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ANTENATAL FETAL MONITORING

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					ANTENATAL FETAL
  MONITORING

          SALWA NEYAZI

CONSULTANT OBESTETRICIAN GYNECOLOGIST
 PEDIATRIC & ADOLESCENT GYNECOLOGIST
     ANTENATAL FETAL MONITORING
WHAT IS THE AIM OF MONITERING?
 To  perinatal morbidity & mortality (outcome of asphyxia)
 It should guide future care
       Reassurance
       More frequent testing
       Admission to hospital
       Delivery

WHICH PATIENTS ARE EXPECTED TO BENEFIT FROM
  THIS TESTING?
Patients at risk
  IUGR                        DM
   fetal movement            Insulin requiring GD
  Post-term pregnancy > 42 wk PPROM
  Preeclampsia / Ch HPT       Ch (stable) abruption
     ANTENATAL FETAL MONITORING

WHEN TO INITIATE TESTING?
 Insulin requiring GD/DM  32- 36 wk
 Post dated pregnancy  41-42
  fetal movement  instantly
 Other conditions  variable according to severity & GA

WHAT IS THE FREQUENCY OF TESTING?
 Depends on the perceived risk of fetal asphyxia
 If risk persists  1-2 /wk
 Some times daily in the premature fetus  to aid timing
 of delivery “max GA” / avoid significant morbidity
    ANTENATAL FETAL MONITORING

WHAT ARE THE AVAILABLE TESTING TECHNIQUES?
 Fetal movement
 Nonstress CTG
 Contraction stress test
 BPP
 Fetal umbilical artery Doppler
                     METHODS OF ANTENATALTESTING



                                 Fetal movement




Selective counting ↑ risk   +       Standard inquiry FM    Routine counting




Cardiff       Sadovsky




                             No difference in  mortality
                      METHODS OF ANTENATALTESTING



                                   CTG

            Non stress test                     Stress test




Non reactive       Reactive               +ve   Suspecious        -ve




 Continue
 Another                         BPP            Perinatal Mortality
  20 Min                                           Within 1wk
                                                  1.2/1000 birth
                              50% of
                              N fetus
Non reactive                   <28
                         METHODS OF ANTENATALTESTING



                                                     Cerebral pulsy risk
                                         BPP         4.7/10001.3/1000


          Amniotic                                               3FM
           fluid
                                  Tone          FBM
                                               30 SEC
   N AF        AF

    +                +                   NST
                           6/10

   6/10        8/10
                                     Term      Deliver


                                     PreT                Intensive Survilence
Equivocal       Repeat
                       METHODS OF ANTENATALTESTING



                                 Umbilical          Only for
                                 Doppler             ↑ risk

           End diastolic                                        IUGR
              Flow                                               PET
                                                               CH HPT
                                         PNM
                                          38%
                                        In ↑ risk
Reversed                   N

              Absent

 PNM                           PNM
 75%                            4%
                PNM
                41%
INTRAPARTUM FETAL
    MONITORING
   INTRAPARTUM FETAL MONITORING

WHAT ARE THE METHODS AVAILABLE FOR FETAL
 MONITERING IN LABOR?
 Electronic fetal heart monitoring External or internal
 Intermittent auscultation
 Fetal scalp sampling  PH determination
 Color of the amniotic fluid

WHAT IS THE AIM OF MONITERING ?
 To  the risk of intrapartum fetal asphyxia
 Improve perinatal morbidity & mortality
INTRAPARTUM FETAL MONITORING

                       All Pt in
                      Active labor


     Intermittent                     Contiuous
     ascultation                        CTG
                                                       + PV 40%
                                                      False + 50%

                     No difference in
                    Neonatal outcome

                                                  False – 1.4%


                                      Dublin
                                     seizures
CONTINUOUS FHR MONITORING


   External                       Internal

                  DISAVANTAGES               ADVANTAGES


               Rupture of membranes            Chance of picking
                   Scalp infection              Maternal pulse
              Transmission of Hepatitis      True representation of
                                                   Variability
                                              Technically easier
    CONTINUOUS FHR MONITORING

WHAT ARE THE FEATURES OF A NORMAL TRACING?
 Baseline 110-160 BPM
 2 Accelerations > 15 BPM > 15 sec / 20 min trace
 Variability > 5 BPM (10-25)
 No decelrations
                        ABNORMALITIES OF FHR TRACING


   Decelrations

                                   Absence of                                     Bradycardia
                                                           Tachycardia
                                  accelerations
         Variability

                                                              >160                <100 BPM
                            1st   feature to indicate         BPM
             <5BPM                                                                 >3 Min
                                  Fetal hypoxia


For 20 Min        For 40 Min           For 90 Min         Infection      Cord prolapse
    N             Suspicious           Abnormal         Maternal fever   ↑↑ Uterine cont
                                                           Ritodrin      Maternal BP
                                                        Fetal anemia     Rapid descent in labor
 Sleep                   Hypoxia
                                                        Fetal hypoxia    Abruption
 cycle            Narcotics / Mg Sulfate
                        CNS abn                                          Congenital heart block
                              DECELRATIONS



             Early                                                   Late

                                    Variable

          Physiologic                                        After the contraction
   Fetal head compression                                 Uteroplacental insufficiency
Mirror image of the contraction                             Fetal asphyxia/acidosis
    FH<60 BPM< 60 sec                                         Worst prognosis


                               Cord compression
                             Not related to the cont
                          Variable duration & degree of
                                 FHR depresiion
MANAGEMENT OF FHR ABNORNMALITIES

WHAT ARE THE FACTRS THAT INFLUENCE OUR
 MANAGEMENT?
 Parity
 Cx dilatation
 Rate of progress of labour
 Associated high risk factors
                         -Thick meconium
                         -Scanty amniotic fluid
                         -IUGR
                         -IU infection
                         -Preterm
                         -Postdates
MANAGEMENT OF FHR ABNORNMALITIES

WHAT ARE THE 1ST STEPS OF MANAGEMENT?
 P/V  To asses progress of labor
 Change of position of the mother  Lt lateral position
 Oxygen by face mask
 Rehydration / IV fluids
 Stop Syntocinon
 Ritodrin in case of hyperstimulation

WHAT IS SUPINE HYPOTENSION SYNDROME?
                    MANAGEMENT OF FHR ABNORNMALITIES

                                                        Absence                    VD
            Absence                                 Of Accelerations          With mnious
        Of Accelerations             Sinusoidal            +                      signs
                                                       Variability
               +1                                       > 90 Min
                                               Late                     Bradicardia
                                            Decelrations
Variability                  Variable                      Shallow dec +
 >40 Min                    Decelerations                  Var + Absence
                                                           of accelerations
               Abnormal
               baseline


                                                           ABNORMAL
               Suspecious                                     FHR
                  FHR


                                                            Deliver
                 FBS
                FBS



         ≥7.2          <7.2




Persistant
   FHR                        Deliver
Abnormality




  Repeat                                Instrumental
                      CS
 20-30 Min                                delivery

				
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posted:8/13/2011
language:English
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