EVALUATION OF FETAL

HEALTH
M.Sc. Res. Ass Cynthia Edwin
 EVALUATION
OF FETAL HEALTH

• During pregnancy, problems seen in

mother and baby can be determined
and managed in early stages of
pregnancy with good care.
• When evaluating fetal health, healthcare
providers typically use different
techniques throughout pregnancy help
ensure the baby's well-being.

2
Cont.
• These various tests can provide valuable information about the baby's
development and detect any potential issues. It's important to attend
regular prenatal visits and follow the healthcare provider's guidance
for a healthy pregnancy.
• Health status of fetus can be monitored by several tests.
 EVALUATION
OF FETAL HEALTH

• These tests are;

• Genetic Screening,
• Maternal Assesment,
• Ultrasound,
• Computerized tomography,
• Magnetic resonance,
• Fetescope,
• Percutaneous umbilical blood samples,
4
Cont.

• Chorionic villus sampling,

• Amniocentesis,
• Fetal stress tests,
• Fetal fibronectin test
• Genetic tests used for down sendrome,
• group b strep culture
• These tests also carry some risks.

5
 6

Evaluating
fetal monitor baby's growth and
health is development
important
for several
reasons. It
allows
Reasons For healthcare
providers
detect any potential abnormalities
or genetic disorders
Fetal to

Evaluation
assess the functioning of vital organs
to ensure that the baby is receiving
enough oxygen and nutrients.
Cont.
• Regular evaluations help identify any issues early on, allowing for
timely interventions or treatments if necessary. It's all about ensuring
the health and well-being of both the baby and the mother
throughout the pregnancy journey.
Risk Factors For Evaluating Fetal Health
Some risk factors can include
maternal age (such as being under 18 or over 35)
certain medical conditions (like diabetes or high blood pressure)
a history of pregnancy complications
exposure to harmful substances (such as tobacco or alcohol)
certain genetic factors.
Cont.
• These risk factors help guide healthcare providers in determining the
appropriate tests and monitoring needed to ensure the well-being of
both the baby and the mother.
 When signs given below is seen,
prenatal tests can be performed;

• Slowdown in fetal movements,

• An increase in maternal blood

EVALUATION OF serum alfafetoprotein,

FETUS • Fetal arrhythmias and,

• Haemoglobinopathy.

10
 DANGER
SIGNS

• History of preterm labor,

• Unexplained perinatal birth,
• Hydramnios,
• Oligoamnios,
• Infections.

11
 DANGER SIGNS

• Multiple pregnancies,
• Early rupture of membrans,
• Completed 41 weeks of pregnancy,
• Hypertensive disease of pregnancy,
• Vaginal bleeding,
• Intrauterine growth retardation.

12
GENETIC
SCREENING

13
GENETIC
SCREENING
• Many genetic abnormalities can
be diagnosed before birth,
• Health personell may
recommend genetic testing
during pregnancy if woman or
her partner has a family history
of genetic disorders,
• Woman may also choose to have
genetic screening if she has had a
fetus or baby with a genetic
abnormality.
14
 GENETIC
SCREENING
• Examples of genetic disorders that
can be diagnosed before birth
include:
• Cystic fibrosis,
• Hemophilia A,
• Polycystic kidney disease,
• Sickle cell disease,
• Tay-Sachs disease and,
• Thalassemia.

15
 MATERNAL
ASSESSMENT
OF FETAL
ACTIVITY
•

16
MATERNAL ASSESSMENT OF
FETAL ACTIVITY

• -Fetal movement counting is an

evaluation method which pregnant
women quantify the fetal movements
they feel.
• -Decreased movement alerts the
mother of a deteriorating fetal
condition,
• -Women who report decreased fetal
movement have an incidence of stillbirth
that is 60 times higher than women
without this complaint.

17
Factors affecting fetal
movements
are;
• -Maternal activity,
• -Position,
• -Obesity,
• -Medications,
• -Gestational age,
• -Placental location and,
• -Amniotic fluid volume.
19
Cont...

• There are no risks to the mother or unborn baby during fetal

movement counting.
• -Information on counting fetal movements;
• -Get started, sit with your feet up or lie on your side,
• -Count each of baby’s movements (kicks, jabs, pokes and
rolls) as one kick and tap the foot on the app until you reach
10 movements,
• -The most important thing is to count baby’s kicks every day
so mother will know what is normal for baby.

20
 -Write down the number of
times mother feel the baby
kick or move in one hour,

Cont... - After several days, mother

may find the baby usually
moves about the same
number of times per hour this
becomes baseline number.

21
Cont...
• -If baby is not moving as much as usual, or takes longer to move in
the usual length of time, or has stopped moving, mother should call
her doctor right away,
• -Other testing can be done to check the condition of the baby.

22
ULTRASOUN
D

23
 ULTRASOUND
Ultrasound is used;
• To determine fetal measures,
• To determine placental condition,
• To determine amniotic fluids conditions .

24
 ULTRASOUND
To determine number of fetus,
To determine duration of pregnancy,
To determine fetal malformations,
To determine fetal position and presentation,
To determine localization of placenta,
To determine amount of amniotic fluid,
To determine presence of a pelvic mass.
25
•

BIOPHYSICAL PROFILE
26
 BIOPHYSICAL PROFILE
• There are 5 criterions for evaluation of biophysıcal profıle
• Fetal breathing movement,
• Body motion,
• Body tone,
• Amniotic fluid volume and,
• Fetal heart rate.

27
 BIOPHYSICAL PROFILE

Two points are given for

Fetal heart reaction is
The first four criteria are each normal findings,
evaluated by nonstress
examined by ultrasound, zero points for abnormal
test,
findings.

30
 EVALUATION OF FETAL
MOVEMENTS
BY MOTHERS
• Inform mother, fetal movements can be felt around the 18th week of
pregnancy, and this move will strengthen gradually,
• Evaluation with this method starts in 27th week of pregnancy,
• Slowing or stopping is important in fetal movement,
• A healthy fetus moves at least 10 times in 3 hours,
• Each fetal movement will be recorded as a special Schedule.

31
COUNTING FETAL MOVEMENTS
• Mother starts every day to count fetal movements at the same time
and continue to do so until 10 counting,
• Each fetal movement will be recorded as special schedule,
• Say mother if the fetus doesn’t move or slow motion described,
immediately contact with your doctor.

32
 FETAL MOVEMENTS

• Mother must bring her schedule during

every prenatal control,
• Fetal movements must be evaluated 1
hour later than meal,
• Side lying position should be preferred
during counting,
• Following the sudden and strong action
cessation of movement is a sign of
acute fetal distress,
• While the fetus rests at least for one
hour, fetal movement may not be felt.

33
 NONSTRESS TEST
(NST)

35
 NONSTRES TEST (NST)
• With this test fetal heart beats are recorded by using electronic fetal
monitoring,
• The relationship between fetal heart rate and fetal movements is
monitored.

36
 NST

• NST especially used for mother

with;
• Diabetes,
• Pregnancy induced hypertension,
• Intrauterine growth retardation,
• Premature rupture of membranes
• Multiple births and other high-risk
pregnancy problems.
37
 CONTRACTION STRESS TEST

38
 Contraction stress testing is to assess the respiratory
function of the placenta
CST is used for ;

CONTRACTI Intrauterine growth retardation(IUGR),

ON STRES Diabetus mellitus,

TEST
Full term babies(42 weeks and over),

Nonreactive NST

Abnormal biophysical profile.

39
CONTRAINDICATIONS OF CST
• Bleeding seen in third trimester(Placenta previa, ablasyo plasenta),
• Pervious Cesarian births,
• Risk of preterm birth,
• Cervixal insufficiency and,
• Multiple pregnancy .

40
AMNIOCENTE
SIS

41
 By amniocentesis, doctor enters uterine
cavity of the mother by a needle,

Amniotic fluid is taken for eveluation of

fetal health,
AMNIOCENTE
SIS It is applied in 16-18. weeks of
pregnancy,

After procedure fetal heartbeat and

mother health are monitorised.

42
 AMNIOCENTESIS
• Mother informed about the following topics,
• Unexpected fetal hyperactivity or cessation of fetal movement,
• Vaginal bleeding or discharge,
• Contractions of the uterus or abdominal pain,
• In case of fever or chills a doctor should be contacted,
• After the amniosentesis at least first 24 hours plenty of fluids must taken and movements
should be restricted.

43
RISK OF AMNIOSENTESIS
• Fetal death (0.3-0.5% risk),
• Injury from needle,
• Maternal hemorrhage,
• Infection,
• Rh isoimmunization,
• Abruptio placenta,
• Labor.

44
 AMNIOCENTESIS
• After amniocentesis Rh-negative mothers Rh immune globilin are
given to prevent the influence.

45
NURSING RESPONSIBILITIES FOR AMNIOCENTESIS

informed consent should taken from Have clients empty bladder before
womanbefore the procedure, amniocentesis,
Baseline vital signs and FHR, then check
every 15 minutes,
Position supine with abdominal scrub.

46
Cont...

• Encourage bed rest and avoidance of strenuous activities,

Instruct client to report any side effects, chills, fever, fluid leakage, decreased fetal
movement and uterine contractions.

47
CHORIONIC
VILLUS
SAMPLING

48
CHORIONIC VILLUS SAMPLING

By chorionic villus It is performed

Usually done at 15
sampling test, a earlier when
to 20 weeks of
sample taken from compered with
pregnancy.
chorionic villi tissue, Amniocentesis,

49
INDICATIONS OF CVS

Mother who has

Mothers older a choromosomal History of 3 or History of
than 35 age, defect family more abortion, hemophilia.
history,

51
RISKS OF CHORIONIC VILLUS
SAMPLING
• Failure to obtain the tissue,
• Rupture of membrans,
• Hemorrhage,
Intrauterine infections,
• Rh sensitization,
Spontaneous abortions .

52
 CHORIONIC VILLUS SAMPLING
• CVS can find many genetic disorders, such as Tay schacs disease and
Hemophilia,
• It can also find chromosome defects, such as Down Syndrome,
• CVS can't find Neural Tube Defects.

53
 Woman will be asked to sign a consent form that gives
her permission to do the procedure,

No special restriction on diet or activity prior to chorionic

NURSING villus sampling,

CARE OF
CHORIONIC Tell the woman to inform her doctor about alergy,

VILLUS
SAMPLING Tell her doctor of all medications (prescribed and over-
the-counter) and herbal supplements,

Tell doctor if she has a history of bleeding disorders or if

taking any anticoagulant (blood-thinning) medications.

54
Cont...
• Tell doctor if you she has Rh negative blood group,
• During the CVS procedure, blood cells from the mother and fetus can mix,
• This may lead to Rh sensitization and breaking down of fetal red blood cells.

55
Cont...
• Woman may or may not be asked to has a full bladder right before the
procedure,
• Depending on the position of the uterus and placenta, a full or empty
bladder may help move the uterus into a better position for the
procedure,
• Woman and fetus will be monitored for a while after the procedure.

56
Cont...
• Woman should tell her doctor to report any of the following:
• Any bleeding or leaking of amniotic fluid from the needle puncture
site or the vagina,
• Fever and/or chills,
• Severe abdominal pain and/or cramping.

57
PERCUTANO
US
UMBLICAL
BLOOD
SAMPLE

58
PERCUTANOUS UMBLICAL BLOOD
SAMPLE

• This test, also referred to as Cordocentesis ,

• Blood samples taken from the umbilical cord in utero.

59
PERCUTANOUS UMBLICAL BLOOD
SAMPLE
• Fetal blood sample taken for;
• Fetal karyotype,
• Fetal infection,
• Platelet disorders,
• Fetal blood group.

60
SCREENING TESTS USED FOR FETAL
HEALTH

Screenıng tests used -Double test and, -Triple or Quad Marker

for fetal health; Screen.

61
 DOUBLE TEST
• It is used for determination of trisomy,
• It is applied 11-14 weeks of pregnancy .

62
TRIPLE TEST

• This test allows detection of Down syndrome( trisomy 21), neural

tube defects and trisomy 18 in 16-18 weeks of pregnancies,
By this test in maternal blood hCG, alpha- fetoprotein (AFP) and estriol
(E3) are examined.

63
 QUAD MARKER SCREEN

• The quad marker screen, similar to the triple marker screen, is a blood
test that provides a woman and health care provider with useful
information about pregnancy,
• The quad marker screen determines if a woman is at higher or lower
risk of carrying a baby with a birth defect,
• It is applied between 15 and 20 weeks of pregnancy, health
care provider may offer woman a quad marker screen.

64
 QUAD MARKER SCREEN

• Problems in the development of the fetus's brain and spinal cord,

called open neural tube defects; the quad marker screen can predict
approximately 75%-80% of open neural tube defects genetic disorders
such as Down syndrome.

65
• GROUP B STREP CULTURE

67
 GROUP B STREP CULTURE
• Group B streptococcus (GBS) is a type of bacteria found in the lower
genital tract of about 20 percent of all women.
• While a GBS infection does not usually cause problems in women
before pregnancy, it can cause serious illness in mothers during
pregnancy.

68
 GROUP B STREP CULTURE
• GBS may cause chorioamnionitis (a severe infection of the placental
tissues) and postpartum infection,
• Urinary tract infections caused by GBS can lead to preterm labor and
birth or pyelonephritis and sepsis.

69
Cont...
• GBS is the most common cause of life-threatening infections in
newborns, including pneumonia and meningitis,
• Newborn babies contract the infection during pregnancy or from the
mother’s genital tract during labor and delivery.

70
Cont...
• The Centers for Disease Control and Prevention recommends
screening all pregnant women for vaginal and rectal GBS colonization
between 35 and 37 weeks gestation.

71
72