Book of Medical Disorders in Pregnancy - Tintash

time periods during the pregnancy for
greatest utility. The techniques
employed for prenatal diagnosis
includes: Ultrasonography,
amniocentesis, Chorionic villus
sampling, fetal blood cells in maternal
blood, maternal serum alpha fetoprotein,
maternal serum beta HCG and Maternal
serum estriol.
Assessment of maternal and fetal well
being:
Maternal assessment - There is no
alternative to a detailed history which
includes present, past reproductive,
medical and surgical history.
History of past obstetrical performance
is especially important because it highlights
and forewarns about the
recurrence of certain risks and their potential
to the maternal and fetal health.
Similarly previous history of reproductive
failure such as abortion, and
stillbirth points towards some genetic
and structural defects. History of
smoking drug addiction and alcoholism
needs special consideration, because of
withdrawal symptoms and teratogenic
effects of these agents.
Physical examination - Conventional
recording of weight, height, and general
body built and review of the different
systems such as gastrointestinal,
cardiovascular, musculoskeletal and
neurological also help in exposing
potential risks to the mother and her
baby.
Fetal assessment:
Methods:
Clinical assessment: The time honored
clinical methods for assessment of fetal
well being, which include indirect
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assessment of fetal growth from
maternal weight gain, enlargement of the
uterus, fundal height, abdominal girth,
quickening, fetal movements and heart
rate still remain the most important and
practical measures even today.
Fig15.3: Radiological appearance of
maternal pelvis with baby.
Radiological assessment - This old
method of assessment of fetal growth
has been generally discarded) because of
the radiation hazards to the mother and
the fetus. In any case it is useless in early
pregnancy, because the fetal skeleton is
not visible before 16 weeks of gestation
and no soft tissue deformity can be
detected by this technique.
Hormonal assessment:
A number of hormones where fetus
plays a direct or indirect role in their
production and excretion have been used
for assessment of fetal well being. These
hormones include HCG, HPL, and
estriol.
HCG:
Human chronic gonadotrophin (a placental
polypeptide hormone) is produced
by the trophoblastic tissue and has been
used for diagnosis of normal and abnormal
pregnancy. i.e. hydatidiform mole.
In certain medical disorders such as
diabetes, Rh isoimmunization and preeclampsia,
the level of this hormone is