Fetal Assessment

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Fetal Assessment

Perinatal Diagnosis
Maliheh Kadivar MD Division of Neonatology Departm
ent of Pediatrics Tehran University of Medical
Sciences
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• With recent advances in perinatal medicine the
  pregnant woman her fetus are increasingly been
  viewed as two treatable patients
• Fetal medicine is now well-established and offers
  a wide range of medical as well as surgical
  diagnostic therapeutic modalities

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Fetal Assessment
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Fetal Radilogy
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Fetal Ultrasound
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3D Fetal Ultrasound
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New Generations of Ultrasound
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nucal cord translucency
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Fetal MRI
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Fetal Echocardiography
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Doppler Ultrasound
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Perinatal Diagnosis of Fetal Disease
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Screening by Maternal Serum

• Maternal serum alpha-fetoprotein (MSAFP)
• Unconjugated estriol (UE)
• B-human chorionic gonadotropin (B-HCG)
• Pregnancy associated protein (PAPPA)
• First trimester serum screening
• Triple panel
• Quad panel
• Second trimester screening

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Maternal Screening

• Blood type (ABO Rh) antibody screen
• Complete blood count (CBC)
• Fasting blood sugar/Glucose tolerance test
• Infectious screening
• Group B streptocococcus (GBS)
• Hepatitis B virus (HBV)
• Syphilis
• Rubella
• .
• Drug screening

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Perinatal Intervention
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Chorionic Villi Sampling
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Pericutaneous Umbilical Blood Sampling
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Fetal Genetic Assessment
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Multidisciplinary Team

• Family counseling
• Maternal transport
• Planned delivery
• Timing
• Mode
• Location
• In utero treatment

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Fetal Management
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Legal Abortion
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Possible Risks

• Further damage
• Prematurity
• Membrane seperation

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Achilles heel of Fetal Therapy

• Appropriate surveillance
• Treatment of preterm labor
• Prompt neonatal care

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Ethical Issues

• Fetal therapy involve a complex assessment of the
  best interests of the fetus and a pregnant
  woman's interest in her own health and freedom
  from unwanted invasion of her body
• In recommending fetal therapy of proven efficacy,
  physicians should respect maternal choice and
  assessment of risk
• If the woman refuses to undergo an intervention
  that poses a risk to her health and well-being,
  her choice and assessment of risk should be
  respected
• Fetal therapy of unproven efficacy should only be
  undertaken as part of an approved research
  protocol

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Common Reasons for Preconception/Prenatal
Genetics Consultation

• Mother will be 35 years or older at delivery
• Abnormal results from a triple marker screen or
  fetal ultrasound
• Personal or family history of a known or
  suspected genetic disorder, birth defect, or
  chromosomal abnormality
• Exposure to a known or suspected teratogen
• Mother has a medical condition known or suspected
  to affect fetal development
• Two or more pregnancy losses
• Close biological relationship of parents
• Ethnic predisposition to certain genetic
  disorders

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