ASSESSMENT

OF
MATERNAL AND FETAL
WELL BEING
DURING PREGNANCY

Presented by:
Archana Bhatti
M.SC.(N) 1st yr.
Definition :
‘ Assessment’ means is ‘to evaluate’ i.e.
here we gather the information of client
status and it dentifies the specific needs of
a client by which better care can be given
to the client and her developing fetus.That
means,it is the systematic
supervision(examination & advice)of a
woman during pregnancy.So,it is the
foundation stone for antenatal care.
AIMS AND OBJECTIVES:
To screen the ‘high risk’ cases.
To prevent or to detect and treat at the earilest
any complications.
To ensure continued medical surveillence and
prophylaxis.
To educate mother about the physiology of
pregnancy and labour by demonstration,charts
and diagrams so that fear is removed and
psychology is improved.
Contd…
To discuss with the couple about the
place,time and mode of delivery and care
of newborn.
To motivate the couple about to the need
of family planning.
To give appropiate advice to couple
seeking MTP.
 ASSESSMENT

Maternal Fetal
Measures Measures
MATERNAL MEASURES :
 History Taking
 Examination
• General
• Physical
• Obstetrical
 Radiological Examination
History Taking
Vital Statistics
 Name: …………………………..
 Date of first examination: ……..
 Address:…………………………
 Age:………………………………
 Gravida:Parity…………………..
 Duration of marriage: ………….
 Religion:…………………………
Contd…
• Occupation: ……………………………
• Period of Gestation: …………………..
 Chief Complaints: …………………….
 History Of present illness:……...........
 History of present pregnancy: ……….
 Obstetrics History:……………………..
 Menstrual history: ……………………..
 Past medical history: ………………….
 Past surgical history: …………………..
Contd…
 Family History
 Personal History
 Investigations
Hb
ABO/Rh
HIV/HbsAg/VDRL
USG
PAP smear
Blood sugar
Urine analysis
ANTENATAL EXAMINATION
Examination :
General and Physical Examination:
• Build:Obese/Avgerage/Thin

OBESE
Contd…
 Nutrition:Good/Average/Poor
Contd…
• Height:Short stature is likely to be
associated with small pelvis.
Contd…
Weight:The total weight gain during the
course of singleton pregnancy for a
healthy women averges 11 kg(24 Ib)
BMI(20-26) is 11 to 16 kg
BMI >29 not gain more than 7 kg
BMI <19 allowed to gain upto 18 kg
Contd…
• Pallor:The sites to be noted are lower
conjunctiva,dorsum of tongue and nail
beds.

EYES TONGUE NAIL BED

Contd…
• Jaundice:The sites to be noted are
conjunctiva,tongue,skin.
Contd…
• Tongue,teeth,gums and tonsils:

GLOSSITIS
STOMATITIS
Contd…
• Neck:Neck veins,thyroid gland or lymph
nodes should be inspected.

NECK VEINS GOITRE

Contd…
• Oedma of legs:The site of oedma are over the
medial malleolus and anterior surface of the
lower 1/3rd of the Tibia.Pitting oedma and
varicosity also should be inspected.

Oedma Varicosity
Contd…
• Breast Examination:It should be inspected
for pregnancy changes.
Obstetrical Examination :

ABDOMINAL VAGINAL
EXAMINATION EXAMINATION
Abdominal Examination:

Lateral grip
Fundal grip

Pawlik’s grip(3rd
Pelvic grip
Leopold)
Contd…

Fundal
height
F.H.S.
Vaginal Examination:
It should be done by using the left fingers(thumb &
index),the character of vaginal discharge,cervix
consistency,cystocele,uterine prolapse,rectocele is to be
elicited.

Prolapse
Contd…
Can be done for taking vaginal swabs for
investigations:
Radiological Examination:
INDICATIONS:(5 Rads)
 Diagnosis of
pregnancy
 Fetal maturity
 X-ray Pelvimetry
 X-ray chest
 Congenital
malformation
Absorbed radiation by the fetus in different
diagnostic radiation procedures:
PROCEDURE DOSE(RADS)

Abdominal X-Ray 0.263

Pelvic X-Ray 0.5-1.1
Chest X-ray <0.001
Abdominal CT 0.50-1.10
Ventilation lung scan 133 Xe 0.004-0.019
FETAL MEASURES
FETAL MEASURES:
 Clinical(Maneuvers)
 Biochemical(MSAFP,Triple
test,AChE,Inhibin A)
 Biophysical
• Fetal movement count(DFMC)
• Non Stress Test(NST)
• Fetal biophysical profile(BPP)
• Cardiotocography
Contd…
• Contraction stress test(CST)
• Doppler Ultrasound
• Vibroacoustic stimulation(VAS) test
 Cytogenetic
• Amniocentesis
• Chorion Villus Sampling(CVS)
• Cordocentesis
• Fluorescence In Situ Hybridisation(FISH)
Biophysical Profile:
It is the screening test for utero-placental
insufficiency.The fetal biophysical activities
are initiated,modulated and regulated
through fetal nervous system.The fetal
CNS is very much sensitive to diminished
oxygenation.
Contd…

Changes in fetal
Hypoxia
Biophysical profile

CNS depression Metabolic Acidosis

Contd…
 It is the continuous electronic
monitoring of the fetal heart rate along
with recording of fetal movements
(cardiotocography) is undertaken.
 FHR acceleration with fetal
movements,which when
present,indicates a healthy fetus.
 It is used as screening test.
 The test is valuable to identify the fetal
wellness rather than illness.
 Test should be started after 30 weeks
and frequency should be twice weekly.
Contd…
• Reactive(Reassuring): When two or more
acceleration of more than 15 beats per
minute above the base line and longer
than 15 sec in duration are present in a 20
min observation.
• Non-Reactive(Non-Reassuring):Absence
of any fetal reactivity.
Fetal Cardiotocography
Fetal movement count(DFMC)

• The patient counts the fetal movements every

morning,noon and evening.
• Three counts each of one hour duration are
recommended.
• If the no. of kicks are less than 10 in 12 hrs. or 3
in each hour it indicates fetal compromise.
• Increased fetal movements associated with
maternal hypoglycemia.
• Decreased FM cause obesity,smoking,hypoxia,
anterior placenta,hydramnios,narcotic drugs.
Indications :
• Diagnosis of pregnancy.
• Assessment of gestational age.
• Diagnosis of multiple pregnancy.
• Assessment of IUGR or BPP.
• Uterine size either > dates or < dates.
• Asessment of liquor volume.
• Diagnosis of any abnormality e.g. placenta
praevia etc.
Contd…
The Nuchal translucency is
used to provide a risk
assessment for
chromosomal
abnormality, specifically
Trisomies 13, 18 and
21(Downs Syndrome).
This is a risk assessment
based on age, heritage,
history, and a specific
ultrasound measurement.
The accuracy of this is
increased by factoring in
the levels of bHCG and
PaPP-A in the maternal
blood. Nuchal
Translucency (11-14
weeks : CRL 45-84mm)
 Associated with spina
bifida (secondary to
cord tethering)
“Banana sign”.

BANANA SIGN
“Lemon Sign" is inward
scalloping of the
frontal bones and is
associated with
"open" spina bifida
and the Chiari II
malformation
Wks of gestation BPD mm FL mm HC mm AC mm
12 21 8 70 56
13 25 11 84 69
14 28 15 98 81
15 32 18 111 93
16 35 21 124 105
17 39 24 137 117
18 42 27 150 129
19 46 30 162 141
20 49 33 175 152
21 52 36 187 164
22 55 39 198 175
WKS in
gestation
BPD mm FL mm HC mm AC mm
23 58 42 210 197
25 64 47 232 208
26 67 49 242 219
27 69 52 252 229
28 72 54 262 240
29 74 56 271 250
30 77 59 280 260
31 79 61 288 270
32 82 63 296 280
33 84 65 304 290
34 86 67 311 299
Wks in BPD mm FL mm HC mm AC mm
gestation
35 88 68 318 309
36 90 70 324 318
37 92 72 330 327
38 94 73 335 336
39 95 75 340 345
40 97 76 344 354
41 98 78 348 362
42 100 79 351 371
Contd…
• IUGR cab be diagnosed accurately with serial measurement of
BPD,AC,HC and amniotic fluid volume.
• AC is the single measurement which best reflects fetal nutrition.
• The avg. increase of BPD beyond 34 wks is 1.7 mm/wk.
• When HC/AC ratio is elevated(>1.0) after 34 wks,IUGR is
suspected.
• A measurement of BPD of 9.8 cm indicates maturity.
• Increased fetal nuchal skin thickness(in first trimester)>3 mm by
TVS is a strong marker for chromosomal anomalies(trisomy
21,18,13)
• CRL(in mm)+6.5=Gestational age in wks.After 12 wks it get
decreased.
• GS should increase by 1.1 mm in diameter/d.
Doppler Ultrasound
Contd…
• Doppler velocimetry of umbilical artery is
studied in pregnancy with complications.
• Used to measure the Peak
systolic(S),peak diastolic(D) and mean
values.
• Pulsatility index(P.I.)=(S-D)/M
• S/D & PI decreases with gestational age if
it increases shows IUGR,HTN.
Modified Biophysical Profile:
It consists of NST and ultrasonography
determined amniotic fluid index(AFI).
Modified BPP is considered abnormal
(nonreassuring) when the NST is non
reactive and/ or the AFI is <5.
Fetal Biophysical Profile: (BPP)
Observation for 30 mins.Normal score =2. Abnormal=0

Parameters Minimal normal criteria Score

Non Stress Reactive pattern 2
Test(NST)
Fetal 1 episode lasting>30 sec 2
Breathing
movements
3 discrete body/limb movements 2
Gross body
movements
Fetal muscle 1 episode of extension with return 2
tone flexion
Amniotic fluid 1 pocket measuring 2 cm in 2 2
perpendicular planes
Contraction stress test:
• It is based to observe the response of the
fetus at risk for uteroplacental insufficiency
in relation to uterine contractions.
• Test is +ve when late decelerations are
present with onset of contractions.
• It has high false +ve rate.
• NST & BPP should be done when CST is
+ve before doing any intervention.
INDICATIONS:
Intrauterine growth restriction
Postmaturity
Hypertensive disorders of pregnancy
Diabetes
CONTRAINDICATIONS:
Compromised fetus
Previous history of Caesarean section
Complications likely to produce preterm
labour
APH
SUMMARIZATION:
• Assessment
• Maternal measures(H/T,OBS. Grips)
• Fetal measures(NST,CST,DFMC,USG)
RECAPTULISATION:
• Assessment of mother
 History Taking
 Examination
• General
• Physical
• Obstetrical
 Radiological Examination
• FETAL MEASURES:
 Clinical(Maneuvers)
 Biophysical
• Fetal movement count(DFMC)
• Non Stress Test(NST)
• Fetal biophysical profile(BPP)
• Cardiotocography & USG.
ASSIGNMENT:
• Other name of CST is Oxytocin challenge
test .Why?What is Oxytocin Sensitivity
test???
BIBLIOGRAPHY:

• Dutta D.C. “TEXTBOOK OF

OBSTETRICS” New Central Book Agency
(P) LTD 2009 Pp 95-113
• Myles “TEXTBOOK FOR MIDWIVES”
Churchill Livingstone 14 edition Pp 251-
272:417-422
• BNS-103 Maternal health Nursing IGNOU
Pp 67-70
Contd ...
• http:www.hps.org/physiccians/radiology-
pregnant-patient-qa.html
• http://www.scribd.com/doc/6624348/Bioph
ysical-Assessment
• http://www.brooksidepress.org/Products/M
ilitary_OBYGN/Ultrasound/2ndand3rdTrim
esterUltrasoundScanning.html
• http://www.ultrasoundpaedia.com/USP2nd
trimesterpathologywinner.html
THANK YOU !!!