The Prenatal Care
It is very essential to the overall health of the neonate and the mother. The common considered elements of prenatal care include assessing the patient, performing prenatal testing, providing nutritional care, and minimizing the discomforts of pregnancy. However, that isn’t where prenatal care ends – or, should we say, where it begins.
The pregnancy first trimester assessment of the fetus prenatally uses direct and indirect monitoring techniques. Common tests include fetal heart rate (FHR) monitoring, ultrasonography, fetal activity determination, CVS, fetoscopy, Non-stress test and prepartum contraction stress test. Most of these screening tests are done to mother at 1st trimester.
Fetal Heart Rate
You can obtain the FHR by placing a fetoscope or Doppler stethoscope on the mother’s abdomen and counting fetal heartbeats. Simultaneously palpating the mother’s pulse helps you to avoid confusion between maternal and fetal heartbeats.
A fetoscope can detect fetal heartbeats as early as 20 weeks of gestation. The Doppler ultrasound stethoscope, a more sensitive instrument, can detect fetal heartbeats as early as 10 weeks of gestation and remains useful tool throughout labor.
Fetal Activity Determination
The activity of the fetus (kick counts) determines its condition in utero. Daily evaluation of movement provides an inexpensive, noninvasive way of assessing fetal well-being. Decreased activity in previous active fetus may reflect a disturbance in placental function.
As early as 7 weeks of gestation, the embryo can produce spontaneous movements; however, these movements don’t become apparent to the mother until sometime between the 14th and 26th weeks (but generally between 18 and 22 weeks). The first noticeable movement of the fetus by the mother is called quickening. The acknowledgement of fetal movements may be delayed if the due date is miscalculated or if the mother does not recognize the sensation.
During pregnancy, the mother is monitored routinely for potential problems. Some problems may be detected by a simple urine test. The urine specimen should be obtained from the patient during her regularly scheduled visit using a clean-catch technique. The specimen is examined for bacteriuria (bacteria in the urine) as well as protein, glucose, and ketones. Urinalysis can detect such problems as infection or diabetes before the mother shows any signs.
Maternal Serum Assays
Serum assays – including estrogens, human placental lactogen (hPL), and hCG – are used in addition to urinalysis to monitor the pregnant mother for problems.
This is a procedure done during the first trimester in which fetoscope – a telescope-like instrument with lights and lenses – is inserted into the amniotic sac, where it can view and photograph the fetus. This procedure makes it possible to diagnose, through blood and tissue sampling, several blood and skin diseases that amniocentesis can’t detect. Fetoscopy is a relatively risky procedure and, because other safer techniques are becoming available to detect the same disorders, it isn’t widely used.
During 1st trimester, blood studies are ordered to assess the mother’s health, screen for maternal condition that may endanger the fetus, detect, and monitor the fetal well-being. Initial studies include blood typing, a complete blood count (CBC) with differential, antibody screening tests, and a serologic test for syphilis and gonorrhea. Other tests may be performed to assess the Alpha Fetoprotein (AFP) levels, blood glucose, and other chemicals, if indicated.
The AFP testing – sometimes called the MSAFP test or maternal serum AFP test – is usually used to detect neural tube defects. AFP is a protein that is secreted by the fetal liver and excreted in the mother’s blood. When testing by immunoassay, AFP value is (less than 15 ng/ml) for non-pregnant women.
Performed by a specially trained nurse, a prepartum NST evaluates fetal well-being by measuring the fetal heart response to fetal movements. Such movements produce transient accelerations in the heart rate of a healthy fetus. Usually ordered during the third trimester of pregnancy, this non-invasive screening test used indirect electronic monitoring to record FHR and the duration of the uterine contraction. It is indicated for suspected fetal distress or placental insufficiency associated with maternal conditions.
Contraction Stress Test
The prepartum CST evaluates respiratory function of the placenta and indicates whether the fetus will be able to withstand the stress of labor. Performed by a specially trained nurse, this test uses indirect electronic monitoring to measure fetal heart response to spontaneous or oxytocin-induced uterine contractions. The CST is indicated when the NST fails to produce reactive results.
Contraindicates to the CST include the flowing maternal conditions:
- Preterm labor or preterm membrane rupture;
- Multiple pregnancy;
- Previous vertical cesarean delivery;
- Abruption placentae.