Beruflich Dokumente
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Prepared by Mrs. Gauri Manohar M.Sc Nursing Previous Govt. College of Nursing Indore (M.P.)
Radiology in Obstetrics
Radiology, is a medical specialty that employs the use of imaging to both diagnose and treat disease visualised within the human body.
Principles of Radiology in Obstetrics Benefits of radiation must outweigh the risks of the procedure. Minimum radiation dose to be used. Appropriate field shielding should be done. First trimester should preferable be avoided. Benefits and safety of Ultrasonography must be considered as an alternative.
Fetal
Diagnosis of Pregnancy Multiple Pregnancy Malpresentations
Hydramnios
Intrauterine Death of the fetus Congenital malformation of the fetus and neonates and birth injuries Fetal Maturity
Maternal
Patient having cardiopulmonary disease may require X- ray chest during pregnancy and that should be done beyond 12 weeks. X- ray pelvimetry is of limited value in assessing cephalopelvic or fetopelvic disproportion.
Radiation Hazards
Tetratogenecity
Oncogenecity
Genetic Damage
Intra Uterine Death
CT Scan
CT scans may be safely obtained with little or no exposure to the fetus.
Fetal exposed to conventional pelvimetry by computed Tomography is 0.23-1.3 rad
MRI
Of little value for fetal assessment. But it can be used to study maternal anatomy e.g. pelvimetry.
CAUTION
Radiation during pregnancy can damage the early phase of embryo .
The risk can be minimised by using the 10 day rule. No woman should be exposed to X- ray for a non urgent indication outside 10 days from her last period during reproductive period.
Amniocentesis
Amniocentesis is the deliberate puncture of the amniotic fluid sac per abdomen.
Diagnostic Early months (14-16 weeks)Antenatal diagnosis of chromosomal and genetic disorder (a) Sex linked disorders, (b) Karyotyping (c) Inborn errors of metabolism (d) Neural tube defects .
Later Months Fetal Maturity Degree of fetal haemolysis in Rh sensitised mother Meconium staining of liquor- An evidence of fetal distress. Amniography or fetography- following instillation of radio-opaque dye in the amniotic fluid cavity.
Procedure
After emptying the bladder ,the patient remains in dorsal position. The abdominal wall is prepared aseptically and draped. The proposes site of puncture is infiltrated with 1% lignocaine.
Precautions Prior sonographic localisation of placenta is desirable to prevent bloody tap and fetomaternal bleeding. Prophylactic administration of 100 mg of anti-D immunoglobulin in Rh-negative non-immunised mother. Hazards are reduced significantly when it is done under direct ultrasound control compared to blind procedure.
Hazards
A) Maternal complications are Infection. Haemorrhage (placental or uterine injury) Premature rupture of the membranes and premature labour. Maternal isoimmunisation in Rh negative cases.
B)
Fetal Hazards areAbortion(1%) Trauma Feto-maternal Haemorrhage. Oligohydramnios due to leakage of amniotic fluid that may lead to a) Fetal lung hypoplasia and Respiratory distress.
Ultrasound in Obstetrics
Obstetric ultrasonography is the application of medical ultrasonography to obstetrics, in which sonography is used to visualize the embryo or fetus in its mother's uterus (womb).
Uses of Ultrasonography
Diagnosis and confirmation of early pregnancy. Vaginal bleeding in early pregnancy. Determination of gestational age and assessment of fetal size. Diagnosis of fetal malformation. Placental localization. Multiple pregnancies. Hydramnios and Oligohydramnios. Other areas.
Clinical Tests during Pregnancy Urine Examination Heat and acetic acid test: Dipsticks (Alubstix) Test for Sugar -Benedicts Test and Dipsticks Test for Acetone Clot observation test (Weiner) Peripheral Blood Smear.
Cord Blood Samples To get a true picture ,the sample should be taken by opening the Kochers forceps from the placental end of the cord as early as possible .
Samples are taken specially of babies born of Rhnegative mothers. 10 ml of cord blood should be collected in a heparinised tube.
Cardiotocography In medicine (obstetrics), cardiotocography (CTG) is a technical means of recording (-graphy) the fetal heartbeat (cardio-) and the uterine contractions (-toco-) during pregnancy, typically in the third trimester.
The machine used to perform the monitoring is called a cardiotocograph, more commonly known as an electronic fetal monitor (EFM).
Baseline fetal heart rate Abnormal baseline is termed bradycardia when the baseline FHR is less than 110 bpm; it is termed tachycardia when the baseline FHR is greater than160 bpm.
Rubella Test
Done for German Measles-(Rubella). If there is history of exposure to an infected individual, ideally, rubella status should be determined prior to getting pregnant