Diagnostic TestsULTRASOUNDUltrasoundPowerPoint PresentationAMNIOCENTESISSlide 6Slide 7Slide 8CHORIONIC VILLUS SAMPLINGSlide 10Chorionic Villi SamplingFETOSCOPYSlide 13Slide 14COMPUTER AXIAL TOMOGRAPHYNUCLEAR MAGNETIC RESONANCE IMAGINGFETAL ECHOCARDIAGRAPHYSlide 18NON-STRESS TESTNon-stress testSlide 21Slide 22Slide 23OXYTOSIN CHALLENGT TESTSlide 25Slide 26Slide 27Slide 28FETAL BIOPHYSICAL PROFILEFetal Biophysical ProfileMATERNAL SERUM STUDIES *** Some of these will be discussed in details throughout the courseTORCHAlpha-Fetoprotein Screening (AFP)Estriol LevelTriple-Marker ScreeningNow, also a Quadruple screenSummary findings:Other tests……THE END!!!!Diagnostic TestsDiagnostic TestsByByProf. Unn HidleProf. Unn HidleUpdated Spring 2010Updated Spring 2010ULTRASOUNDULTRASOUNDUltrasoundUltrasoundDescriptionDescriptionOutlines and identifies fetal and maternal structures Outlines and identifies fetal and maternal structures (uses high frequency sound-waves)(uses high frequency sound-waves)Assists to confirm estimated date of deliveryAssists to confirm estimated date of deliveryImplementationImplementationPreviously, the test used to be done with a full Previously, the test used to be done with a full bladder (drink 6-8 glasses of water pre-test), but with bladder (drink 6-8 glasses of water pre-test), but with high-tech ultrasound, it is usually no longer high-tech ultrasound, it is usually no longer necessarry. necessarry. Inform the client that the test presents no known Inform the client that the test presents no known risks to client or fetus risks to client or fetusAMNIOCENTESISAMNIOCENTESISDescriptionDescriptionAspiration of amniotic fluid done from 14 Aspiration of amniotic fluid done from 14 weeks of pregnancy and on weeks of pregnancy and on Performed to determine genetic disorders Performed to determine genetic disorders (after AFP), the sex of the fetus, and fetal (after AFP), the sex of the fetus, and fetal lung maturity (L/S ratio - lung maturity (L/S ratio - this is later in this is later in pregnancypregnancy))RisksRisksMaternal hemorrhageMaternal hemorrhageInfection Infection Rh isoimmunizationRh isoimmunizationAbruptio placentaeAbruptio placentaeAmniotic fluid emboliAmniotic fluid emboliImplementationImplementationInstruct client to Instruct client to empty bladderempty bladder before before procedureprocedurePrepare client for ultrasound, which is Prepare client for ultrasound, which is performed to locate the placentaperformed to locate the placentaObtain baseline vital signs and FHR, and Obtain baseline vital signs and FHR, and monitor every 15 minutesmonitor every 15 minutesPosition client supinePosition client supineInstruct client that if chills, fever, leakage of Instruct client that if chills, fever, leakage of fluid at the needle insertion site, decreased fluid at the needle insertion site, decreased fetal movement, or uterine contractions fetal movement, or uterine contractions occur, to notify the physician or health care occur, to notify the physician or health care providerproviderCHORIONIC CHORIONIC VILLUS SAMPLINGVILLUS SAMPLINGChorionic Villus Sampling (CVS)Chorionic Villus Sampling (CVS)DescriptionDescriptionAspiration of a small sample of chorionic villus tissue Aspiration of a small sample of chorionic villus tissue at at 8 to 12 weeks' gestation Test is performed for the purpose of detecting genetic Test is performed for the purpose of detecting genetic abnormalitiesabnormalitiesImplementationImplementationUsually, the client is instructed to drink water to fill Usually, the client is instructed to drink water to fill the bladder before the procedure to aid in the the bladder before the procedure to aid in the position of the uterus for catheter insertionposition of the uterus for catheter insertionInstruct the client to report bleeding, infection, or Instruct the client to report bleeding, infection, or leakage of fluid at insertion site after procedureleakage of fluid at insertion site after procedureRh-negative women may be given RhoGAM for risks Rh-negative women may be given RhoGAM for risks related to the procedurerelated to the procedureChorionic Villi SamplingChorionic Villi SamplingFETOSCOPYFETOSCOPYEndo-vaginal ultrasound used to Endo-vaginal ultrasound used to locate area to insert catheter into locate area to insert catheter into uterus through the maternal uterus through the maternal abdomen for skin and blood abdomen for skin and blood samples:samples:Percutaneous umbilical blood Percutaneous umbilical blood sampling (PUBS)sampling (PUBS)Fetal blood is used to help diagnose Fetal blood is used to help diagnose conditions such as hemophilia, conditions such as hemophilia, congenital rubella, toxoplasmosis, congenital rubella, toxoplasmosis, etc.etc.COMPUTER AXIAL COMPUTER AXIAL TOMOGRAPHYTOMOGRAPHY(CAT SCAN or CT SCAN)(CAT SCAN or CT SCAN)NUCLEAR MAGNETIC NUCLEAR MAGNETIC RESONANCE IMAGINGRESONANCE IMAGING(NMRI)(NMRI)FETAL FETAL ECHOCARDIAGRAPHYECHOCARDIAGRAPHY(EFM & IFM)(EFM & IFM)NON-STRESS TESTNON-STRESS TEST(NST)(NST)Non-stress testNon-stress testDescriptionDescriptionPerformed to assess placental Performed to assess placental function and oxygenationfunction and oxygenationDetermines Determines fetal well-beingEvaluates fetal heart rate (FHR) Evaluates fetal heart rate (FHR) in response to fetal movementin response to fetal movementImplementationImplementationExternal ultrasound transducer and the External ultrasound transducer and the tocodynamometer (toco) are applied to the tocodynamometer (toco) are applied to the mother and a tracing of at least 20 minutes’ mother and a tracing of at least 20 minutes’ duration is obtained so that the FHR and the duration is obtained so that the FHR and the uterine activity can be observeduterine activity can be observedObtain baseline blood pressure and monitor BP Obtain baseline blood pressure and monitor BP frequentlyfrequentlyPosition mother in the left lateral position to Position mother in the left lateral position to avoid vena cava compression (avoid vena cava compression (reality: reality: SUPINE!!!!)SUPINE!!!!)Ask mother to press a button every time she Ask mother to press a button every time she feels fetal movementfeels fetal movementThe monitor records a mark at each point of The monitor records a mark at each point of fetal movement, which is