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PRENATAL DIAGNOSTIC

Deviana S. Riu

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

Purpose:
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

How to monitor the fetus


Clinical
Biochemistry
Genetic
Fetal biophysical

profiles

Clinical :
Maternal weight gain
Measurement fundal height
Maternal abdominal circumference
Estimated fetal weight
Palpation fetal position & location
Fetal heart examination
State of maternal health

Biochemistry
Alpha-fetoprotein levels
NTD
14 to 22 weeks
Depending on gestational age, multiple pregnancy,

fetal death
-hCG
Pregnancy-associated plasma protein A (Papp-A)
Down Syndrome
Trimester I
Estriol: decrease : a sign of severe fetus
The ratio of lecithin-sfingomielin: assessing lung

maturity

Human plasental lactogenic (HPL)

< 4 gr/ml : sign of placental function decreased


significantly only in the third trimester of
pregnancy
Spektrometrik bilirubin levels in Rh immunization
Creatinine levels in the amniotic
fetal renal function

Degree of acidity (pH) fetal blood.

Genetic
Allegation of fetal anomalies
Indications:
Maternal age> 35 yrs
Have a family history of congenital

abnormality or congenital disease


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

Invasive
Amniocentesis
Trimester I: 11 - 14 weeks
Big risk
Abortion
Abnormalities in the fetus: fetal

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

Chorionic villus sampling (CVS)


Vili placenta
10 -13 weeks

Percutaneous umbilical cord

blood sampling (PUBS) =


cordocentesis = fetal blood
sampling
Faster results 24 - 48 hours

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
Fetoscopy
Ultrasonography
cardiotocography

Examined are :
Fetal breathing movements, fetal

movements, fetal tone


Abnormalities of shape, position,
fetal biometry
Estimated fetal weight and
gestational age
Number of amniotic fluid, state and
location of the placenta.
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


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

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

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.

Fetoscopy
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

THANK YOU