Amniocentrices(from the Greek amnion for “sac” and kente-

sis for “puncture”) is the aspiration of amniotic fluid from the

pregnant uterus for examination. The procedure can be done

in a physician’s office or in an ambulatory clinic. It is typi-

cally scheduled between the 14th and 16th weeks of preg-

nancy to allow for a generous amount of amniotic fluid to be

present. The technique can be used again near term to test

for fetal maturity.

Amniocentesis is a technically easy procedure, but it can

be frightening to a woman. Because it involves penetration of

the integrity of the amniotic sac, there also are risks to the

fetus, although the incidence of these is low (less than 0.5%).

Fetal complications range from hemorrhage from penetra-

tion of the placenta, infection of the amniotic fluid, and

puncture of the fetus. If it leads to irritation of the uterus, it

can initiate premature labor (Alfirevic, 2009).

In preparation for amniocentesis, ask the woman to void

(to reduce the size of the bladder and prevent an inadver-

tent puncture). Place her in a supine position on an exam-

ining table and drape her appropriately, exposing only her

abdomen. Place a folded towel under her right buttock to

tip her body slightly to the left and move the uterus off the

vena cava, to prevent supine hypotension syndrome. Attach

fetal heart rate and uterine contraction monitors. Take her

blood pressure and measure the fetal heart rate for baseline

levels.
A biophysical profile combines five parameters (fetal reac-

tivity, fetal breathing movements, fetal body movement,

fetal tone, and amniotic fluid volume) into one assessment.

The fetal heart and breathing record measure short-term

central nervous system function; the amniotic fluid volume

helps measure long-term adequacy of placental function.

The scoring for a complete profile is shown in Table 9.5.

With use of this system, each item has the potential for

scoring a 2, so 10 would be the highest score possible. A

biophysical profile is more accurate in predicting fetal well-

being than any single assessment (Lalor, et al, 2009).

Because the scoring system is similar to that of the Apgar

score determined at birth on infants, it is popularly called a

fetal Apgar.

Biophysical profiles may be done as often as daily during

a high-risk pregnancy. If the fetus score on a complete pro-

file is 8–10, the fetus is considered to be doing well. A score

of 6 is considered suspicious; a score of 4 denotes a fetus

probably in jeopardy. For simplicity, some centers use only

two assessments (amniotic fluid index and a nonstress test)

for assessment. Referred to as a modified biophysical pro-

file, this predicts short-term viability by the nonstress test

and long-term viability by the AFI. A healthy fetus should

show a reactive nonstress test and an AFI range between 5

and 25 cm (Chang & Blakemore, 2007).

KEypoints

A biophysical profile is a combination of fetal assessments

that predicts fetal well-being better than measuring single

parameters.
Alpha-Fetoprotein (AFP). If the fetus has an open body

defect, such as anencephaly, myelomeningocele, or om-

phalocele, increased levels of AFP will be present in the

amniotic fluid because of leakage of AFP into the fluid.

The level will be decreased in the amniotic fluid of

fetuses with chromosomal defects such as Down syn-

droe. Acetylcholinesterase is another compound that

can be obtained from amniotic fluid in high levels if a

neural tube defect is present.

Chorionic villi sampling (CVS) is a biopsy and chromoso-

mal analysis of chorionic villi that is done at 10–12 weeks of

pregnancy. This procedure is discussed in Chapter 7.

Coelocentesis (transvaginal aspiration of fluid from the ex-

traembryonic cavity) is an alternative method to remove

cells for fetal analysis.

Ultrasonography, which measures the response of sound

waves against solid objects, is a much-used tool in modern

obstetrics, although the recommendations for its use are

being questioned because of unproven benefits in the face of

added expense (Neilson, 2009). 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 that a fetus is growing and has no gross anom-

alies, such as hydrocephalus, anencephaly, or spinal cord,

heart, kidney, and bladder defects

• Establish sex if a penis is revealed

• Establish the presentation and position of the fetus

• Predict maturity by measurement of the biparietal diame-ter if the head

Ultrasonography can also be used to discover complica-

tions of pregnancy, such as the presence of an intrauterine

device, hydramnios or oligohydramnios, ectopic pregnancy,

missed miscarriage, abdominal pregnancy, placenta previa,

premature separation of the placenta, coexisting uterine tu-

mors, multiple pregnancy, or genetic disorders such as Down

syndrome. Fetal anomalies such as neural tube disorders, di-

aphragmatic hernia, or urethral stenosis also can be diag-

nosed. Fetal death can be revealed by a lack of heartbeat and

respiratory movement. After birth, an ultrasound may be

used to detect a retained placenta or poor uterine involution

in the new mother.

a phospholipid substance, is formed and

excreted by the alveolar cells at about the 24th week of

pregnancy. This decreases alveolar surface tension on ex-

piration, preventing alveolar collapse and improving the

infant’s ability to maintain respirations in the outside

environment (Soll, 2009).

Surfactant has two components: lecithin (L) and sphin-

gomyelin (S). Early in the formation of surfactant, sphin-

gomyelin is the chief component. At about 35 weeks, there is

a surge in the production of lecithin, which then becomes the

chief component by a ratio of 2:1. As a fetus practices breath-

ing movements, surfactant mixes with amniotic fluid. Analysis

of the L/S ratio regarding whether lecithin or sphingomyelin is

the dominant component by amniocentesis technique is a pri-

mary test of fetal maturity. Respiratory distress syndrome, a

severe breathing disorder, can develop if there is lack of surfac-

tant or it has not changed to its mature form at birth

The neural tube forms the early brain and spine. These types of birth defects develop very early during
pregnancy, often before a woman knows she is pregnant. The two most common NTDs are spina bifida
(a spinal cord defect) and anencephaly (a brain defect).

A Pap smear is used to screen for cervical cancer. The Pap smear is usually done in conjunction with a
pelvic exam. In women older than age 30, the Pap test may be combined with a test for human
papillomavirus (HPV) — a common sexually transmitted infection that can cause cervical cancer.