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Newborn Care

Fetus and Newborn Infant Fetal Assessment
Testing During pregnancy
Time (week) Assessment
Initial (as early as possible) Hemoglobin or hematocrit measurement

Urinalysis, including microscopic examination and infection screen

Blood group and Rh type determinations

Antibody screen

Rubella antibody titer measurement

Syphilis screen

Cervical cytology

Hepatitis B virus screen

8-18 Ultrasound

Amniocentesis

Chorionic villus sampling

Maternal serum alpha-fetoprotein

26-28 Diabetes screening

Repeat hemoglobin or hematocrit measurement

28 Repeat antibody test for unsensitized Rh-negative patients

Prophylactic administration of Rho(D) immune globulin

32-36 Ultrasound

Testing for sexually transmitted disease

Repeat hemoglobin or hematocrit measurement

Culture for Group B streptococcal colonization



Indications for Prenatal Diagnostic Testing for Birth Defects

Cytogenetic Indications
  1. Advanced maternal age (>35 yrs)
  2. Previous offspring with chromosome abnormality, especially trisomy
  3. Chromosome abnormality in either parent, especially translocation
  4. Need to determine fetal sex when there is a family history of serious X-linked disease
Single gene disorder in a sibling or carrier parent

Multifactorial disorder in first-degree relatives

Routine Assessment of Intrauterine Growth and Maturation

Document maturity and EDC

  1. Documentation of fetal heart tones for 30 weeks by Doppler ultrasound.
  2. 36 weeks of positive pregnancy test (HCG).
  3. Ultrasound examination documenting one of following:
    1. Crown rump length between 6-11 weeks
    2. Evaluation at 12-20 weeks that confirms clinical history and physical examination
Assessment of Continued Growth
  1. Crown rump length, femur length, chest and abdominal circumference, head circumference
Assessment of Pulmonary Maturity
  1. Presence of phosphatidylglycerol (PG) indicates maturity.
  2. A ratio of lecithin to sphingomyelin (L:S) ratio >2 is consistent with maturity
  3. Foam stability index: complete bubble ring indicates maturity
  4. Delta optical density 650 >0.15 indicates maturity
Assessment of Placental Integrity
  1. Ultrasound evaluation of placenta and fetus (location, size, morphology)
  2. Doppler Flow Studies. Assessment of blood flow velocity in uterus, placenta, cord vessels, and fetal aorta/carotid arteries. May be useful in conditions of compromised blood flow (eg, IUGR, hypertension, diabetes mellitus and postmaturity). Elevated systolic:diastolic umbilical artery velocity ratio, elevated pulsatility index and reduced end-diastolic flow velocity suggest fetal distress.
Periumbilical Blood Sampling (PUBS)
  1. HCT determination
  2. Rapid karyotype
  3. Platelet assessment
  4. Acid-base assessment
  5. Biochemical and serologic studies

Intrapartum Assessment