THE CONTROL OF THE FETUS

Nowadays it is possible to follow the development and the growth of the fetus by means of a series of examinations, many of them of simple and safe accomplishment, that they allow to make a pursuit rational of any pregnancy.
Between these examinations, but the current ones they are the echogram, the amnioscopy, the fetoscopy and the cardiotocograph.
The control of the health of the fetus in the normal pregnancy is reduced to few and simple verifications made during the obstetrical recognition.

AVERAGE OF CONTROL

The regular development of the uterus is a test of the growth of the fetus, and a fetus that grows well in the time is more likely a healthy fetus.
From 12ª week of gestation it is possible to verify the fetal beat cardiac by means of ultrasounds, and from 25-30ª week by means of estetoscopy. The beat cardiac of the fetus is a safe test of vitality.
The existence of fetal movements is also sign of good health; the mother would have to begin to notice did them 18ª week of gestation yes is multiple birth (this is, if it has already had other children) and towards 20-22ª week yes is first birth (that is to say, it has yes not had before any other son). The absence of movements during a whole day or a considerable reduction of such is an index of fetal suffering.
An examination which all the pregnant women would have to be put under, even for want of special indications, is the echogram.
In effect, one has demonstrated that this examination can as much show the normality of the fetus like pathological situations that otherwise hardly would be diagnosed, like anomalies of placental insertion, fetal diameters noncorresponding to the time of pregnancy or pregnancy to gemelar.
Thanks to the echogram can in addition diagnose some fetal malformations.

The period more indicated to make the echogram is of 18ª to 24ª week of gestation. In this period of time the relation fetus-I eliminate amniotic is the optimal one and the fetus is quite small, reason why it can easily be visualized and be studied in his totality. In addition, the parameters of measurement of the fetus (diameter of the head, torax diameter, abdominal circumference) are seen less influenced in this period that in following by defects or the excesses of development, reason why is possible to establish with enough exactitude in what moment of the gestation is the woman.
If the different visualized maternal and fetal parameters are normal, if fetal movements are detected and these are regular and yes also the echogram is normal, more complementary tests are not necessary. Only if the childbirth does not take place in the anticipated date, but that the pregnancy extends more time (gestation outside term), is necessary to make in alternating days, beginning by the anticipated date of the childbirth, a amnioscopy.

A metal tube is introduced by the uterine neck and it leans on the membranes that surround the fetus and, by means of an illumination system, is observed the color of the amniotic liquid.
If this one is sure it means that the fetus is well, if is of color (yellow, green), means that the fetus has emitted meconio, symptom of fetal suffering.
This examination is made in the pregnancies outside term because in them it is easier that the fetus undergoes some upheaval.

.In some pregnancies the fetus presents displays a greater risk than in the general population to undergo certain chromosomic anomalies, metabolic diseases, malformations or hereditary diseases of the blood (talasanemia). In these cases, between 16a and 18a week of pregnancy, can be made an amniocentesis, very useful for the diagnosis of the sex of the boy, chromosomic anomalies and certain metabolic defects.

Inasmuch as it concerns to the other types of anomalies, except the visualized ones by means of echogram (it pricks bifid, hidrocefaly, enanism, etc.), will be however necessary to carry out a fetoscopy, at the present time attainable examination in very little centers.
In the risk pregnancy, as much by bad maternal conditions as by development defects of the fetus or the placenta, the check tests must much more be strict.
The placenta is an organ not only with function of interchange between the mother and the fetus, but also with a hormonal function.
Clinically more important the placental hormones are the coriónica gonadotropina (HCG) and the lactogenoplacental hormone (HPL). The HCG is a hormone of very precocious appearance, to such an extent that is used in the gestation diagnosis.
In the threat of abortion and the abortion its hematic value diminishes until disappearing if the gestation is interrupted.
However, since the negativization of the pregnancy test can even take place 10-15 days after the interruption, the valuation of the HCG to diagnose the abortion already has been almost completely replaced by the echogram, that offers immediate results. It did the week 15ª of gestation begins to be valueable in blood the HPL. Normal levels of this hormone are indicative of a good placental functionality and therefore they indirectly confirm the good state of the fetus.
In the risk pregnancy the echogram also plays a role fundamental.
The accomplishment of echograms seriadas with measurement of the fetal diameters allows to value the fetal growth with much greater exactitude than by means of medical examination. A normal and regular growth in the time is indicative of good state of the fetus.
Another indispensable instrument of diagnosis is the cardiotocography. On a strip of mílimetrado paper they are registered two layouts, one that correspond to the detected fetal cardiac beat by means of ultrasounds, and the other to the pressure parallelly that exerts the uterus against a sensor applied on the abdomen.
If the layout is normal it means that the fetus is healthy and reacts normally to the stimuli (movement, contractions). The amnioscopy is a test of great validity and easy execution. In the pathological pregnancies tests along with is used others even before the end of the pregnancy.
However, since the risk of the amnioscopy is in the breakage of membranes, week is used only from 36ª.

The pursuit of a risk pregnancy must be made therefore in a hospital, resorting simultaneously to hormonal tests, cardiotUltrasound, Ultrasound and amnioscopy, aside naturally to cure the possible maternal disease.
All these controls are made generally in the third trimester of gestation, moment at which the fetal upheavals are evident and in which the result of the controls can orient the intervention of the dr.
If these controls indicate a fetal suffering or if the conditions of health of the mother put in danger the continuation of the pregnancy, the Caesarean one becomes necessary. Generally, to make it, week of gestation is expected to 34ª, when the fetus is already the sufficiently mature thing like having good possibilities of survival.
If on the contrary the conditions are so serious that to postpone the intervention until 34ª week it would suppose the death of the fetus or the precipitation of the maternal conditions, the operation will even be made before.

Tags: childbirth