Help the medical students to know about the fetal clinical parameters. Very rarely material present in the books. I prepared this for the little bit help from my side.

1. FETAL MEASURES-CLINICAL
PARAMETERS
SAKSHI RANA
MSC NURSING

2. FETAL MEASUREMENT
Fetal measurements reflect whether the
fetus has grown enough or whether the
measurements fall outside the normal
range. They also reflect if there are
anomalies of the fetus.

3. Contt..
During pregnancy many different ultrasounds
measurements can be done. Fetal ultrasound
measurements can include:
• Crown rump length (CRL),
• Biparietal diameter (BPD),
• Femur length (FL),

4. Contt..
• Head circumference (HC),
• Occipitofrontal diameter (OFD),
• Abdominal circumference (AC),
• Humorous length (HL),
• Estimated fetal weight (EFW).

5. Gestational sac (GS)

6. Contt..
• The gestational sac (GS) is a structure that
surrounds an embryo.
• The first pregnancy structure that can see
on ultrasound in early pregnancies.
• The GS encloses not only the embryo, but
also the amniotic fluid, which helps to
nourish and protect the developing baby.

7. Fetal Pole

8. Contt..
• The fetal pole is a mass of cells before the
embryo is visible. Fetal pole becomes visible
somewhere between five-and-a-half and six-
and-a-half weeks of gestational age.

9. Contt..
• It grows at a rate of about 1 mm a day,
starting at the 6th week of gestational age.
Thus, a simple way to "date" an early
pregnancy is to add the length of the fetal
pole (in mm) to 6 weeks. Using this method,
a fetal pole measuring 5 mm would have a
gestational age of 6 weeks and 5 days.

10. Crown-rump length (CRL)

11. Contt..
• The CRL measurement is the distance
between the top of the embryo and it's
rump. The CRL can be measured between 7
to 13 weeks

12. Biparietal diameter (BPD)

13. Contt..
• The diameter between the 2 sides of the
head. This is measured after 13 weeks. It
increases from about 2.4 cm at 13 weeks to
about 9.5 cm at term.

14. Head circumference (HC)

15. Contt..
• The head circumference or HC measures
the circumference of the fetus' head. The
HC is usually done after 13 weeks of the
pregnancy

16. Femur length (FL)

17. Contt..
• Measures the longest bone in the body and
reflects the longitudinal growth of the fetus.
It increases from about 1.5 cm at 14 weeks
to about 7.8 cm at term. Similar to the BPD,
dating using the FL should be done as early
as is feasible.

18. Abdominal circumference (AC)

19. Contt..
• The single most important measurement to
make in late pregnancy. It reflects more of
fetal size and weight rather than age. Serial
measurements are useful in monitoring
growth of the fetus. AC measurements
should not be used for dating a fetus.

20. Estimated fetal Weight (EFW)

21. Contt..
• The weight of the fetus at any gestation can
also be estimated with great accuracy using
polynomial equations containing the BPD,
FL, and AC.

23. BIOCHEMICAL TESTS

24. HUMAN ESTRIOL
ESTROGEN:
• An estrogen test measures the level of the
most important estrogen hormones in
a blood or urine sample. It
measures estradiol, estriol, and estrone

25. PURPOSES
• Help find fetal birth defects
• Check for estrogen-producing tumors of the
ovaries
• Monitor treatment with fertility medicines.

26. PROCEDURE

27. Contt..
• Wrap an elastic band around upper arm to
stop the flow of blood. This makes the veins
below the band larger so it is easier to put a
needle into the vein.
• Clean the needle site with alcohol.
• Put the needle into the vein. More than one
needle stick may be needed.

28. Contt..
• Attach a tube to the needle to fill it with
blood.
• Remove the band from your arm when
enough blood is collected.
• Put a gauze pad or cotton ball over the
needle site as the needle is removed.
• Put pressure on the site and then put on a
bandage.

29. RESULTS
• Estriol in pregnant women
• 1st trimester Less than 38 nanogramsper
milliliter (ng/mL)
• 2nd trimester 38-140 ng/mL
• 3rd trimester 31-460 ng/mL

30. ACETYL CHOLINE ESTRASE
(ACHE)
This test measures the amount of an enzyme
called acetyl cholinesterase in amniotic
fluid. It is used during pregnancy to help
identify unborn babies who have neural
tube defects, including anencephaly, spina
bifida, and heart defects

31. INDICATIONS
Patients on valproic acid anti-seizure
medication

32. Contt..
• Insulin dependent diabetic patients

33. Contt..
• Previous pregnancy with a NTD

34. Contt..
• Ultrasound indications of a NTD or open
ventral wall defect

35. PROCEDURE

36. • A sample of this fluid is collected by a
procedure called an amniocentesis.

37. RESULTS
Normal range by method :
–Polyacrylamide gel electrophoresis:
Negative
–AE-2 immunoassay: Negative
–Inhibition assay: 5.17 ± 2.63 milliunits/mL
(5.17 ± 2.63 units/L)

38. MATERNAL SERUM ALPHA
FETOPROTIEN
• MSAFP is a screening test that examines the
level of alpha-fetoprotein in the mother’s
blood during pregnancy.
• Normally, low levels of AFP can be found in
the blood of a pregnant woman. No AFP (or
only a very low level) is generally found in
the blood of healthy men or healthy,
nonpregnant women.

39. PURPOSE
The AFP test is done to:
• Check the developing baby (fetus) of a
pregnant woman for brain or spinal
problems
• Check the developing baby (fetus) of a
pregnant woman for Down syndrome.
• Find certain cancers, especially cancer of
the testicles, ovaries, or liver

40. Contt..
• Check how well treatment for cancer is
working.
• Check for liver cancer (called hepatoma) in
people who have cirrhosis or
chronic hepatitis B.

41. PROCEDURE
The health professional drawing blood will:
• Wrap an elastic band around your upper
arm to stop the flow of blood. This makes
the veins below the band larger so it is
easier to put a needle into the vein.
• Clean the needle site with alcohol.

42. Contt..
• Put the needle into the vein. More than one
needle stick may be needed.
• Attach a tube to the needle to fill it with
blood.
• Remove the band from your arm when
enough blood is collected

43. Contt..
• Put a gauze pad or cotton ball over the
needle site as the needle is removed.
• Put pressure on the site and then a bandage.

44. RESULTS
• Alpha-fetoprotein in blood
• Men and nonpregnant women:
0-40 nanograms per milliliter (ng/mL)
or micrograms per liter (mcg/L)2
• Women 15-18 weeks pregnant:
10-150 ng/mL or mcg/L3

45. Contt..
• High values
In a pregnant woman, high alpha-fetoprotein
values can mean:
– The age (gestational age) of the baby is wrong.
– The woman is pregnant with more than one
baby, such as twins or triplets.

46. Contt..
– The baby has a neural tube defect.
– The baby's intestines or other abdominal
organs are outside the body (called
an abdominal wall defect or omphalocele).
Surgery after birth will be needed to correct the
problem.
– The baby is not alive.

47. Contt..
Low values
• In a pregnant woman, a low level of alpha-
fetoprotein can mean:
• The age (gestational age) of the baby is
wrong.
• The baby may have Down syndrome.

48. TRIPLE TEST
• The triple screening measures the amounts
of three substances in a pregnant
woman's blood: alpha-fetoprotein
(AFP), human chorionic
gonadotropin (hCG), and estriol (uE3). This
is also called the maternal serum triple, the
expanded AFP test, the AFP plus test, or the
multiple marker screening test.

49. Contt..
• Down syndrome

50. Contt..
• Spina bifida

51. Contt..
• Anencephaly

52. INDICATIONS
All pregnant women in the second trimester
(between weeks 15 and 22) are tested. Those
in the following categories are at a higher
risk:
• Women over 35 years old
• Those taking insulin for treating diabetes
• Women having a family history of birth
defects

53. Contt..
• Use of certain medications
• Exposure to high radiation levels
• Having complications, viral infections,
during pregnancy

54. PROCEDURE

55. Contt..
• Wrap an elastic band around your upper
arm. This makes the veins below the band
larger so it is easier to put a needle into the
vein.
• Clean the needle site with alcohol.
• Put the needle into the vein.
• Attach a tube to the needle to fill it with
blood.

56. Contt..
• Remove the band from your arm when
enough blood is collected.
• Put a gauze pad or cotton ball over the
needle site as the needle is removed.
• Put pressure on the site and then put on a
bandage.

57. RESULT
• A "positive" result means that there is a
higher-than-average chance ,baby has a
birth defect. If the result is "negative," or
normal, it means that baby probably doesn't
have a birth defect.

58. AMNIOCENTHESIS

59. Contt..
Amniocentesis is a prenatal test in which a
small amount of amniotic fluid is removed
from the sac surrounding the fetus for
testing. The sample of amniotic fluid is less
than one ounce.

60. INDICATIONS
Genetic diagnosis
Down syndrome (trisomy 21)

61. Contt..
• Patau syndrome (Trisomy 13)

62. Contt..

63. Contt..
• Edward's syndrome (Trisomy 18)

64. Contt..

65. Contt..
• Fragile X

66. Contt..

67. Contt..
• Rare, inherited metabolic disorders

68. Contt..
• Neural tube defects

69. Contt..
• Lung maturity

70. Contt..
Other
• Amniocentesis can also be used to detect
problems such as:
• Infection, in which amniocentesis can detect a
decreased glucose level, a Gram stain showing
bacteria or an abnormal differential count of
white blood cells.
• Rh incompatibility
• Decompression of polyhydramnios

71. PROCEDURE

73. Contt..
• The woman’s abdomen is cleaned with antiseptic.
• A fine sterile needle is guided through the
woman’s abdominal wall and the wall of the
uterus (womb) into the amniotic fluid.
• The path of the needle is watched by ultrasound.
• As the procedure is rapid, a local anaesthetic is
usually not necessary.

74. Contt..
• Most women say that the procedure is no more
painful than any type of injection. Some
women feel cramping when the needle enters
the uterus or pressure as the fluid is being
withdrawn.
• Once the needle is seen to be in the right place,
a small amount (about 20ml) of amniotic fluid
is taken out and the needle is withdrawn.
• The sample of amniotic fluid is sent to the
laboratory for testing.

75. Contt..
• The amount of amniotic fluid in the uterus
returns to normal within a few hours.
• Occasionally the doctor is unable to obtain
enough amniotic fluid on the first attempt.
If this happens, another sample may need to
be taken.

76. DRAWBACKS
• Amniocentesis is performed between the 15th and
20th week of pregnancy, performing this test
earlier may result in fetal injury.
• Complications of amniocentesis include preterm
labor and delivery.
• Chance of infection and miscarriage.
• Ethical problem arise when parents decide for an
abortion following the test results when there is a
baby girl in the womb of mother.
• It is expensive process.

77. CORDOCENTHESIS
• Cordocentesis, also sometimes called
Percutaneous Umbilical Cord Blood
Sampling (PUBS), is a diagnostic test
which examines blood from the fetus to
detect fetal abnormalities.

79. INDICATIONS
• High risk of chromosomal disorders (based
on biochemical screening);
• Identification of anomalies during fetal
ultrasound, which may be associated with
chromosomal diseases (eg, short femur,
hypoplasia of the nasal bone and other.);

80. Contt..
• The presence of the parents of hereditary
diseases, if they already have children with
congenital developmental disorders;
• Suspicion of Rhesus-conflict, intrauterine
infection;
• Suspicion of hemophilia;

81. CONTRAINDICATIONS
• Cordocentesis is contraindicated in infectious
processes, with cervical incompetence
(cervical insolvency), with large myoma
nodes (in the projection of the puncture) and
bleeding disorders in pregnant women.
Cordocentesis is also impossible to carry out
the threat of termination of pregnancy.

82. PROCEDURE

83. Contt..
• An advanced imaging ultrasound determines the
location where the umbilical cord inserts into the
placenta. The ultrasound guides a thin needle
through the abdomen and uterine walls to the
umbilical cord. The needle is inserted into the
umbilical cord to retrieve a small sample of fetal
blood.
• The sample is sent to the laboratory for analysis,
and results are usually available within 72 hours.

84. RISK AND SIDE EFFECTS TO
THE MOTHER OR BABY
• Miscarriage
• Other potential side effects include:
• Blood loss from the puncture site
• Infection
• Drop in fetal heart rate
• Premature rupture of membranes
• Contact your healthcare provider if these
symptoms remain or get worse.

85. Contt..
You should also contact your healthcare
provider if you experience:
• Fever

86. Contt..
• Chills

87. Contt..
• Leaking of amniotic fluid

88. COMPLICATIONS
• Bleeding from the puncture area
• Violation of the functional state of the fetus
as chorioamnionitis
• Alloimmune cytopenias (the baby)

89. CHORIONIC VILLUS SAMPLING

90. Contt..
• Chorionic villus sampling (CVS), sometimes
called "chorionic villoussampling" (as
"villous" is the adjectival form of the word
"villus"), is a form of prenatal diagnosis to
determine chromosomal or genetic
disorders in the fetus

91. INDICATIONS
• Possible reasons for having a CVS can
include:
• Abnormal first trimester screen results
• Increased nuchal translucency or other
abnormal ultrasound findings
• Family history of a chromosomal
abnormality or other genetic disorder

92. Contt..
• Parents are known carriers for a genetic
disorder
• Advanced maternal age (maternal age
above 35). AMA is associated with increase
risk of Down's syndrome and at age 35, risk
is 1:400. Screening tests are usually carried
out first before deciding if CVS should be
done.

93. PROCEDURE

94. Contt..
There are two ways samples are collected:
• Transcervical: An ultrasound guides a thin
catheter through the cervix to your
placenta. The chorionic villi cells are gently
suctioned into the catheter. This is the most
common method.

96. Contt..
• Transabdominal: An ultrasound guides a
long thin needle through the abdomen to
your placenta. The needle draws a sample of
tissue and then is removed. This procedure
is similar to that of amniocentesis.

98. RISK AND SIDE EFFECTS TO THE
MOTHER OR BABY
• Miscarriage
• CVS is not recommended for women who:
• Have an active infection (i.e. STD)

99. Contt..
• Are carrying twins

100. Contt..
• Have experienced vaginal bleeding
during pregnancy

101. Contt..
Transcervical CVS is not recommended for
women who:
• Have uterine fibroids

102. Contt..
• Have a tilted uterus which impedes the
catheter

103. Contt..
Following the procedure, the mother may
experience one or more of the following side
effects:
• Infection

104. Contt..
• Spotting

105. Contt..
• Cramping and pain at puncture point

106. Contt..
You should also contact to healthcare provider
if you experience:
• Fever

107. Contt..
• Chills

108. Contt..
• Leaking of amniotic fluid

109. RESULTS
• Normal: No abnormalities are found in the
genetic material of the chorionic villus cells.
• Abnormal: Abnormalities are found in the
genetic material of the chorionic villus cells.

110. THANK YOU