Obs. Investigations

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ObstetricalInvestigations

Prepared by Mrs. Gauri Manohar

M.Sc Nursing PreviousGovt. College of Nursing

Indore (M.P.)


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Radiology in Obstetrics Radiology, is a medical specialty that employs theuse of imaging to both diagnose and treat diseasevisualised within the human body.
http://en.wikipedia.org/wiki/Medical_specialtyhttp://en.wikipedia.org/wiki/Medical_imaginghttp://en.wikipedia.org/wiki/Medical_imaginghttp://en.wikipedia.org/wiki/Medical_specialty


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Principles of Radiology in

Obstetrics- Benefits of radiation must outweigh the risks ofthe procedure.

Minimum radiation dose to be used. Appropriate field shielding should be done. First trimester should preferable be avoided. Benefits and safety of Ultrasonography must be

considered as an alternative.


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Indications- Fetal Maternal


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Fetal Diagnosis of Pregnancy Multiple Pregnancy

Malpresentations Hydramnios

Intrauterine Death of the fetus

Congenital malformation of the fetus and neonates andbirth injuries

Fetal Maturity


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Maternal Patient having cardiopulmonary disease mayrequire X- ray chest during pregnancy and thatshould be done beyond 12 weeks.

X- ray pelvimetry is of limited value in assessingcephalopelvic or fetopelvic disproportion.


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Radiation Hazards Tetratogenecity Oncogenecity

Genetic Damage

Intra Uterine Death


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CT Scan CT scans may be safely obtained with little or noexposure to the fetus.

Fetal exposed to conventional pelvimetry bycomputed Tomography is 0.23-1.3 rad


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MRI Of little value for fetal assessment. But it can be used to study maternal anatomy e.g.

pelvimetry.

It works on radiofrequency signal emitted by hydrogenprotons of tissues.

MRI uses no ionising radiation. It is more accurate andbiologically safe.


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CAUTION Radiation during pregnancy can damage the earlyphase of embryo .

The risk can be minimised by using the 10 dayrule.

No woman should be exposed to X- ray for a nonurgent indication outside 10 days from her lastperiod during reproductive period.


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Amniocentesis Amniocentesis is the deliberate puncture of theamniotic fluid sac per abdomen.


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Indications- Diagnostic Therapeutic


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Diagnostic- Early months (14-16 weeks)- Antenatal diagnosis of chromosomal and geneticdisorder

(a) Sex linked disorders, (b) Karyotyping (c) Inborn errors of metabolism (d) Neural tube defects .


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Later Months - Fetal Maturity

Degree of fetal haemolysis in Rh sensitised mother

Meconium staining of liquor- An evidence of fetaldistress.

Amniography or fetography- following instillation ofradio-opaque dye in the amniotic fluid cavity.


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Therapeutic- First Half (a) Induction of abortion by instillation ofchemicals such as hypertonic saline ,urea orprostaglandins.

(b) Repeated decompression of the uterus inacute Hydramnios.


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Second Half - (a) Decompression of uterus in unresponsive case of chronic

hydramnios .

(b) To give intrauterine fetal transfusion in severehaemolysis following Rh-isoimmunisation.

(c) Amino infusion- Infusion of warm normal saline into theamniotic cavity is done transabdominally or transcervicallyto increase the volume of amniotic fluid.


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Procedure- After emptying the bladder ,the patient remainsin dorsal position.

The abdominal wall is prepared aseptically anddraped.

The proposes site of puncture is infiltrated with1% lignocaine.


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Precautions-

Prior sonographic localisation of placenta isdesirable to prevent bloody tap and feto-maternal bleeding.

Prophylactic administration of 100 mg of anti-Dimmunoglobulin in Rh-negative non-immunisedmother.

Hazards are reduced significantly when it is doneunder direct ultrasound control compared toblind procedure.


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Hazards A) Maternal complications are

Infection. Haemorrhage (placental or uterine injury) Premature rupture of the membranes and

premature labour. Maternal isoimmunisation in Rh negative

cases.


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B) Fetal Hazards are- Abortion(1%) Trauma Feto-maternal Haemorrhage. Oligohydramnios due to leakage of amniotic

fluid that may lead to a) Fetal lung hypoplasiaand Respiratory distress.


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Chorionic Villus Sampling

(CVS) A test done in early pregnancy. The procedure involves inserting a needle into the

uterus cavity into the placental site to suck out avery small bit of tissue.

This test is done to determine certain geneticdisorders like Sickle Cell Anemia, Thalassemia,Downs Syndrome.

The risk involved in this procedure is risk ofabortion and damage to fetal limb.


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Daily Foetal Movement

Count (DFMC) The easiest way is during the evening hours torecord the time that has elapsed to feel the babykick 10 times.

The average time taken to feel 10 movements is21 minutes.

If you have taken 2 hours or more to feel 10movements, contact your doctor.


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Non Stress Test It is a non- invasive test and carries no risk of theprocedure. The duration of the test is approximately 20 minutes.

In this test , movements of the baby are monitored alongwith the heart rate with each movement.

The baby needs to be awake during this test.With the movement of the baby, there is a correspondingincrease in the heart rate.

The NST is done in a high risk pregnancy and is usually doneafter the 36 th week and repeated weekly.


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Ultrasound in Obstetrics Obstetric ultrasonography is the applicationof medical ultrasonography to obstetrics , inwhich sonography is used to visualize

the embryo or fetus in itsmother's uterus (womb).
http://en.wikipedia.org/wiki/Medical_ultrasonographyhttp://en.wikipedia.org/wiki/Obstetricshttp://en.wikipedia.org/wiki/Embryohttp://en.wikipedia.org/wiki/Fetushttp://en.wikipedia.org/wiki/Uterushttp://en.wikipedia.org/wiki/Uterushttp://en.wikipedia.org/wiki/Fetushttp://en.wikipedia.org/wiki/Embryohttp://en.wikipedia.org/wiki/Obstetricshttp://en.wikipedia.org/wiki/Medical_ultrasonography


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Uses of Ultrasonography Diagnosis and confirmation of early pregnancy. Vaginal bleeding in early pregnancy. Determination of gestational age and assessment

of fetal size. Diagnosis of fetal malformation. Placental localization. Multiple pregnancies.

Hydramnios and Oligohydramnios. Other areas.


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Clinical Tests duringPregnancy-

Urine Examination- Heat and acetic acid test: Dipsticks (Alubstix) Test for Sugar - Benedicts Test and Dipsticks Test for Acetone Tests for blood Coagulation Disorders- Clot observation test (Weiner) Peripheral Blood Smear.


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Cord Blood Samples- To get a true picture ,the sample should be taken

by opening the Kochers forceps from theplacental end of the cord as early as possible .

Samples are taken specially of babies born of Rh-negative mothers.

10 ml of cord blood should be collected in aheparinised tube.


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Cervical and VaginalCytology

Cervical : Suspected cervix toexclude premalignant or malignant

lesion.

Vaginal : Vaginitis to know the

specific pathogen


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Cardiotocography- In medicine (obstetrics ), cardiotocography (CTG)

is a technical means of recording ( -graphy )the fetal heartbeat (cardio- ) and

the uterine contractions (-toco- )during pregnancy, typically in the third trimester.

The machine used to perform the monitoring is

called a cardiotocograph, more commonly known asan electronic fetal monitor (EFM).
http://en.wikipedia.org/wiki/Medicinehttp://en.wikipedia.org/wiki/Obstetricshttp://en.wikipedia.org/wiki/Fetushttp://en.wikipedia.org/wiki/Pulsehttp://en.wikipedia.org/wiki/Uterushttp://en.wikipedia.org/wiki/Contraction_(childbirth)http://en.wikipedia.org/wiki/Pregnancyhttp://en.wikipedia.org/wiki/Pregnancyhttp://en.wikipedia.org/wiki/Contraction_(childbirth)http://en.wikipedia.org/wiki/Uterushttp://en.wikipedia.org/wiki/Pulsehttp://en.wikipedia.org/wiki/Fetushttp://en.wikipedia.org/wiki/Obstetricshttp://en.wikipedia.org/wiki/Medicine


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Baseline fetal heart rate-

Abnormal baseline is termed bradycardia whenthe baseline FHR is less than 110 bpm; it istermed tachycardia when the baseline FHR is

greater than160 bpm.


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Rubella Test Done for German Measles-(Rubella). If there is

history of exposure to an infected individual,ideally, rubella status should be determined prior

to getting pregnant


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Blood test for Alphafeto- protein (AFP)

This test can be done on mothers blood (MSAFPor Maternal Serum AFP) around the 14th 16th week of pregnancy.

High levels make the doctor suspect defects inthe development of spinal cord or brain (neuraltube defects) in the baby.


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Triple Marker Test This specialized test may be recommended if you

or your doctor is worried that the baby may nothave developed normally. It tests a pregnant

womans blood around 14 16 weeks for AFP (asabove) hCG (human chronic gonadotrophin), andestiol.


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Obs. Investigations

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