Patients are tested between 24-28 weeks' gestation if they meet the low-risk criteria for gestational diabetes (25 years, normal weight, belonging to an ethnic group with a low prevalence of diabetes, no first-degree relatives with diabetes, no history of abnormal glucose tolerance, and no history of poor obstetric outcome). Patients with risk factors (>35 years, BMI >30, history of gestational diabetes, delivery of a large-for-gestational-age infant, polycystic ovarian syndrome, strong family history of diabetes) should have a plasma glucose screening at their first prenatal visit, followed by another at 24-28 weeks.
Blood glucose management is the most important factor impacting pulmonary maturity in diabetes moms' babies. Fetal lung development is not delayed in women who have adequate control. Phosphatidylglycerol (PG) promotes phospholipid distribution on alveoli and its presence signals advanced fetal lung development and function. The fetal lung maturity test measures surfactant levels in milligrams per gram of albumin. The test utilized is the AminoSTAT, which utilizes 55mg of surfactant/gram albumin as "mature." Lamellar bodies are lamellated phospholipids that constitute a surfactant storage form. Because lamellar bodies are comparable in size to platelets, a lamellar body count may be acquired quickly using a hematology analyzer's platelet channel. It is proposed that the fetal lung maturity cut off be 50,000 microliters. When combined with the PG test, the lecithin/sphingomyelin ratio is optimal. The PG represents the advanced stage of progressive lung development.
In the late second and early third trimesters, fetal fibronectin (fFN) is rare in cervicovaginal secretions. fFN is an extracellular glycoprotein that acts as an adhesive between the fetal membrane and the uterine wall and is damaged by inflammation. After a positive test result, a premature delivery within two weeks is likely. Cervical ferritin is an inflammatory marker, not a biomarker, and its presence supports the hypothesis that infection is a mediator of premature delivery. In both term and preterm pregnancies, maternal plasma corticotropin-releasing hormone concentrations are high. It appears to be a part of the same labor route regardless of gestation. Placental alpha-microglobulin-1 is a protein discovered to be a biomarker for membrane rupture.
Moderate fetal heart rate (FHR) variability is closely related with an arterial umbilical greater than 7.15. Normal FHR variability gives confidence concerning fetal health and the absence of metabolic acidemia. FHR variability is the most accurate predictor of fetal well-being. Variability is the most significant single FHR attribute. Regardless of gestational age, the FHR baseline is 110 to 160 bpm. Decelerations are caused by head compression, umbilical cord compression, or a temporary disruption in oxygen delivery. The nonstress test is based on accelerations, which are strongly predictive of the absence of fetal metabolic acidemia. They occur in tandem with fetal movement.
According to the biophysical profile (BPP), more variables are a stronger predictor of outcome than fewer ones. Each indication receives a value of 0 if it is missing or 2 points if it is present, and management is based on the overall score. A score of 10 suggests that fetal hypoxia is quite improbable. For the remaining components, the BPP consists of a nonstress test employing an electronic fetal monitor and real time restricted ultrasonography to watch the fetus. Fetal tone, fetal movement, fetal breathing, the nonstress test, and the amniotic fluid index are among the components. The BPP does not account for fetal posture or heart rate.
Premature membrane rupture is one of the most prevalent pregnancy problems that results in an infant being admitted to the NICU. AmniSure ROM is a bedside immunoassay test that is straightforward, easy to conduct, quick (5-10 minutes), and less invasive. This test detects a placental glycoprotein that is rich in amniotic fluid but low in maternal blood and cervicovaginal secretions. Prolactin is in charge of priming the breast tissue in preparation for lactation, whereas Alpha-fetoprotein is used to detect neural tube abnormalities (high) and Down Syndrome (low). Fetal fibronectin is an extracellular glycoprotein that acts as an adhesive between the fetal membranes and the uterine wall and is used to predict premature delivery.
When women give birth upright, their PCo2 levels are lower than when they give birth supine. A supine position during labor should be avoided to minimize maternal hypotension and to increase uteroplacental blood flow to keep the fetus pH within normal ranges. Women who give birth in an upright position have higher pH and PO2 values. A normal pH, PO2, and PCo2 should suggest a normal base excess.
