King Faisal University

College of Applied Medical Sciences

Respiratory Care Department
MSRT411: Perinatal and Pediatric Respiratory Care

Antenatal Assessment
Ghazi Alotaibi, PhD, RRT

Lec04-Sep26
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 What do we mean by …….

Antenatal Assessment??

 Why is it important?
Determines the wellbeing of the newborn and
chance for survival (mother history)
 Maternal History and Risk Factors

 Comprehensive maternal history and physical

examination is important to point out the risk
factors.
 Risk factors can be related to mother, during
pregnancy, during labor and delivery, or after
delivery.
 Antenatal assessment starts with determination of
risk factors.
 Better knowledge about risk factors better
preparation to care for the patient.
 Risk Factors
Preterm Birth:
 What is considered preterm??
 The second greatest cause of morbidity and
mortality in neonates.
 Previous preterm birth increases the subsequent
preterm birth:
 1 prior = 15% of subsequent preterm birth.
 2 prior = 32% of subsequent preterm birth.
 Risk Factors
Incompetent Cervix:
 Caused by cervical trauma, previous surgery, or
may be congenital.
 Usually leads to membrane rupture and
premature delivery.
 If severe, a suture around the cervical canal is
performed.
 Risk Factors
Maternal Smoking and Alcohol
Intake:
 In the US, about 10% of pregnant mothers smoke,
drink alcohol or use drugs.
 Maternal intake of alcohol leads to fetal growth
problems.
 Smoking HBCO decreases availability of
oxygen to placenta and fetus.
 Risk Factors
Maternal Hypertension
 Complicates 6-8% of pregnancies in the US.
 Hypertension during pregnancy (after W24) is
termed: Preeclampsia.
 Preeclampsia (High BP, proteinuria, edema)
 Can lead to placental abruption, and preterm
delivery.
 Risk Factors
Diabetes:
 Increase the risk for CV and CNS malformations,
and metabolic disturbances.
 When appears during pregnancy (Gestational
Diabetes Mellitus, GDM).
 Treatment: glycemic control.
 Risk Factors
Infections Diseases:
 Infections can be transmitted to fetus.
 Early screening and detection of the infection is
important.
 Complicated by the rupture of the membrane.
 Risk Factors
 Problems in Placenta, UC, and
Fetal Membrane:
 premature rupture : causes 50% of preterm
births in the US.
 UC : Prolapse, short, single artery (3%)
 Placental problems (see lec. # 3)
 Antenatal Assessment
ULTRASOUND
 Save as compared to radiography.
 Uses high frequency sound waves.
 Hand-held transducer is placed directly over the
mother’s abdomen, and reflected waves are
recorded on screen image.
 Can give valuable information about pregnancy
and fetus (see next slide).
Clinical Uses of Ultrasound
 Identify pregnancy.
 Determine fetal age.
 Observe amniotic fluid
abnormalities.
 Detect fetal anomalies.
 Identify placental abnormalities.
 Determine fetal position.
 Examine fetal HR, and RR
 Antenatal Assessment
AMNIOCENTESIS
 Is the procedure of obtaining a sample of amniotic
fluid.
 Usually performed after W15 (w15-20).
 A needle is inserted through the skin and uterine
wall to the amniotic sac.
 Insertion is guided by Ultrasound.
 Sample from amniotic fluid is obtained for analysis.
 Very safe procedure (complication rate <1%).
 What Info can be obtained by doing
Amniocentesis???
1. Diagnosis of Genetic and Chromosomal
Disorders.
Eg. Down, sickle cell.
By analyzing cells in the amniotic fluid.
2. Lung Maturity Test.
 L/S Ratio:
(>2 indicates lung maturity)
Falsely high if sample contaminated.
 S/A Ratio:
>70: mature lung
 What Info can be obtained by doing
Amniocentesis???

3. Identification of Meconium Staining:

 Meconium (greenish, thick) is passed to amniotic
fluid due to fetal asphyxia.
 If aspirated collapse or hyperinflation.

 Common in postterm fetus (40% in >42 wks)

 Antenatal Assessment
FETAL HEART RATE (FHR) MONITORING
 Heart starts to beat between W16-W20, but beats
can be detected as early as W8.
 Normal 120-160 bpm.
 Becomes very common test.
 Use:
To determine fetal distress.
 How?
External transducer/electrodes OR electrode over the fetal
scalp.
FHR Monitoring
 FETAL HEART RATE (FHR) MONITORING
 FHR is monitored during uterine contraction.
 During normal contraction (nonstress test NST, and
during contraction stress test CST).

NST CST
(positive result) (positive result)
FHR rises => 15 beats per No late deceleration of FHR is
minute at least 15 s with mother’s seen with each contraction
feeling of fetal movement
 FETAL BIOPHYSICAL PROFILE (FBP)
 Assessment of fetal well-being suing ultrasound.
 8-10 normal
 6 : repeat after 24 hrs.
 0-4: abnormal, requires careful evaluation and maybe
immediate delivery.
Reading Assignment
 Risk Factors
Czervinske p20-24.

 AntenatalAssessment
Kent p31-46.