpm] in 20 minutes) - NSTAmniotic Fluid Volume (One 1x1 cm pocket) - UNormal Score is 8-1010 is normal; 0 to 4 abnormal.TABLE 3-1 p. 26
17 Fetal Heart Rate Monitoring Average fetal HR is 140/min (120 to 160/min)Decreases to 120/min near term.Fetal Heart Rate Monitoring can determine fetal distress.Fetal Heart Rate Monitoring is correlated with uterine contractions during labor.
18 Fetal Heart Patterns Baseline Heart Rate Bradycardia Tachycardia Less than 120 beats/minute or a drop of 20 beats/minute or more from baseline heart rate.Common causes:Asphyxia (rule out immediately)Give the mother oxygen may help.Fetal scalp sample for pH determination.Congenital Heart DefectsHypothermiaDrugs/medications given to motherTachycardiaHR above 160/minCausesMaternal Fever/InfectionInfection of the fetusMaternal dehydrationMaternal anxietyAsphyxiaDrugs given to the mother
19 Fetal Heart PatternsDecelerations: HR drops below 120/min for less than 2 minutes.Early Decelerations (Type I)Usually due to fetal head compression.Poses little threat to fetus.Late Decelerations (Type II)Uteroplacental insufficiency.Begin at peak of contractions.Associated with fetal distress.Variable Decelerations (Type III)Most common.Cord compression.May indicate fetal hypoxia.Usually doesn’t correlate with contractions
23 Fetal Scalp pH Assessment Asphyxia results in a drop of pHIncrease in PaCO2Anaerobic metabolism resulting in increased lactic acid.ProcedureMother is placed in a lithotomy position.Fetal head is visualized through the cervix.An incision is made in the scalp and a blood sample is obtained.
24 Fetal Blood pH Normal fetal blood pH is above 7.25 pH between 7.15 – 7.24Slight asphyxiapH less than 7.15Severe asphyxiaThe pH of the mother should be determined concurrently
25 Estimated Date of Confinement (EDC) Delivery DateNone of the methods are exactNägele’s RuleFundal HeightQuickeningDetermination of Fetal Heartbeat
26 Nägele’s Rule Most common method used to determine EDC Example: Subtract 3 months from the first day of the last menstrual period.Add 7 daysExample:First day of last menstrual period is 3/25Subtract 3 months = 12/25Add 7 days = January 1
27 Fundal HeightThe Fundus of the uterus is the end opposite the cervix and can be measured as the uterus grows with the fetusUnreliable during the last trimesterA measurement is taken from the symphysis pubis to the top of the fundusIf the distance is 20 cm, the gestation is 20 weeks.
28 QuickeningQuickening is the first sensation of fetal movement experienced by the mother.16 – 22 weeks (average is 20 weeks).Very rough estimation of fetal age.
29 Determination of Fetal Heartbeat Fetal heartbeat can be heard as early as 16 weeks.Nearly always heard by 20 weeks.With the use of Doppler devices, the heartbeat can be heard earlier (8 weeks).
30 Meconium Presence in Amniotic Fluid Meconium is the thick, dark greenish stool found in the fetal intestine.Passage of the meconium into the amniotic fluid occurs in 40% of post-term fetuses of greater than 42 weeks gestation.This occurs due to asphyxia.Meconium release may result in meconium aspiration syndrome (MAS).