PRENATAL DIAGNOSTIC

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 µgr/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 weeks
 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