Check point of estimation of gestational age and viability of fetus
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This document discusses methods for estimating gestational age and fetal viability. It outlines several signs and symptoms of early pregnancy that can help determine gestational age, such as cessation of periods, nausea, and breast changes. Tests for human chorionic gonadotropin levels and ultrasound measurements of fetal structures are also described. The document then covers various screening methods for assessing fetal health, growth, and detecting chromosomal/structural abnormalities, including nuchal translucency testing, maternal serum screening, anomaly scans, and tests for infectious exposures. Invasive diagnostic tests like amniocentesis and chorionic villus sampling are also summarized.
Check point of estimation of gestational age and viability of fetus
- 1. CHECK POINTS OF ESTIMATION OF GESTATIONAL AGE AND VIABILITY OF FETUS DR. ROBINA TARIQ Associate Professor DEPARTMENT OF OBS & GYNAE UNIT-I SERVICES INSTITUTE OF MEDICAL SCIENCES /
- 2. 22 It is important to diagnose the pregnancy as soon as possible, in order to i) Determine the complications in early pregnancy. ii) Adverse drug exposure can be avoided in early pregnancy. iii) Exact dating or DOP will help to diagnose prematurity, prolong pregnancy, IUGR or macrosomia.
- 3. 33 DIAGNOSIS OF PREGNANCY a) SYMPTOMS 1) Cessation of regular menstrual cycle. 2) Nausea & vomiting 3) Breast symptoms a) Mastodynia or breast tenderness. b) Enlargement of sebaceous glands of areola (Montgomery’s tubercle) c) Clostrum secretion after 16 weeks. d) Darkening of areola
- 4. 44 4) Quickening – 16-20 weeks in multi para. 18-20 weeks in primigravida 5) Urinary Tract a) Bladder irritability, frequency, noeturia, UTI SIGNS OF PREGNANCY 1) ↑sed B.B.T (basal body temp.) 2) ↑sed pulse 3) Skin – Cholasma,,Linea nigera, Strech marks.
- 5. 55 Signs 1) Pelvic Organs a) Chad wick sign b) Hegar’s sign 2) Abdominal enlargement 3) Uterine contractions
- 6. 66 POSITIVE MANIFESTATIONS OF PREGNANCY a) Fetal heart tones b) Palpation of fetus c) Ultrasound examination of fetus d) Pregnancy test – Serum pregnancy test (Serum βhCG) – Urine for pregnancy test
- 7. 77 HUMAN CHORIONIC GONADOTROPHIN hCG is a glycoprotein which is exclusively produced by the trophoblastic tissues. βhCG is specific test for pregnancy and can be detected in blood as early as six days after fertilization. It double every 36-48 hours and reaches a peak at about 10 weeks which is 10,000- 100,000 i.u/24 hours.
- 8. 88 ESTIMATION OF GESTATIONAL AGE It is an important part of antenatal care to monitor the development of fetus and associated complications. i) By date of last menstrual period. Months Menstrual LMP, EDD and DOP Gestation Calendar
- 9. 99
- 10. 1010 ii) Level of serum HCG iii) Clinical assessment of uterine size. P/V P/A – Symphisio fundal height can be measured in cm and is equal to weeks of pregnancy from 12-36 weeks.
- 11. 1111
- 12. 1212 iv) Ultrasonography / dating scan Benefits of dating scan are it reliably depicts the gestational age in Irregular cycle Forgotten LMP Early diagnosis of twins Early diagnosis of miscarriages Reduce incidence of induction of labour
- 13. 1313 PARAMETER ASSESSED ON ULTRASONOGRAPHY Size of gestational sac.
- 14. 1414 Crown Rump Length (CRL)
- 15. 1515 BPD (Biparietal Diameter), HC (Head Circumference) FL (Femur Length)
- 16. 1616 VIABLE OR NOT? 1) Cardiac activity on ultrasonography between 6-7 weeks of gestation. 2) Sonic aid and fetoscope to listen to fetal heart beat. 3) Fetal movements - - - Cardiff’s count to 10. 4) CTG – trace 5) Biophysical profile - - - score is calculated by visualizing the activity of fetus on ultrasonography.
- 17. 1717 PROCEDURES FOR ASSESSMENT OF FETAL STATUS
- 18. 1818 SCREENING FOR FETAL PROBLEMS 1) Chromosomal abnormalities. 2) Structural defects. 3) Fetal infection 4) Disorders of fetal growth
- 19. 1919 1) CHROMOSOMAL ABNORMALITIES Non-invasive prenatal testing. a) Nuchal-translucency (NT Thickness) Done on ultrasonography between 11-14 weeks. If > 2.5mm it suggests chromosomal abnormalities. b) Soft marker of aneuploidy on ultrasonography e.g low set ears, double bubble sign. c) Maternal serum screening Alpha feto proteins (AFP) AFP + Beta HCG.
- 20. 2020 d) Fetal RBC’s / Fetal DNA is extracted from maternal circulation. Its a new technology and still under trial.
- 21. 2121 CHROMOSOMAL ABNORMALITIES Invasive prenatal testing. a) Chorion villus sampling 10-14 weeks of gestation. Sample is placental tissue. Culture is obtained on 10-14 days.
- 22. 2222 b) Amniocentesis Amniotic fluid is sampled From 15 weeks onwards Fibro blasts are cultured results obtained in 2- 3 weeks. c) Cordocentesis Fetal blood is sample From 20 weeks onwards Blood culture will yield results in 48 hours.
- 23. 2323 2) STRUCTURAL ABNORMALITIES a) Anomaly scan at 18 weeks. b) 22 weeks scan
- 24. 2424 3) INFECTIOUS DAMAGE TO THE FETUS a) Ultrasonography will show the signs of infection e.g hydrops fetalis, venticularmegaly, polyhydramnios and oligohydramnios. b) Specific IgG and IgM in maternal serum. c) Fetal sampling Blood and liqour
- 25. 2525 4) ASSESSMENT OF FETAL GROWTH History, Weight gain, uterine enlargment and kick count. On examination – weight, fundal height, fetal heart sounds. Any associated risks to the pregnancy. Investigations – USG CTG Fetal Scalp Blood Sampling in Labour