Foetal Measures &

Biochemicals
Presenting By
Ms. Juhi Labana
F.Y. Msc Nursing

Foetal
Measures

Foetal biometric parametersare

antenatal ultrasound measurements
that are used to indirectly assess the
growthandwellbeingofthefetus.

Standard Parameters

Biparietaldiameter(BPD)
Headcircumference(HC)
Abdominalcircumference(AC)
Femurlength(FL)

Additional parameters are

following:
Humourslength(HL)
Renalpelvis/foetalpyelectasis
(FP)
Trans-cerebellardiameter(TCD)
Occipito-frontaldiameter(OFD)
Intraoculardistance(IOD)
Binoculardistance(BOD)

Ratios:
foetalcardio-thoraciccircumf
erenceratio
foetalthoracictoabdominal
circumferenceratio
foetalthoracictohead
circumferenceratio

1.Biparietal diameter (BPD):

Thetransversewidthoftheheadatit's
widest.
Wemeasurebetweentheparietal
eminenceoneachsideofthehead.

2.Head circumference (HC)

HCismeasuredatthesamelevel
asthebiparietaldiameter,aroundthe
outerperimeterofthecalvarium.
This measurement is not
affected
by
head
shape.

3.FEMUR AND HUMERUS LENGTH

The long bones are measured with the bone
acrossthebeamaxis.
The strong acoustic shadow behind the
femoral or humeral shaft and the visualisation
of both cartilaginous ends indicates that the
image plane is on the longest axis and is the
optimalmeasurementplane.
Thecallipersareplacedalongthediaphyseal
shaftexcludingtheepiphysis.

4.ABDOMINAL CIRCUMFERENCE
Thesemeasurementsaremoreappropriately
used in the assessment of foetal growth,
particularly in the second half of the
pregnancy, than in the assessment of
gestationalage.
It is an appropriate measurement in the
second trimester to demonstrate normalfoetal
proportions.
The abdominal circumference is measured
attheleveloftheliverandstomach,including
theleftportalveinattheumbilicalregion.

5.Foetal weight estimation

Foetal weight can be estimated by obtaining
measurements such as the biparietal
diameter, head circumference, abdominal
circumference or average abdominal
diameter, and femoral diaphysis length.
Results from various prediction models can
be compared to foetal weight percentiles
frompublishednomograms.

Itisnowrecommendedthatallpregnantwomen
haveadatingscaninthefirsttrimester-ideally
at10to13weeksofpregnancy-toconfirmyour
dates. This is especially important if you are
going
to
have
any
screening
testsforDown'ssyndrome,asknowingtheexact
dates makes sure your result is accurate. Most
hospitals offer a scan in the second trimester at
about20weeks(theanomalyscan)tocheckthat
yourbabyisdevelopingnormally.

There are many parts of the uterus,

placenta, amniotic fluid, and the fetus
examinedduringtheanatomicultrasound
examination around 20 weeks of the
pregnancy.

Foetalcardiacactivity,foetalnumber,and
presentation..
Aqualitativeorsemiquantitativeestimate
of amniotic fluid volume should be
reported.

Placenta
Theplacentallocation,appearance,and
relationshiptotheinternalcervicalos
shouldberecorded.Theumbilicalcord
shouldbeimaged,andthenumberof
vesselsinthecordshouldbeevaluated
whenpossible.

Gestational (menstrual) age assessment.

First-trimestercrown-rumpmeasure-ment
is the most accurate means for
sonographic dating of pregnancy. Beyond
this period, a variety of sonographic
parameters such as biparietal diameter,
abdominal circumference, and femoral
diaphysis length can be used to estimate
gestational(menstrual)age.

Head, face, and neck Cerebellum

Choroid plexus Cisterna magna Lateral
cerebral ventricles Midline falx Cavum
septipellucidiUpperlip.Ameasurementof
the nuchal fold may be helpful during a
specificageintervaltosuggestanincreased
riskofaneuploidy.

Chest
The basic cardiac examination includes a
4-chamber view of the foetal heart. If
technically feasible, views of the outflow
tracts should be attempted as part of the
cardiacscreeningexamination.

Abdomen: Stomach (presence, size, and

situs); Kidneys; Bladder; Umbilical cord
insertion site into the foetal abdomen;
Umbilicalcordvesselnumber

Spine: Cervical, thoracic, lumbar, and

sacralspine

Extremities: Legs and arms: presence or

absence

Sex: Medically indicated in low-risk

pregnancies only for evaluation of
multiplegestations.

BIOCHEMICAL TEST
FOR FOETAL

1.Human estriol
2.Maternal serum alpha feto protein
3.Acetyl choline esterase
4. Triple test
5.Amniocentesis
6.Cordocentesis
7.Chorionic villi sampling

Human estriol:Normal estriol production is dependent on a

physiologicallynormalfetusandplacenta.
Estriolcanbemeasuredinmaternalbloodor
urine and can be used as a marker of foetal
healthandwellbeing.
A value above 12 mg indicates foetal well
beings, while value between 4 and 12 mg
indicate foetal jeopardy (exposure to or
imminence of death, loss, or injury), Growth
retardation, foetal distress and Placental
insufficiency.

Maternal serum alpha feto protein:AFPisanalfafetalprotein(Molecularweight

70,000).
ThenormalAFPconcentrationinliquoramnii
at16thweekisabout20mg/L
Itisproducedbyyolksacandfoetalliver.
Highest level of AFP in foetal serum and
amniotic fluid is reached around 13 weeks and
thereafteritdecreases.
Maternal serum level reaches a peak around
32weeks.

MSAFPleveliselevatedinnumberof
followingcondition;
Wronggestationalage
Openneuraltubedefect
Multiplepregnancy
Rhimmunization
Intrauterinefoetaldeath
Anteriorabdominalwalldefect
Renalanomalies'

MSAFPlevelislowfoundinfollowing
condition;
Downsyndrome
Gestationaltrophoblasticdisease
Thistestisdonebetween15-20weeks.
AFP testing is sequence of tests. The first
twoarefrommaternalserumandthefinaltest
isofamnioticfluid.
Elevated MSAFP detects 85% of all neural
tubedefects.

Acetyl choline esterase:

Acetylcholinesterase,alsoknownasAChEor
acetylhydrolase.
Itistheprimarycholinesteraseinthebody.
Itisanenzymethatcatalyzesthebreakdown
of acetylcholine and of some other choline
estersthatfunctionasneurotransmitters.
Amniotic fluid AChE level is eleveted in
mostcaseofopenneuraltubedefects.

Triple test:
It is a combine biochemical test which
includes
MSAFP,
hCG,
and
UE3(unconjugatedoestriol).
ItisusedfordetectionofDownsyndrome.
In an affected pregna, level of MSAFPand
hUE3tendstobelowwhilethatofhCGlevel
ishigh.
Itisperformedat15-18weeks.

Amniocentesis:
Amniocentesis is a procedure, where in
amniotic fluid is aspirated by insertion of a
needleintotheamnioticcavity.
Itisusuallyperformedat16weekofgestation.
Itisdonefordetectfollowingcondition;
Chromosomalabnormalities
Sex-linkeddisorder
Autosomalrecessivedisorder
Singlegenedisorder.

Ithelpinassessmentoffoetallungmaturity
Italsohelpindiagnosisoffetalneuraltube
defect
Ithelpinrelievethehydramnios.

Cordocentesis:
Itisprocedurewhereinumbilicalcordblood
isaspiratedbytheinsertionofspinalneedle(A
22 gauze spinal needle 13 cm length) through
the maternal abdominal and uterine wall under
realtimeultrasoundguidance.
The needle tip is progressed carefully and it
puncturestheumbilicalveinapproximately1-2
cm.fromtheplacentalinsertion.
Generally0.5-2mlbloodiscollected.

ItalsoknownasPercutaneousumblicalblood
sampling.
It used to diagnose the variety of fetal
disorders.
It used in rapid karyotyping of fetus which
suspectedtohavechrosomalabnormalities.

Chorionic villus sampling:

Thechorionicvillussamplecanbecollected
by putting a thin flexible tube (catheter)
through
thevaginaandcervixinto
the
placenta. The sample can also be collected
through a long, thin needle put through the
belly into the placenta.Ultrasoundis used to
guide the catheter or needle into the correct
spotforcollectingthesample.

It is a form of prenatal diagnosis to

determinechromosomalorgeneticdisordersin
thefetus.
It may also be done when the maternal age
35 year it increases the chance ofhavinga
babywithachromosomedefect.
It is carried out transcervically between 1012weekofgestation.
Chorionic villi are tiny finger-shaped
growthsfoundintheplacenta.

Thank you