Chapter 9: Nursing Care During Normal
Pregnancy and Care of the developing fetus
ASSESSMENT
Measuring fundal height
▪
and fetal heart rate
▪
Knowledge about fetal
growth
and
development
NURSING DIAGNOSIS
▪
Readiness for enhanced
knowledge released to
usual fetal growth
▪
Anxiety related to lack of
fetal movement
Deficient
knowledge
▪
related for good prenatal
care for healthy fetal
well-being
IMPLEMENTAION
▪
Learning how fetus
mature at various points
of pregnancy
▪
Viewing sonogram and
learning the fetal sex
OUTCOME
Focus on determining if the
woman has made any
changes in her
lifestyle such as:
a. Smoke-free living by
next prenatal visit
b. Records number of
movements fetus makes
during 1 hour daily
c. Attends all scheduled
prenatal visits
d. Looking forward to the
birth of her baby
A. The Nursing Role and Nursing care During Normal
Pregnancy and Birth
Assures the health of the mother, and also her baby
▪
▪
Obtain a complete history and provide a physical
examination that influence the fetal development
▪
Ensure prenatal visit to avoid risk due to complications.
B. Stages of Fetal Development
 In 38 weeks, a fertilized egg developed into fetus
 Consist of three periods:
a. Pre-embryonic (1st 2 weeks, beginning with
fertilization)
b. Embryonic (weeks 3 through 8)
c. Fetal (weeks 8 through birth)
NAME
TIME PERIOD
Ovum
From ovulation to fertilization
Zygote
From
fertilization
to
implantation
Embryo
From implantation to 5-8
weeks
Fetus
From 5-8 weeks until term
Conceptus
Developing
embryo
and
placental
structures
throughout pregnancy
Age of Viability
The earliest age at which
fetuses survive if they are
born is generally accepted as
24 weeks or at the point a
1
fetus weighs more than 500600g
1. Fertilization: The Beginning of Pregnancy
Fertilization
→ Also known as conception and impregnation.
→ It is known as the union of an ovum and spermatozoon.
Occurs in the outer 1/3 of fallopian tube, also known as
●
ampullar portion
●
Only one ovum matures each month, so fertilization must
occur quickly because it has the capable to fertilize for
only about 24 hours and spermatozoon in about 48 hours,
possibly as long as 72 hours.
PROCESS:
1. Ovum exit from the Graafian follicle, surrounded by
zona pellucida (ring of mucopolysaccharide fluid) and
corona radiata (circle of cell).
2. Zona pellucida and corona radiata serve as protective
buffers.
3. Ovum propelled into fallopian tube by fimbriae
through the help of peristaltic action and movement
of tube cilia.
Note: Semen ejaculation averages 2.5 ml of fluid that
contains 50 to 200 million sperm, An average of 400
million sperm per ejaculation.
4. Woman cervical mucus reduce, in that way sperm
can easily penetrate it.
5. The sperm reach the cervix within 90 secs and reach
the outer end of fallopian tube within 5 minutes.
Note: Species-specific reaction is the mechanism of
spermatozoa
Note: In order for the sperm to enter the egg, it releases
hyaluronidase (proteolytic enzyme)
6. After that, a zygote is formed.
Fertilization occur in 3 factors
egg and sperm must be mature
ability of sperm to reach egg
ability of sperm to penetrate
2. Implantation
Implantation
→ Contact between the growing structure and uterine
endometrium, occurs approximately 8 to 10 days after
fertilization.
 Occurs high in uterus on the posterior surface
 Zygote migrate toward the body of uterus in 3 to 4 days
 Mitotic cell division occurs

a)
b)
c)
Process:
1. 24 hours- cleavage occurs
2. Every 22 hours- cleavage division continues
3. Next 3 to 4 days- large cells collect periphery of the
ball. Trophoblast (outer ring) forms placenta and
membranes. Embryoblast (inner ring) forms the
embryo.
4. 8 to 10 days- implantation
Note: if the implantation is low in the uterus, the growing
placenta may block the cervix and make birth child
difficult.
C. Embryonic and Fetal Structure
ISHING
Placenta and Membranes- serve as the fetal lungs, kidneys,
anddigestive tracts in utero as well as help provide protection
for the fetus.
1. Decidua or uterine Lining
−
This structure continues to grow in thickness and
vascularity instead of falling off and it will be discarded
after birth of child.
2. Chorionic Villi
−
It is a miniature villus, resembling probing fingers that
reach out from trophoblast cell into uterine endometrium.
It has: Central core
→ composed of connective tissue and fetal capillaries
→ surrounded by double layers that produce placental
hormones (hCG, hPL,estrogen and progesterone) . double
layers named syncytiotrophoblast and cytotrophoblast.
3. Placenta
−
Latin for “pancake”, 15 to 20 cm in diameter and 2 to 3
cm in depth.
Provides oxygen and nutrients to fetus, and removes
−
waste products from baby’s blood.
a. Circulation
a. 12th day of pregnancy, maternal blood begins to collect in
the intervillous spaces of the uterine endometrium
surrounding chorionic villi.
b. 3rd week, oxygen and other nutrients from the maternal
blood through the cell layers of chorionic villi into villi
capillaries
c. 50 ml/min at 10 weeks to 500 to 600 ml/min at term
Note: Woman should not take nonessential drugs during
pregnancy because it can cause diorders such as unusual
facial features, low-set ears and cognitive challenge.
Note: Mother should lie on her left side because it lifts the
uterus away from the inferior vena cava, prevent blood trap
in lower extremities.
b. Endocrine function
Human Chorionic Gonadotropin
▪
a) First placental hormone produce that can be found
in maternal blood and urine.
b) Levels vary throughout pregnancy
c) Act as a fail-safe measure to ensure the corpus
luteum of the ovary to continues to produce
progesterone ans estrogen so the uterine lining
maintain.
d) Suppress maternal immunologic response
▪
Progesterone
a) Hormone that maintains pregnancy
b) Maintain endometrial lining and present in maternal
serum as early as the 4th week as aresult,
continuation of corpus luteum
c) Reduce contractility of uterus during pregnancy, thus
preventing premature labor.
▪
Estrogen
a. Hormone of women
b. Second product of the syncytial cells of placenta
c. Contributes
to woman’s mammary
gland
development in lactation
d. Stimulates uterine growth to accommodate the
developing fetus
▪
Human Placental Lactogen (Human Chorionic
Somatomammotropin)
2
a)
Hormone with both growth-promoting and
lactogenic properties
b) Produce by the placenta beginning as early 6th
week,increasing to a peak level at term
c) Promotes mammary gland growth in preparation for
lactation in mother.
d) Serve the important role of regulating maternal
glucose, protein and fat levels so adequate amount
of these nutrients available to the fetus.
c. Placental proteins
Note: Has not been well documented, but may contribute
decreasing immunologic impact of growing placenta and
help prevent hypertension
4. Amniotic Membranes
−
Forms beneath the chorion, it is a dual-walled sac with the
chorion as the outermost part and the amnion as the
innermost part.
Have no nerve supply, so when spontaneously rupture at
−
term or are artificially ruptured via a procedure, neither
the mother or fetus experiences any pain.
Offers support to amniotic fluid and produces the fluid.
−
Produces a phospholipid that initiates the formation of
−
prostaglandins. May triggers that initiates labor.
5. Amniotic Fluid
−
Shield the fetus against pressure or a blow to the
mother’s abdomen
−
Aids muscular development and allows fetus to move
freely
It protects the umbilical cord from pressure, thus
−
protecting the fetal oxygen supply
−
Slightly alkaline, with a pH of about 7.2
−
Never become stagnant because it is constantly being
newly formed and absorbed by direct contact with the
fetal surface of placenta.
−
Ranges from 800 to 1,200 ml
Note: Hydramnios- excessive amniotic fluid (more than 2,000
ml, larger than 8 cm on ultrasound)
Note: Oligohydramnios- a reduction in the amount of amniotic
fluid
6. Umbilical Cord
−
Formed from the fetal membranes, the amnion and
chorion,and provides a circulatory pathway that connects
the embryo to the chorionic villi of placenta.
Transport oxygen and nutrients to the fetus from the
−
placenta and to return waste products from the fetus to
the placenta,
About 53 cm (21 in) in length and 2 cm (0.75) thick
−
The bulk of chord contains Wharton jelly, gives cord body
−
and prevents pressure on the vein and arteries that pass
through it.
−
Contains only one vein and two arteries
Rapid of blood flow is rapid (350 ml/min)
−
D. Origin and Development of Organ System
1. Stem Cells
● 4 days of life- totipotent stem cells
● Another 4 days - pluripotent stem cells
● Another few days- multipotent
2. Zygote Growth
●
Cephalocaudal- a head to tail direction
3. Primary Germ Layers
GERM LAYER
BODY PORTIONS FORMED
Ecoderm
a. Central nervous system
ISHING
b.
c.
d.
Mesoderm
e.
a.
b.
c.
d.
Endoderm
a.
b.
c.
(brain and spinal cord)
Peripheral
nervous
system
Skin , hair , nails , and
tooth enamel
Mucuos membranes of
the anus , mouth and
nose
Mammary glands
Supporting structures of
the body (connective
tissue, bones, cartilages,
muscle , ligaments , and
tendons)
Upper portion of the
urinary system (kidneys
and ureters)
Reproductive system
Heart
,
lymph,and
circulatory systems and
blood cells
Lining of pericardial ,
pleura , and peritoneal
cavities
Lining
of
the
gastrointestinal tract .
respiratory
tract
,
tonsils , parathyroid ,
thyroid and thymus
glands
Lower urinary system
(bladder and urethra)
4. Cardiovascular System
1st system to become functional in intrauterine life
−
▪
16th day- network of blood and single heart tube
▪
24th day- beats
▪
6th or 7th week- septum develops
7th week- heart valves develop
▪
▪
10th or 12th week- heartbeat heard Doppler instrument
▪
11th week- ECG may be recorded
a. Fetal Circulation
a. Blood is highly oxygenated and entered through
umbilical vein,
b. Infant’s oxygen saturation level- 95% to 100% and
pulse rate- 80 to 140 beats/min
b. Fetal Hemoglobin
a. Different composition that differs from adult
hemoglobin)
b. More concentrated and has greater affinity, 2
features that increase its efficiency
c. Newborn’s hemoglobin level- 17.1 g/ml while adult’s
hemoglobin- 11g/ml
d. Newborn’s hematocrit- 53% while adult’s
hematocrit- 45%
5. Respiratory System
3rd week of intrauterine life
−
Exist as a single tube with digestive tract
−
▪
End 4th week- septum divide the esophagus from traches;
lung buds appear on trachea
End of 7th week- diaphragm does not completely divide
▪
the thoracic cavity from the abdomen
3
▪
3 months of gestation and continues- spontaneous
respiratory practice movement
▪
After birth- specific lung fluid is rapidly absorbed
24th week- surfactant formed and excreted by alveolar
▪
cells.
Note: Surfactant has 2 components: lecithin and
sphingomyelin.
6. Nervous System
−
Begins to develop extremely early in pregnancy
3rd week of gestation- neural plate
▪
▪
All parts of brain form in utero but none are completely
mature
8th week- brain waves detected on EEG
▪
▪
24 weeks- ear and eye respond
7. Endocrine System
▪
Fetal pancreas produce insulin
Thyroid and parathyroid gland plays vital role in fetal
▪
metabolic function and calcium balance
▪
Fetal adrenal glands supply precursor for estrogen
synthesis by placenta
8. Digestive System
4th week of intrauterine life- separate from respiratory
−
tract
−
Rapidly grow
6th week- intestine become too large to be contained in
▪
the abdomen
▪
10th week- portion of intestine pushed into the base of
umbilical cord
16th week- meconium produce
▪
▪
36th week- secrete enzymes essential for carbs and
protein digestion
Note:
◦
Omphalocele- intestine remains outside the
abdomen in the base of the cord
Gastroschisis- similar defect, occurs when the
◦
original midline fusion that occurred at the
early cell stage is incomplete.
◦
Gastrointestinal tract is sterile before birth
Liver is also active and filter between incoming
◦
blood and fetal circulation and as a deposit site
for fetal stores such as iron and glycogen,
9. Musculoskeletal System
1st -to 2 weeks- cartilage prototypes provide position and
▪
support to the fetus
▪
12th week- ossification of cartilage bone begins
11th week- fetus can be seen move on ultrasonography
▪
16th to 20th week of movement of fetus
▪
10. Reproductive System
Sex can be determined at the moment of the conception
−
by a spermatozoon carrying an X or Y chromosome
8th weeks- chromosomal analysis on mother’s
▪
bloodstream
11. Urinary System
Presence of kidneys does not appear because the
−
placenta clears the fetus’ waste products
−
Fetal urine is being excreted at a rate of up to 500 ml/day
12. Integumentary System
Skin is covered by soft downy hairs (lanugo), it serves as
−
insulation to preserve warmth in the utero
▪
36th weeks- skin of fetus appears thin and translucent
13. Immune System
ISHING
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4
20th weeks - maternal antibodies cross the placenta into
the fetus
E. Milestones of fetal growth and development
End of Fourth Gestational Week
The length of the embryo is about 0.75 cm; weight is
about 400 mg.
The spinal cord is formed and fused at the midpoint.
The head is large in proportion and represents about onethird of the entire structure.
The rudimentary heart appears as a prominent bulge on
the anterior surface.
Arms and legs are bud-like structures; rudimentary eyes,
ears, and nose are discernible.
End of Eighth Gestational Week
The length of the fetus is about 2.5 cm (1 in.); weight is
about 20 g.
Organogenesis is complete.
The heart, with a septum and valves, beats rhythmically.
Facial features are definitely discernible; arms and legs
have developed.
External genitalia are forming, but sex is not yet
distinguishable by simple observation.
The abdomen bulges forward because the fetal intestine
is growing so rapidly.
A sonogram shows a gestational sac, which is diagnostic of
pregnancy
End of 12th Gestational Week (First
Trimester)
The length of the fetus is 7 to 8 cm; weight is about 45 g
Nail beds are forming on fingers and toes.
Spolly too faint to be felt by the motherhough they are
usually too faint to be felt by the mother.
Some reflexes, such as the Babinski reflex, are present.
Bone ossification centers begin to form.
Tooth buds are present.
Sex is distinguishable on outward appearance.
Urine secretion begins but may not yet be evident in
amniotic fluid
The heartbeat is audible through Doppler technology.
End of 16th Gestational Week
The length of the fetus is 10 to 17 cm; weight is 55 to120
g.
Fetal heart sounds are audible by an ordinary
stethoscope.
Lanugo is well formed.
Both the liver and pancreas are functioning.
The fetus actively swallows amniotic fluid, demonstrating
an intact but uncoordinated swallowing reflex; urine is
present in amniotic fluid.
Sex can be determined by ultrasonography.
End of 20th Gestational Week
The length of the fetus is 25 cm; weight is 223 g.
Spontaneous fetal movements can be sensed by the
motheritt
Antibody production is possible.
Hair, including eyebrows, forms on the head; vernix ca-
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seosa begins to cover the skin.
4 composes
Meconium is present in the upper intestine.
of suben.
Brown fat, a special fat that aids in temperature regulation, begins to form behind the kidneys, sternum, and
posterior neck.
Passive antibody transfer from the pregnant person to
fetus begins.
Definite sleeping and activity patterns are distinguishable
as the fetus develops biorhythms that will quide
sleep/wake patterns throuphout life.
End of 24th Gestational Week (Second
Trimester)
The length of the fetus is 28 to 36 cm; weight is 550 g.
Meconium is present as far as the rectumidid fertion e
Active production of lung surfactant begins.
Eyelids, previously fused since the 12th week, now open;
pupils react to light.
Hearing can be demonstrated by response to sudden
sound.
When fetuses reach 24 weeks, or 500 to 600 g, they have
achieved a practical low-end age of viability if they are
cared for after birth in a modern intensive care nursery.
End of 28th Gestational Week
The length of the fetus is 35 to 38 cm; weight is 1,200 g.
Lung alveoli are almost mature; surfactant can be
demonstrated in amniotic fluid.
Testes begin to descend into the scrotal sac from the
lower abdominal cavity.
The blood vessels of the retina are formed but thin and
extremely susceptible to damage from high oxygen
concentrations (an important consideration when caring
for preterm infants who need oxygen).
End of 32nd Gestational Week
The length of the fetus is 38 to 43 cm; weight is 1,600 g
Subcutaneous fat begins to be deposited (the former
stringy, "little old man" appearance is lost).
Fetus responds by movement to sounds outside the
pregnant person's body.
An active Moro reflex is present.
Iron stores, which provide iron for the time during which
the neonate will ingest only breast milk after birth, are
beginning to be built.
Fingernails reach the end of fingertips.
End of 36th Gestational Week
The length of the fetus is 42 to 48 cm; weight is 1,800 to
2,700 g (5 to 6 lb).
Body stores of glycogen, iron, carbohydrate, and calcium
are deposited.
Additional amounts of subcutaneous fat are deposited.
Sole of the foot has only one or two crisscross creases
compared with a full crisscross pattern evident at term.
Amount of lanugo begins to diminish.
Most fetuses turn into a vertex (head down) presentation
during this month.
ISHING
▪
▪
▪
▪
▪
▪
End of 40th Gestational Week (Third
Trimester)
The length of the fetus is 48 to 52 cm (crown to rump, 35
to 37 cm); weight is 3,000 g (7 to 7.5 lb).
Fetus kicks actively, sometimes hard enough to cause the
pregnant person considerable discomfort.
Fetal hemoglobin begins its conversion to adult
hemoglobin.
Vernix caseosa starts to decrease after the infant reaches
37 weeks gestation and may be more apparent in the
creases than the covering of the body as the infant
approaches 40 weeks or more gestational age.
Fingernails extend over the fingertips.
Creases on the soles of the feet cover at least two-thirds
F. DETERMINATION OF ESTIMATED BIRTH DATE
Traditionally, this date was referred to as the estimated
date of confinement (EDC).
 Because people are no longer"confined" after childbirth,
the acronym EDB (estimated date of birth) is more
commonly used today.
 Gestational age wheels and birth date are available
 Naegele rule is the standard method used to predict
length of pregnancy.
G. Assessment of Fetal Growth and Development
Tests for fetal growth and development are commonly done
for a variety of reasons, including to:
● Predict the outcome of the pregnancy.
● Manage the remaining weeks of the pregnancy.
● Plan for possible complications at birth.
● Plan for problems that may occur in the newborn
infant,
● Decide whether to continue the pregnancy.
● Find conditions that may affect future pregnancies.
HEALTH HISTORY
1. Ask the pregnant person specifically about any illnesses
prior to pregnancy such as gestational diabetes or heart
disease because these both can interfere with fetal
growth.
2. Ask about any drugs a pregnant person takes; for
instance, common drugs taken for recurrent seizures can
be teratogenic and therefore pose a risk in pregnancy
3. Inquire about nutritional intake because eating a wellbalanced diet is important to ensure adequate nutrients
for fetal growth
4. Be certain to also ask about personal habits such as
cigarette smoking, both prescription and recreational
drug use, alcohol consumption, and exercise
PHYSICAL EXAMINATION
 second step in evaluating fetal health.
1. Assess maternal weight and general appearance because
both obesity and underweight
2. Bruises may indicate intimate partner violence that could
have bruised the fetus as well.
3. An elevated blood pressure may be the beginning of
hypertension of pregnancy, which can restrict fetal
growth
H. ASSESSING FETAL GROWTH AND HEALTH
 number of procedures, both noninvasive and invasive, are
used to evaluate fetal growth.
Fetal Growth

5
As a fetus grows, the uterus expands to accommodate its
size.
 typical fundal (top of the uterus) measurements are:
Over the symphysis pubis at 12 weeks
▪
▪
At the umbilicus at 20 weeks
▪
At the xiphoid process at 36 weeks
McDonald rule
 an easy method of determining mid-pregnancy growth
 Typically, tape measurement from the notch of the
symphysis pubis to over the top of the uterine fundus
 equal to the week of gestation in centimeters between
the 20th and 31st weeks of pregnancy (e.g., in a
pregnancy of 24 weeks, the fundal height should be 24 cm)
Fetal Heart Rate
 can be heard and counted as early as the 10th to 11th
week of pregnancy by the use of an ultrasound Doppler
technique
 This is done routinely at every prenatal visit past 10 weeks.
Daily Fetal Movement Count (Kick Counts)
 Fetal movement that can be felt by the pregnant person
(quickening) occurs at approximately 18 to 20 weeks of
pregnancy and peaks in intensity at 28 to 38 weeks
 The technique for "kick counts" varies from institution to
in-stitution, but a typical method used is to ask patients
with high-risk pregnancies to:
Lie in a left recumbent position after a meal.
▪
▪
Observe and record the number of fetal
movements (kicks) their fetus makes until they
have counted 10 movements.
Record the time (typically, this is under an hour).
▪
▪
If an hour passes without 10 movements, they
should walk around a little and try a count
again.
▪
If 10 movements (kicks)cannot be felt in a
second 1-hour period, they should telephone
their primary healthcare provider.
Rhythm Strip Testing
 refers to an assessment of fetal well-being and assesses
the fetal heart rate for a normal baseline rate.
 The baseline reading refers to the average rate of the fetal
heartbeat.
 Long-term variability reflects the state of the fetal
sympathetic nervous system.
 average fetus moves about twice every 10 minutes, and
movement causes the heart rate to increase, there will
typically be two or more instances of fetal heart rate
acceleration in a 20-minute rhythm strip
 Variability is rated as:
a. Absent: No peak-to-trough range is detectable.
b. Minimal; An amplitude range is detectable, but the
rate is five beats per minute or fewer.
c. Moderate or normal: An amplitude range is
detectable; rate is six to 25 beats per minute.
Nonstress Testing
 Measures the presence of the fetal heart rate to fetal
movement.
 Usually done for 20 minutes
 The test is said to be reactive (healthy) if two
accelerations of fetal heart rate (by 15 beats or more)
lasting for 15 seconds occur after movement within the
time period.
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ISHING
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6
The test is nonreactive (fetal health may be affected) if no
accelerations occur with the fetal movements.
Vibroacoustic Stimulation
For acoustic (sound) stimulation, a specially designed
acoustic stimulator is applied to the pregnant person's
abdomen to produce a sharp sound of approximately 80
dB at a frequency of 80 Hz, thus startling and waking the
fetus
Ultrasonography
which measures the response of sound waves against
solid objects, is a much-used tool for fetal health
assessments.
It can be used to:
Diagnose pregnancy as early as 6 weeks
▪
gestation.
Confirm the presence, size, and location of the
▪
placenta and amniotic fluid.
Establish a fetus is growing and has no gross
▪
anomalies such as hydrocephalus; anencephaly;
or spinal cord, heart, kidney, and bladder
concerns.
Establish the sex if a penis is revealed.
▪
Establish the presentation and position of the
▪
fetus.
▪
Predict gestational age by measurement of the
biparietal diameter of the head or crown-torump measurement.
▪
Discover complications of pregnancy
Biparietal Diameter
side-to-side measurement of the fetal head
Doppler Umbilical ultrasonography
measures the velocity at which red blood cells in the
uterine and fetal vessels travel.
determine the vascular resistance present in patients w
gestational diabetes or hypertension and whether result
placental insufficiency
Placental Grading for Maturity
Placentas can be graded by ultrasound based on the
particular amount of calcium deposits present in the base.
Placentas are graded as:
▪ 0: between 12 and 24 weeks
▪ 1: 30 to 32 weeks
▪ 2: 36 weeks
▪ 3: 38 weeks (Because fetal lungs are apt to be matureby 38 weeks, a grade 3 placenta suggests the fetus is
mature.)
Amniotic Fluid Volume
another way to estimate fetal health because a portion of
the fluid is formed by fetal kidney output.
A decrease in amniotic fluid volume puts the fetus at risk
for compression of the umbilical cord with interference of
nutrition as well as lack of room to exercise and maintain
muscle tone
Between 28 and 40 weeks, the total pockets of amniotic
fluid revealed by sonogram average 12 to 15 cm. An
amount greater than 20 to 24 cm indicates hydramnios
An amount less than 5 to 6 cm indicates oligohydramnios
Nuchal Translucency
Children with a number of chromosomal anomalies have
unusual pockets of fat or fluid present in their posterior
neck, which show on sonograms as nuchal translucency.
Biophysical Profile
A biophysical profile combines five parameters
▪ fetal re-activity
▪ fetal breathing movements
▪ fetal body movement
▪ fetal tone
▪ amniotic fluid volume
 Scoring system is similar to an APGAR score determined at
birth on infants , it is often referred to as fetal APGAR
score.
 Biophysical profiles may be done as often as daily during a
high-risk pregnancy. The fetal scores are as follows:
▪
A score of 8 to 10 means the fetus is considered
to be doing well.
A score of 6 is considered suspicious.
▪
▪
A score of 4 denotes a fetus potentially in
jeopardy.
Magnetic Resonance Imaging
 causes no harmful effects to the fetus or pregnant patient,
MRI has the potential to replace or complement
ultrasonography as a fetal assessment technique because
it can identify structural anomalies or soft tissue disorders
 most helpful in diagnosing complications such as ectopic
pregnancy or tropho-blastic disease
Maternal Serum
 Because a number of trophoblast cells pass into the
maternal bloodstream beginning at about the seventh
week of preg-nancy, maternal serum analysis can reveal
information abou the pregnant patient as well as the fetus.
Maternal Serum Alpha-Fetoprotein
→ Close to 0.5% of concéptions result in a fetus that has the
trisomy 21 defect.
→ It is more frequent in pregnant people with advanced
maternal age.
→ Down syndrome can be identified in the first or early
second trimester through maternal serum testing for
alpha-fetoprotein (MSAFP)
Maternal Serum for Pregnancy-Associated Plasma Protein A
→ Pregnancy-associated plasma protein A (PAPP-A) is a
protein secreted by the placenta; low levels in maternal
blood are associated with fetal chromosomal anomalies,
including cabimies 13, 18, and 21 or small-for-gestational
age (SCA) babies.
→ A high PAPP-A level may predict an LGA baby.
Quadruple Screening
 four indicators of fetal health
▪ AFP , unconjugated setriol (UE:an enzyme produced
by the placenta that estimates general well being
▪ HCG , also produced by placenta
▪ Inhibin A , a protein produced by the placenta and
corpus luteum associated with down syndrome
▪ MSAFP , requires only a simple venipuncture of the
pregnant person.
Fetal Sex
 can be determined as early as 10 weeks by analysis of
maternal serum
 helpful to a pregnant patient who has an X-carrying
genetic disorder to discover if a male fetus could inherit
the disease or a female fetus will be disease-free
Invasive Fetal Testing
 a number of invasive measures allow for more refined
investigation.
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Examples include chorionic villi sampling and
amniocentesis
Amniotic fluid (obtained through amniocentesis, Fig. 9.14)
can be analyzed for:
▪ AFP
▪ Acetylcholinesterase
▪ Bilirubin determination
▪ Chromosome analysis.
▪ Color
▪ Fibronectin
▪ Inborn errors of metabolism
Percutaneous Umbilical Blood Sampling
Percutaneous umbilical blood sampling (PUBS; also called
cordocentesis or funicentesis) is the aspiration of blood
from the umbilical vein for analysis.
After the umbilical cord is located by sonography, a thin
needle is inserted by amniocentesis technique into the
uterus and is then guided by ultrasound
Fetoscopy
The use of a fetoscopy, in which the fetus is visualized by
inspection through a fetoscope (an extremely narrow,
hollow tube inserted by amniocentesis technique), can be
yet another way to assess fetal well-being.
This method allows direct visualization of both the
amniotic fluid and the fetus
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