Check point of estimation of gestational age and viability of fetus

1. CHECK POINTS OF
ESTIMATION OF
GESTATIONAL AGE AND
VIABILITY OF FETUS
DR. ROBINA TARIQ
Associate Professor
DEPARTMENT OF OBS & GYNAE UNIT-I
SERVICES INSTITUTE OF MEDICAL SCIENCES /

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It is important to diagnose the pregnancy as
soon as possible, in order to
i) Determine the complications in early
pregnancy.
ii) Adverse drug exposure can be avoided in
early pregnancy.
iii) Exact dating or DOP will help to diagnose
prematurity, prolong pregnancy, IUGR or
macrosomia.

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DIAGNOSIS OF PREGNANCY
a) SYMPTOMS
1) Cessation of regular menstrual cycle.
2) Nausea & vomiting
3) Breast symptoms
a) Mastodynia or breast tenderness.
b) Enlargement of sebaceous glands of areola
(Montgomery’s tubercle)
c) Clostrum secretion after 16 weeks.
d) Darkening of areola

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4) Quickening – 16-20 weeks in multi para.
18-20 weeks in primigravida
5) Urinary Tract
a) Bladder irritability, frequency, noeturia, UTI
SIGNS OF PREGNANCY
1) ↑sed B.B.T (basal body temp.)
2) ↑sed pulse
3) Skin – Cholasma,,Linea nigera, Strech marks.

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Signs
1) Pelvic Organs
a) Chad wick sign
b) Hegar’s sign
2) Abdominal enlargement
3) Uterine contractions

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POSITIVE MANIFESTATIONS OF PREGNANCY
a) Fetal heart tones
b) Palpation of fetus
c) Ultrasound examination of fetus
d) Pregnancy test
– Serum pregnancy test (Serum
βhCG)
– Urine for pregnancy test

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HUMAN CHORIONIC GONADOTROPHIN
hCG is a glycoprotein which is exclusively
produced by the trophoblastic tissues.
βhCG is specific test for pregnancy and can
be detected in blood as early as six days after
fertilization.
It double every 36-48 hours and reaches a
peak at about 10 weeks which is 10,000-
100,000 i.u/24 hours.

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ESTIMATION OF GESTATIONAL AGE
It is an important part of antenatal care to
monitor the development of fetus and
associated complications.
i) By date of last menstrual period.
 Months
 Menstrual LMP, EDD and DOP
 Gestation Calendar

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ii) Level of serum HCG
iii) Clinical assessment of uterine size.
 P/V
 P/A – Symphisio fundal height can be
measured in cm and is equal to weeks of
pregnancy from 12-36 weeks.

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iv) Ultrasonography / dating scan
Benefits of dating scan are it reliably depicts
the gestational age in
 Irregular cycle
 Forgotten LMP
 Early diagnosis of twins
 Early diagnosis of miscarriages
 Reduce incidence of induction of labour

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PARAMETER ASSESSED ON ULTRASONOGRAPHY
 Size of gestational sac.

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 Crown Rump Length (CRL)

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 BPD (Biparietal Diameter), HC (Head
Circumference) FL (Femur Length)

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VIABLE OR NOT?
1) Cardiac activity on ultrasonography between
6-7 weeks of gestation.
2) Sonic aid and fetoscope to listen to fetal heart
beat.
3) Fetal movements - - - Cardiff’s count to 10.
4) CTG – trace
5) Biophysical profile - - - score is calculated by
visualizing the activity of fetus on
ultrasonography.

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PROCEDURES FOR
ASSESSMENT OF
FETAL STATUS

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SCREENING FOR FETAL PROBLEMS
1) Chromosomal abnormalities.
2) Structural defects.
3) Fetal infection
4) Disorders of fetal growth

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1) CHROMOSOMAL ABNORMALITIES
Non-invasive prenatal testing.
a) Nuchal-translucency (NT Thickness)
Done on ultrasonography between 11-14
weeks.
If > 2.5mm it suggests chromosomal
abnormalities.
b) Soft marker of aneuploidy on ultrasonography
e.g low set ears, double bubble sign.
c) Maternal serum screening
Alpha feto proteins (AFP)
AFP + Beta HCG.

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d) Fetal RBC’s / Fetal DNA is extracted from
maternal circulation. Its a new technology and
still under trial.

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CHROMOSOMAL ABNORMALITIES
Invasive prenatal testing.
a) Chorion villus sampling 10-14 weeks of
gestation.
Sample is placental tissue.
Culture is obtained on 10-14 days.

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b) Amniocentesis
Amniotic fluid is sampled
From 15 weeks onwards
Fibro blasts are cultured results obtained in 2-
3 weeks.
c) Cordocentesis
Fetal blood is sample
From 20 weeks onwards
Blood culture will yield results in 48 hours.

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2) STRUCTURAL ABNORMALITIES
a) Anomaly scan at 18 weeks.
b) 22 weeks scan

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3) INFECTIOUS DAMAGE TO THE
FETUS
a) Ultrasonography will show the signs of
infection e.g hydrops fetalis, venticularmegaly,
polyhydramnios and oligohydramnios.
b) Specific IgG and IgM in maternal serum.
c) Fetal sampling
Blood and liqour

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4) ASSESSMENT OF FETAL GROWTH
 History, Weight gain, uterine enlargment and
kick count.
 On examination – weight, fundal height, fetal
heart sounds.
Any associated risks to the pregnancy.
 Investigations – USG
CTG
Fetal Scalp Blood
Sampling in Labour

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