diagnosis prenatal

Click here to load reader

Upload: andty-hardyanti

Post on 24-Jan-2016

53 views

Category:

Documents


1 download

DESCRIPTION

Diagnosis Prenatal

TRANSCRIPT

DIAGNOSIS PRENATAL

Deviana S. RiuPRENATAL DIAGNOSTIC

INTRODUCTIONPerinatal mortality rate in Indonesia 40-50/1000 live birth.This can be reduced if:Quality:Antenatal care eligible.Delivery is safe and cleanGood maternal healthPerinatal period: from 28 weeks pregnancy -1week Post Partum

Purpose:Is a fetus can continue living safely uterin intra? OrIs the fetus needs treatment and resuscitation intra uterin? OrFetal life is threatened and needs to be born

How to monitor the fetusClinicalBiochemistryGeneticFetal biophysical profilesClinical :Maternal weight gainMeasurement fundal height Maternal abdominal circumference Estimated fetal weightPalpation fetal position & locationFetal heart examinationState of maternal health

BiochemistryAlpha-fetoprotein levelsNTD14 to 22 weeksDepending on gestational age, multiple pregnancy, fetal death-hCGPregnancy-associated plasma protein A (Papp-A)Down SyndromeTrimester IEstriol: decrease : a sign of severe fetusThe ratio of lecithin-sfingomielin: assessing lung maturityHuman plasental lactogenic (HPL) < 4 gr/ml : sign of placental function decreased significantly only in the third trimester of pregnancySpektrometrik bilirubin levels in Rh immunizationCreatinine levels in the amnioticfetal renal functionDegree of acidity (pH) fetal blood.

GeneticAllegation of fetal anomaliesIndications:Maternal age> 35 yrsHave a family history of congenital abnormality or congenital diseaseThe existence of mental disorder or developmental disorder in the previous pregnancyA history of exposure to hazardous substances or teratogensAbortion habitualisInvasiveAmniocentesisTrimester I: 11 - 14 weeksBig riskAbortionAbnormalities in the fetus: fetal clubfoot (talipes)FailedTrimester II: 15 to 20 weeksChorionic villus sampling (CVS)Vili placenta10 -13 weeks Percutaneous umbilical cord blood sampling (PUBS) = cordocentesis = fetal blood samplingFaster results 24 - 48 hours

Advantages: can predict fetal condition which examined the metabolic products of the fetal and placenta. Levels were changed when there is interference with the circulation fetoplasenter.The disadvantage: the results take a long time , expensive and can be invasiveFetal biophysical profilesBased on the examination of patterns of motion and image of the fetus Simple by mother: feeling fetal movementpalpation and auscultation. ElectronicsFetoscopyUltrasonographycardiotocography

Examined are :Fetal breathing movements, fetal movements, fetal toneAbnormalities of shape, position, fetal biometryEstimated fetal weight and gestational ageNumber of amniotic fluid, state and location of the placenta.Pattern of fetal heart rate & ECGFetal movementState & fetal health can be judged from the activities of the fetus in the uterus.Subjective monitoring (mother):mothers were asked to monitor fetal movements 30-60 mins 3x /day.The drawback is a weak motion is not observed,which can be felt only 40-80%.Fetal heart rateFrekuensi denyut jantung basal Normal 120-160 /mntMild tachycardia160 -180/mnt.Severe tachycardia> 180/mnt.Bradikardia light 100-119/mntWeight Bradikardia