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Prenatal and Neonatal Assessment

Prenatal and Neonatal Assessment. PSY 417. Prenatal Diagnostic Tests. 98% of all tests indicate an unaffected fetus. Alpha-fetoprotein (AFP) test. Maternal blood test to assess level of AFP – substance produced only by fetus In typical pregnancy, some AFP found in mom’s blood.

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Prenatal and Neonatal Assessment

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  1. Prenatal and Neonatal Assessment PSY 417

  2. Prenatal Diagnostic Tests • 98% of all tests indicate an unaffected fetus

  3. Alpha-fetoprotein (AFP) test • Maternal blood test to assess level of AFP – substance produced only by fetus • In typical pregnancy, some AFP found in mom’s blood. • If fetus has open abdominal wall or neural tube defect, AFP leaks into amniotic fluid and then maternal bloodstream • Elevated AFP levels – risk of neural tube defects • Lower levels – higher risk of Down Syndrome (20% of DS can be detected this way)

  4. Ultrasound/Sonogram • Uses sound waves to produce moving image of fetus • Sound waves penetrate body and are reflected back as “echoes” • Allows visualization of placenta, fetal body parts, movement • Can diagnose major malformations

  5. Ultrasound/Sonogram • Early in pregnancy • Viable Pregnancy? • Ectopic Pregnancy? • Multiple Pregnancy? • After 16-18 weeks • To detect large birth defects • Sex of baby

  6. 10 Weeks

  7. 16 weeks

  8. 25 Weeks

  9. 33 Weeks

  10. Chorionic Villi Sampling (CVS) • Obtain biopsies of chorion: outermost membrane surrounding embryo • Transabdominal needle or transcervical catheter • Genetic testing of embryonic cells – fetal karotype

  11. Amniocentesis • 14-18 weeks • Withdraw 1-2 ounces of fluid • Karotype • Slight risk of miscarriage

  12. Amniocentesis

  13. Apgar test • Virginia Apgar (1909-1974) • Studied anesthesia in childbirth • At the time, doctors focused on mother, not baby • Do new drugs depress infant respiration?

  14. Apgar test • Developed new test to be given in first minute of life • Appearance • Pulse • Grimace (reflex irritability_ • Activity • Respiration • Scoring 0-10 (2 points per subscale) • “Nobody, but nobody stops breathing on me!” • Virginia Apgar

  15. Nuchal Translucency • Between 11 and 14 weeks • Accumulation of fluid behind fetal neck • Size can indicate chromosomal abnormality80% effective for detecting DS • If combined with blood test, 90% effective for detecting DS

  16. Neonatal Behavioral Assessment Scale • Infants 3 days to 4 weeks of age • Neonatal Competence • 28 behavioral items • 18 reflexes • Assumptions of NBAS • Infants are highly capable when born • Infants communicate through behavior • Infants are social organisms

  17. NBAS • Widely used as research tool • Used a tool to help parents understand their infants • Prematurity, substance-exposure • Drawbacks as assessment tool • No norms • No real “scores” • No predictive validity

  18. Neurobehavioral Assessment of the Preterm Infant (NAPI) • Measures the maturity of preterm infants between 32 weeks post-conceptional age and term.

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