You are on page 1of 4

PRENATAL DIAGNOSTIC ~ dr devianna ~

Ezyan
INTRODUCTION
Perinatal mortality rate in
Indonesia
40-50/1000 live birth.
This can be reduced if:
Quality:
Antenatal care eligible.
Delivery is safe and clean
Good maternal health
Perinatal period: from 28 weeks
pregnancy -1week Post Partum
Clinical :
Maternal weight gain
Measurement fundal height
Maternal abdominal
circumference
Estimated fetal weight
Palpation fetal position &
location
Fetal heart examination
State of maternal health

Purpose

by: Dr.
How to monitor the fetus

Is a fetus can continue living


safely uterin intra? Or
Is the fetus needs treatment and
resuscitation intra uterin? Or
Fetal life is threatened and needs
to be born

Clinical
Biochemistry
Genetic
Fetal biophysical profiles

Biochemistry
Alpha-fetoprotein levels
Human plasental lactogenic (HPL)
o NTD
< 4 gr/ml : sign of placental
function decreased significantly only in the
o 14 to 22 weeks
third trimester of pregnancy
o Depending on gestational age,
Spektrometrik bilirubin levels in Rh
multiple pregnancy, fetal death
immunization
-hCG
Creatinine levels in the amniotic
Pregnancy-associated plasma
fetal renal function
protein A (Papp-A)
Degree of acidity (pH) fetal blood.
Down Syndrome
Trimester I
Estriol: decrease : a sign of severe
fetus
The ratio of lecithin-sfingomielin:
assessing lung maturity

Genetic
Allegation of fetal anomalies
Indications:

Maternal age> 35 yrs


Have a family history of congenital
abnormality or congenital disease

Invasive
Amniocentesis
o Trimester I: 11 - 14 weeks
o Big risk
o Abortion

Chorionic villus sampling (CVS)


o Vili placenta
o 10 -13 weeks
Percutaneous umbilical cord blood
sampling (PUBS) = cordocentesis =

The existence of mental disorder or


developmental disorder in the
previous pregnancy
A history of exposure to hazardous
substances or teratogens
Abortion habitualis

o
o
o

Abnormalities in the fetus: fetal


clubfoot (talipes)
Failed
Trimester II: 15 to 20 weeks

fetal blood sampling


o Faster results 24 - 48 hours

amnioncentesis
Chorionic villus sampling
Fetal blood sample= cordocentesis
Advantages: can predict fetal condition which examined the metabolic products of the fetal and placenta. Levels were
changed when there is interference with the circulation fetoplasenter.
The disadvantage: the results take a long time , expensive and can be invasive

Fetal biophysical profiles

Based on the examination of


patterns of motion and image of
the fetus
Simple by mother:feeling fetal
movement palpation and
auscultation.
Electronics
o
Fetoscopy
o
Ultrasono
graphy
o
cardiotoco
graphy

Examined are :
o Fetal breathing movements, fetal
movements, fetal tone
o Abnormalities of shape, position,
fetal biometry
o Estimated fetal weight and
gestational age
o Number of amniotic fluid, state and
location of the placenta.
o Pattern of fetal heart rate & ECG

Fetal movement
State & fetal health can be judged
from the activities of the fetus in the
uterus.
Subjective monitoring (mother):
mothers were asked to monitor
fetal movements 30-60 mins 3x /day.
The drawback is a weak motion is
not observed,
which can be felt only 40-80%.

Fetal heart rate

USG

Frekuensi denyut jantung basal


Normal 120-160 /mnt
Mild tachycardia160 -180/mnt.
Severe tachycardia> 180/mnt.
Bradikardia light 100-119/mnt
Weight Bradikardia <100/mnt

Fetus as a pasien :
Diagnostic tool.
Monitoring the course of the
disease & the results of therapy.
Curative action.

CTG

Fetoscopy

Cardiotocography (CTG)
a useful tool in assessing the fetal
heart activity
monitoring the pattern of externally
FHR (Indirect), noninvasive nature,
using 2 transducers: 1 transducer to
monitor the FHR & 1 other
transducer to monitor the uterine
contractions.

This tool can be seen directly


fetus, invasive, but with the
progress of ultrasound was rarely
used.
Still occasionally do a biopsy
performed in the fetal / taking
blood directly from the umbilical
vein in the diagnosis of inherited
disorders