Biochemical Methods Obg

NIGHTINGALE INSTITUTE OF NURSING NOIDA
SEMINAR
ON
TOPIC: BIOCHEMICAL METHODS OF FETAL WELL BEING

SUBJECT: OBSTETRICS AND GYNAECOLOGY
SUBMITTED TO: SUBMITTED BY:

Ms. RENUKA MAM Ms. RUPALI ARORA
LECTURER MSc. NURSING FIRST YEAR
NIGHTINGALE INSTITUTE OF NIGHTINGALE INSTITUOF
NURSING NOIDA NURSING NOIDA
OBJECTIVES
GENERAL OBJECTIVE : At the end of the class group will be able to have knowledge about
the biochemical methods of fetal well being which is necessary for their department.
SPECIFIC OBJECTIVES :
 Introduction of biochemical method

 Aims of biochemical method
 Indications of fetal monitoring
 Assessment in early pregnancy
 Various biochemical methods
 Biochemical analytes
 MSAFP explaination
 Triple test
 Amniocentesis
 CVS
 Cordiocentesis
 Conclusion
 Bibliography
INTRODUCTION
Biochemical markers are used to assess maternal, placental and fetal health. They help to
diagnose and monitor maternal conditions such as gestational diabetes, fetal chromosomal
abnormalities, trophoblastic disease ,neural tube defect etc.These biochemical tests constitute
only one aspect of obstetric care. They should be used together with clinical findings and
imaging, ;particularly USG. Majority of fetal deaths occur in the antepartum period. Hence
antenatal assessment is mandatory for fetal well being.
The primary objective of antenatal assessment is to avoid fetal death.
AIMS:
 To ensure satisfactory growth and well being of the fetus throughout pregnancy.
 To screen out the high risk factors that affect the growth of the fetus.
 To detect those congenital abnormalities or inborn metabolic disorders during early
pregnancy.
INDICATIONS FOR FETAL MONITORING

 Pregnancy with obstetrics complications.
 Pregnancy with medical complications.
 Routine antenatal testing.
ASSESSMENT IN EARLY PREGNANCY
BIOCHEMICAL
METHOD
CYTOGENIC
METHOD BIOPHYSICAL
METHOD
BIOCHEMICAL METHODS
Various biochemical methods are:
1. MSAFP (maternal serum alpha fetoprotein)

2. Triple test
3. Amniocentesis
4. Chorionic villus sampling
5. Fetal blood sampling (cordocentesis)
BIOCHEMICAL ANALYTES
1. MSAFP
2. Inhibin A
3. Others include hCG,uE3,PAPP
MATERNAL SERUM ALPHA FETOPROTEIN

 AFP is an oncofetal protein.
 It is produced by yolk sac and fetal liver.
 Highest level of AFP in fetal serum and amniotic fluid is reached around 13 weeks
and thereafter it decreases.
 Maternal serum level reaches a peak around 32 weeks.
MSAFP LEVEL IS ELEVATED IN A NUMBER OF CONDITIONS:

 wrong gestational age.
 Open neural tube defects.
 Multiple pregnancy.
 IUFD
 Anterior abdominal wall defects
 Renal anomalies
Low levels are found in trisomies (down’s syndrome) and gestational
trophoblastic disease.
MSAFP is done between 15 to 20 weeks. Elevated MSAFP detects 85%

of all neural tube defects. Cases with such high values are considered
for high resolution USG or amniocentesis. Very low levels are
associated with increased rates of miscarriage, stillbirth and neonatal
death.
TRIPLE TEST
 It is a combined test which includes MSAFP, hcg and Ue3.
 It is used for detection of Down syndrome.
 In an affected pregnancy, levels of MSAFP and uE3 tend to be low while
that of hCG is high.
 It is performed at 15-22 weeks.
 It gives a risk ratio and for confirmation CVS/amniocentesis has to be done.
 The result is considered to be screen positive if the risk ratio is 1:250 or
greater.
AMNIOCENTESIS
WHAT IS AN AMNIOCENTESIS?
Amniocentesis is a procedure performed usually in the beginning of pregnancy to

examine a baby’s chromosomes. During this procedure, amniotic fluid is removed
for testing. Cells within the amniotic fluid are examined in the lab to test for
specific fetal disorders. The entire amniocentesis appointment last approx. for 45
minutes most of which involves a detailed ultrasound examination.
WHO IS OFFERED FOR THIS ?
Amniocentesis is offered for:

 A woman who will be 35 years old or more at time of delivery.
 A couple with a child or other family member with a chromosome
abnormality or a neural tube defect.
 A woman with positive screening test result.
 A couple in which one of the partner has a chromosome rearrangement.
 A couple wityh increase risk of having a child with genetic disease for which
testing is available.
WHAT CAN BE DETECTED THROUGH AN AMNIOCENTESIS?

 Nearly all chromosome disorders, including Down syndrome as well as sex
chromosome abnormalities such as turner syndrome and Klinefelter
syndrome.
 Neural tube defects such as spina bifida.
 Several hundred genetic disorders such as cystic fibrosis and sickle cell
disease. The test is not used to look for all of them, but if your baby is at
increased risk for one or more of these disorders, in most cases amnio can
usually tell you whether he has the disease.
 INCRESED LEVEL OF AFP: open body defect such as anencephaly,
myelomeningocele, or omphalocele.
 DECREASED LEVEL OF AFP: chromosomal defect such as Down
syndrome.
IS THERE ANY RISKS WITH AN AMNIOCENTESIS?
There is a natural miscarriage rate throughout pregnancy. Although its often

estimated to be between one in 200 and one in 400. There’s no real
consensus on the actual risk of miscarriage due to amniocentesis. One large
recent study estimated the risk to be as low as one in 1600.
HOW IS IT PERFORMED?
DURING THE PROCEDURE:
 Firstly the health care provider will use ultrasound to determine the
baby’s exact location in your uterus.
 Patient will lie on her back on an exam table and expose your
abdomen.
 Health care provider will apply a gel to the abdomen and then use a
small device known as an ultrasound transducer to show your baby’s
position on the monitor.
 Health care provider will clean the area with an antiseptic solution.
 Guided by USG health care provider will insert a thin, hollow needle
through your abdominal wall into the uterus. A small amount of
amniotic fluid will be withdrawn and the needle will be removed.
 Patient need to lie still while the needle is inserted and the fluid is
withdrawn.
AFTER THE PROCEDURE:
 After amniocentesis, health care provider will continue using the

ultrasound to monitor baby’s heart rate.
 Patient might experience mild discomfort after the procedure nd
asked to avoid strenuous exercise and sexual activity for a day or
two.
 Contact your health care provider if any loss of or vaginal bleeding
or loss of amniotic fluid through the vagina , fever , redness and
inflammation where the needle was inserted , unusal fetal activity
or lack of fetal movement.
CHORIONIC VILLUS SAMPLING
WHAT IS CVS?
 CVS is the removal of a small piece of chorionic villi from the uterus during
early pregnancy to screen the baby for genetic defects.
 In 1983 an italian biologist named Giuseppe Simoni discovered it.
INDICATIONS
 Abnormal first trimester screen results.

 Increased nuchal translucency or other USG findings.
 Family history of a chromosomal abnormality or other genetic disorder.
 Advanced maternal age (above 35 ).
AMA is associated with increase risk of Down syndrome risk is 1:400.
PROCEDURE
Two ways : 1. Transcervical 2. Transabdominal
Preparation of the patient : An abdominal USG is performed to determine the

position of the uterus, the size of the gestational sac, and the position of the
placenta within the uterus. Vulva, vagina, cervix and abdomen are cleaned with an
antiseptic.
TRANSABDOMINAL : it is performed by inserting a needle through the abdomen

uterus to reach placenta with the help if USG guided images.
It can be performed from 10 weeks to term.
TRANSCERVICAL: it is performed by inserting a thin plastic tube through vagina

and cervix to reach placenta with the help of USG guided images.
Performed between 10 weeks to 12 weeks.
 Sample collected are sent to lab for direct preparation and culgture in special
fluids.
 The sample is used to study the DNA, chromosomes , certain signs of
disease in the developing baby.
 It can be done sooner than amniocentesis, about 10 to 12 weeks after last
menstural period.
 Test results take about 2 weeks.
RESULTS
Normal results means there are no signs of any genetic disorder.
Abnormal results suggest: down syndrome, sickle cell anemia , sex linked
disorder muscular dystrophy.
More than 200 genetic disorders can be identified.

It does noty detect neural tube defects, rh incompatibility, congenital defects.
RISKS
 Miscarriage 1:100
 Infection
 Spotting
 Cramping and pain at puncture point
 Bleeding
 Rupture of membrane
CONTRAINDICATIONS
 Women who have an active infections (STD)

 Carrying twins
 Have experienced vaginal bleeding during pregnancy
 Having uterine fibroid
 Having tilted uterus.
CORDOCENTESIS
WHAT IS CORDOCENTESIS?
It is also known as PERCUTANEOUS UMBLICAL BLOOD SAMPLING. It is as

diagnostic prenatal test in which a sample of the baby’s blood is removed from the
umbilical cord for testing.
It is done after 18 weeks of pregnancy and can be used to detect genetic disoreder,
blood conditions and infections.
It is also used to deliver blood and medication to a baby through the cord.
PURPOSE
All the information as obtained in amniocentesis or CVS coiled be gathered.

Additional values are mentioned below:
 Hematological : for fetal anaemia, bleeding disorders
 Fetal infections: toxoplasmosis, viral infections.
 Fetal blood gas and acid base status
 Fetal therapy : blood transfusion
RISK
1. Fetal bleeding
2. Cord hematoma
3. Slowing of the baby’s heart rate
4. Infection
5. Fetal matenal bleeding
6. Maternal infection
7. Pregnancy loss.
PROCEDURE
During the procedure
 About 30 to 60 minutes before the procedure, patient might be given

antibiotics to reduce the risk of uterine infection. This is usually done
through a tube inserted into a vein.
 Health care provide use USG to determine the umbilical cord’s location in
the uterus.
 Guided by USG health care provider will insert a thin hollow needle though
abdominal wall into the uterus. A small amount of blood from the vein in the
umbilical cord will be withdrawn into a syringe and than needle is removed.
After the procedure

 After the sample is taken patient might experience cramping or small
amount of discomfort.
 Baby’s heart rate is monitored.
 Health care provider suggest rest for the remaining day and ask to resume
normal activites from the next day.
 Call your health care provider for vaginal bleeding or fluid leakage.
CONCLUSION
As we have discussed the biochemical methods of fetal well being .
Biechemical methods like amniocentesis , CVS , cordiocentesis are very useful in early detection of
genetic disorders and these can reduce the risk of birth of abnormal child. These screening test are thus
available for all pregnant women. There is progressive decline in maternal deaths all over the world.
Currently more interest is focused on fetal health hence, all these tests are important for fetal well
being.
BIBLIOGRAPHY
 Textbook of obstetrics by Hiralal Konar , DC
Dutta’s , JAYPEE publications pg no : 128 to 131.
 Textbook for midwives 15th edition MYLES , edited
by Diane M. Fraser and Margaret A. Cooper pg no:
303-305
 Mayo clinic’s

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NIGHTINGALE INSTITUTE OF NURSING NOIDA

TOPIC: BIOCHEMICAL METHODS OF FETAL WELL BEING

SUBMITTED TO: SUBMITTED BY:

 Introduction of biochemical method

The primary objective of antenatal assessment is to avoid fetal death.

INDICATIONS FOR FETAL MONITORING

ASSESSMENT IN EARLY PREGNANCY

1. MSAFP (maternal serum alpha fetoprotein)

MATERNAL SERUM ALPHA FETOPROTEIN

MSAFP LEVEL IS ELEVATED IN A NUMBER OF CONDITIONS:

MSAFP is done between 15 to 20 weeks. Elevated MSAFP detects 85%

Amniocentesis is a procedure performed usually in the beginning of pregnancy to

WHO IS OFFERED FOR THIS ?

Amniocentesis is offered for:

WHAT CAN BE DETECTED THROUGH AN AMNIOCENTESIS?

IS THERE ANY RISKS WITH AN AMNIOCENTESIS?

There is a natural miscarriage rate throughout pregnancy. Although its often

AFTER THE PROCEDURE:

 After amniocentesis, health care provider will continue using the

CHORIONIC VILLUS SAMPLING

 Abnormal first trimester screen results.

Two ways : 1. Transcervical 2. Transabdominal

Preparation of the patient : An abdominal USG is performed to determine the

TRANSABDOMINAL : it is performed by inserting a needle through the abdomen

It can be performed from 10 weeks to term.

TRANSCERVICAL: it is performed by inserting a thin plastic tube through vagina

Performed between 10 weeks to 12 weeks.

Normal results means there are no signs of any genetic disorder.

More than 200 genetic disorders can be identified.

 Women who have an active infections (STD)

It is also known as PERCUTANEOUS UMBLICAL BLOOD SAMPLING. It is as

All the information as obtained in amniocentesis or CVS coiled be gathered.

During the procedure

 About 30 to 60 minutes before the procedure, patient might be given

After the procedure

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