CARBOHYDRATE METABOLISM

1. First trimester pregnancy scans CARBOHYDRATE METABOLISM

2. The purpose of this is to establish: 1• that the pregnancy is viable and intrauterine (not ectopic) 2• to measure the NT if the gestation is appropriate and screening for Down syndrome 3• to accurately define the gestational age 4.to determine fetal number (and chorionicity or amnionicity in multiple pregnancies) 5• to detect gross fetal abnormalities, such as anencephaly (absence of the cranial vault).

4. -Early ultrasound scanning is beneficial, in reducing the need to induce labour for post maturity -A gestation sac can usually be visualized from 5 weeks' gestation and a small embryo from 6 weeks. Until 13 weeks - gestational age can be accurately assessed by CRL measurement (the length of the fetus from the top of the

5. head to the end of the sacrum). • -Care must be taken to ensure that the fetus is not flexed • at the time of measurement. • - Mothers are asked to be a full bladder, this • aids visualization of the uterus at an early gestation.

6. Dealing with increased nuchal translucency • -A nuchal translucency of >3.5 mm occurs in about 1% of pregnancies • -Increased NT is associated with a risk • of chromosomal abnormalities & other structural abnormality (mainly cardiac)

7. Second trimester ultrasound scans After 13+6 weeks of pregnancy, gestational age is primarily assessed using the head circumference (HC).

8. The detailed fetal anomaly screening scan -performed at 18–20+6 weeks of pregnancy. The purpose of this scan is @to reassure the mother that the fetus has no obvious structural anomalies that fall into the following categories: • anomalies that are incompatible with life; • anomalies that are associated with significant morbidity and long-term disability; • anomalies that may benefit from intrauterine therapy; • anomalies that may require postnatal treatment or investigation.

9. @show fetal position, multiple pregnancy, fibroids or maternal obesity may mean that a second scan before 23 weeks is offered. @ Some structural problems do not have sonographic signs that would be visible at this gestation or even at all. Anal atresia does not have a clear appearance on ultrasound; hydrocephalus and other bowel obstructions may not appear until later in pregnancy.

11. 18+0 to 20+6 weeks fetal anomaly ultrasound scan base menu -Spine, vertebrae and skin covering in transverse and longitudinal sections. • Head and neck: Head shape and internal structures cerebellum,ventricular size at atrium). Nuchal fold. Face and lips. • Thorax: Four-chamber view of heart, cardiac outflow tracts, lungs. • Abdominal shape and content – at level of the stomach with small portion ofintrahepatic vein, abdominal wall, renal pelves, bladder.

12. • Limbs: Arms – three bones and hand (metacarpals). Legs – three bones and foot (metatarsals). • Placental location and amniotic fluid. -Some features on ultrasound may be seen that increase the risk of another problem such as Down syndrome. -An increased skin fold measurement of >6 mm at the level of the nuchal fold (an associated increase in the risk for Down syndrome of at least 10-fold. -Mild cerebral ventriculomegaly should be noted as there is again an increased risk of chromosomal abnormalities of about 10%.

13. Echogenic bowel can be seen in cases of 1- cystic fibrosis 2- fetal infection 3-growth restriction 4- mild renal pelvis dilatation (>7 mm) can progress to significant hydronephrosis.

14. Advantages and disadvantages of fetal anomaly scans -Care must be taken to ensure that parents are fully informed of the purpose,benefits and limitations of ultrasound scans before they consent to this procedure -need sufficient expertise -faced with difficult and unexpected decisions, - allows parents the choices that would be denied without this knowledge.

15. many parents are offered reassurance The mother can then give birth in a unit with appropriate facilities. -reduce morbidity in cases of gastroschisis, cardiac abnormalities and intestinal obstruction - careful planning regarding place of birth, care of the baby after birth - multidisciplinary support can be provided. -has the capacity to cause great anxiety and distress.

16. what is gastroschisis an abdominal wall defect, adjacent to the umbilicus, allowing the intestines and other abdominal organs to protrude outside the body),

17. New and emerging technologies Fetal imaging techniques u\s neurological scanning Magnetic resonance imaging (MRI) has also been applied in the examination of the fetus This technique has not been widely applied because ultrasound can give similar diagnostic information at a lower cost.

18. -MRI has been effective when examining the brain. may provide additional information and change the counselling and management for a significant number of pregnancies where brain abnormalities are suspected -MRI offers to postmortem following termination or perinatal death.

19. - MRI imaging has been used to refine the diagnosis of many other conditions including diaphragmatic hernias and sacrococcygeal teratomas

21. Free fetal DNA identifies free fetal DNA in thematernal circulation. to identify fetal sex, blood group and some genetic disorders. - testing for Down syndrome

22. Screening for maternal conditions 1-Infectious diseases all pregnant women are screened for: • HIV • syphilis • hepatitis B (HBV) .rubella. Rubella screening cannot reduce the risk if a mother develops the illness but allows immunization in the future to reduce risk.

23. Human immune deficiency virus (HIV) -Knowledge and adequate management of women with HIV can reduce mother to child transfer to less than 1% and improve maternal health. - Screening should be offered at booking and again later in pregnancy in women at high risk

24. 1- women who are paid for Sex 2- women who have an untested partner from an area of high prevalence, 3-intravenous drug users. 4-Women who decline screening should also be re-offered testing later in pregnancy.

25. Hepatitis B (HB) -Adequate immunization programmes for infants at risk of vertical transmission of HBV can reduce infant infection rates by 90% and improvements in maternal health -Referral to a specialist is required for women who are found to be hepatitis B positive. -Establishing the neonatal and maternal risk will be determined by testing of antibody and antigen status and viral DNA levels. -Occasionally hepatitis B can reactivate in pregnancy and knowledge of status can aid management of the pregnant mother.

26. Syphilis -Syphilis is a rare infection -Treatment of syphilis can prevent 1-pregnancy loss 2- congenital syphilis 3- long-term problems for the mother. - A positive screening result does not distinguish between syphilis and other treponemal infections

27. Rubella Screening to avoid of potentially infected individuals during pregnancy and to offer postnatal vaccination. For the above infections, testing in early pregnancy is recommended. the midwife should discuss the following • The infections that are screened for, their routes of transmission and the implications of a positive test. •

28. The benefits, to both mother and baby, • The results procedure, including the feedback of results and the possibility of a false negative or false-positive result. • All pregnant women should be advised that if they develop, or are exposed to, a rash during the pregnancy

29. -in labour can be urgently screened. -Women with a positive result for syphilis, HIV or HBV should be seen and counselled as soon as possible and within 10 days - Appropriate referrals should then be made to ensure that the correct care pathway is inducted. -Screening for infectious diseases in pregnancy can be cultural and social stigma -The midwife needs to have enough knowledge to understand the disease, the process following a positive test and the ability to answer questions or direct women to the answers.

30. Thank you