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Antenatal Fetal Assessment

2 min read

Description #

This is an Obstetrics and Gynecology unit.

Learning Objectives #

The Students should be able to:

– Assess fetal growth, well-being and maturity

– Distinguish an “at-risk” pregnancy

– Discuss screening tools that are used to identify the fetus at risk

– Review the etiologies and diagnosis of IUGR

– Review the factors that influence interpretation of test results

Introduction #

Antenatal Care (ANC) means “care before birth”, and includes education, counselling, screening and

treatment to monitor and to promote the well-being of the mother and fetus.

The aim of good antenatal care is to detect any potential problems early and to prevent and treat them if possible.

The current challenge is to find out which type of care and screening is considered sufficient to ensure good quality of

care for low-risk pregnant women.

Initial visit #

It is recommended that every pregnant patient have their first antenatal visit within 12 weeks of the LMP or earlier if less than 20 or more than 35 years old.

Get a complete history especially focusing on signs or symptoms of disorders like Gestational hypertension/ diabetes.

Ask about general maternal health and fetal movements (if any).

Check blood pressure, Maternal weight gain, Symphysis- fundal height (SFH) and Fetal heart rate with doptone (handheld doppler). 

Investigations:

  • bloodwork
  • CBC, blood group and type, Rh antibodies, infection screening as per preconception counselling
  • urine R&M, C&S
  • bacteriuria & proteinuria
  • pelvic exam
  • Pap smear (according to the guidelines unless done within last 6-12 mo), culture for N. gonorrheae (GC) and C. trachomatis, bacterial vaginosis (BV) swab

Evidence-based effective recommendations for antenatal care include:

• antenatal education for breast feeding;

• energy/protein supplementation in women at risk for low birth weight;

• folic acid supplementation to all women before conception and up to 12 weeks of gestation to avoid neural tube defects in the foetus;

• iodine supplementation in populations with high levels of cretinism;

• calcium, Vit D, Iron supplementation in communities with low dietary intake;

• smoking and alcohol consumption cessation for reducing low birth weight and preterm delivery;

• acupressure (sea bands) and ginger for nausea control;

• bran or wheat fibre supplementation for constipation;

• exercise in water, massages and back care classes for backache;

• screening for pre-eclampsia with a comprehensive strategy including an individual risk assessment at first visit, accurate blood pressure measurement, urine test for proteinuria and education on recognition of advanced pre-eclampsia symptoms;

• anti-D given during 72 hours postpartum to Rh-negative women who have had a Rh-positive baby;

• Down’s syndrome screening;

• screening and treatment of asymptomatic bacteriuria during pregnancy;

• screening of hepatitis B infection for all pregnant women and delivery of hepatitis B vaccine and immunoglobulin to babies of infected mothers;

• screening for HIV in early pregnancy, a short course of antiretroviral drugs, and C-section for infected mothers at 38 weeks, to reduce vertical transmission;

• screening for rubella antibody in pregnant women and postpartum vaccination for those with negative antigen;

• screening and treatment of syphilis;

• routine ultrasound early in pregnancy (before 24 weeks);

• external cephalic version at term (36 weeks) by skilled professionals, for women who have an uncomplicated singleton breech pregnancy; and

• a course of corticosteroids given to women at risk of preterm delivery to reduce respiratory distress syndrome in the baby and neonatal mortality.

Sexual intercourse has been found safe during pregnancy except in patients at risk for abortion, preterm labour, or placenta previa.

travel is not considered harmful , but stress related to travel may be associated with preterm labour and air travel is usually discouraged after 36 weeks.

Further evaluation #

What would prompt you to do further evaluation when you do these assessments in the office?

  • Pre-existing Medical conditions: Pre-existing diabetes, Hypertension, Cardiac disease, Lupus
  • Pregnancy Related: Multiple gestation, Oligohydramnios, Postdates, PPROM, 2nd/3rd trimester bleeding, Previous fetal demise
  • Screening test positive:

-Decreased SFH measurement

-Decreased fetal movement

-Weight gain less than expected

-Increased BP

-Abnormal FHR on doptone

Further Fetal surveillance tools:

  • Fetal Movement counting
  • Non Stress test
  • Ultrasound

Growth

Amniotic fluid assessment

Fetal behavior (Biophysical Profile)

Fetal Doppler assessment (Umbilical artery +/- other fetal vessels)

  • Contraction Stress Test