Presentation on theme: "FETAL MONITORING ANTE AND INTRAPARTUM"— Presentation transcript:
1 FETAL MONITORING ANTE AND INTRAPARTUM DR. OSHINOWOM.B;B.S, FRCOGOBSTETRICIAN/GYNAECOLOGIST
2 INTRODUCTION The aim of ANC Identifying risks factors Ensure maternal well beingEnsure Fetal well beingIdentifying risks factorsMonitoring of certain parameters ie Weight, BP, Urinalysis, Blood sugar (if necessary)
4 PHYSICAL FUNDAL HEIGHT SMALL FOR DATE LARGE FOR DATE OLIGOHYDRAMNIOS IUGRIUDLARGE FOR DATEMULTIPLE GESTATIONPOLYHYDRAMNIOSFIBROIDS
5 ULTRASONOGRAPHY Comes in 2D, 3D and recently 4D modes Demonstrates features like Fetal anatomy, fetal weight, fetal movement, placental location, amniotic fluid volumeHelpful in specialized procedures like amniocentesis, Chorionic villus sampling, Biophysical profile, Fetal doppler, Fetal echocardiogram etc
6 GROWTH ULTRASOUND Performed every 3 to 4 weeks Fetus at risk of fetal growth restrictions secondary to medical conditions of pregnancy or fetal abnormalities
7 FETAL MOVEMENT ASSESSMENT Normal: 10 movements/fetal kicks in 12 hours (Cardiff count to ten)Decreased fetal movement may precede fetal death by daysMothers should be encouraged to keep a FKC especially in high risks patientscre
8 NON STRESS TEST (NST) Assesses fetal movements with FHR acceleration Reactive/Reassuring NST: 2 or more FHR accelerations at least 15 bpm above the baseline lasting at least 15 secs in a 20 mins periodNon reassuring NST may suggest fetal acidosisWhat to do depends on gestational age
9 BIOPHYSICAL PROFILE (BPP) Composes of 5 componentsNon stress test (NST)Amniotic Fluid Volume (vertical pocket of 2cm or more)Fetal breathing movements (30 secs or more in 30 mins)Fetal movements (3 or more in 30 mins)Fetal tone (Extension/Flexion of an extremity)Each carry a score of 2 points, a total of 8 or 10 is Normal, 6 is Equivocal, and 4 or less is abnormal
10 MODIFIED BIOPHYSICAL PROFILE Combines Non stress Test + Amniotic Fluid Index (AFI)AFI is measured by dividing the uterus into 4 quadrants and measuring the largest vertical pocket in each quadrant; the result summed up in millimetersA nonreactive NST + AFI less than 50mm requires further intervention
11 CONTRACTION STRESS TEST (CST) Rarely used todayMeasures the response of Fetal HR to contractionsThe test requires 3 contractions in 10 minsA positive or Abnormal test results in decelerations in more than half of the contractionsNegative result: no deceleration with the contractionsContraindication : Any case where labour not allowed
12 DOPPLER STUDIES Assesses multi-vessel evaluation of fetal status Can be used to assess a compromised fetus i.e growth restrictionFunctions as a diagnostic tool that alerts the clinician
14 Baseline Fetal Heart Rate (FHR) Is the mean level of the FHR when this is stable, excluding accelerations and decelerationsIt is determined over a time period of 5-10 minutes, expressed as beats per minute (bpm)NOTE: Preterm fetuses tend to have values towards the upper end of the normal range
16 Baseline Variability Is the minor fluctuation in baseline FHR It is assessed by estimating the difference in bpm between the highest peak and lowest trough of fluctuation in one minute segments of the traceUterine activity Normal variability is reassuring Sign that fetus nervous system is intact
18 2 types of VariabilityShort- Term variability or Beat to Beat variabilityIs the difference between successive heartbeats or the momentLong Term VariabilityIs wider fluctuationsOver one (1) minute that causes wavy appearance in the monitorAbsent - No fluctuation Minimal - 5 bpm or less Moderate/Normal – 5bpm to 25
19 AccelerationsAre transient increases in FHR of 15bpm or more above the baseline and lasting 15 seconds.Accelerations in preterm fetuses may be of lesser amplitude and shorter duration.
20 DecelerationsAre transient episodes of decrease of FHR below the baseline of more than 15 bpm lasting at least 15 seconds, which are:Early, Variable and DelayedTime relationships with contraction cycle may be variable but most commonly occur simultaneously with contractions.
21 EFM Decelerations Decelerations- transient slowing of FHR below the baseline level ofmore than 15 bpmand lasting for 15 sec.Or more.
22 Early DecelerationUniform,repetitive decrease of FHR withslow onset early in the contraction andslow return to baseline by the end of the contraction
24 Late decelerationsUniform, repetitive decreasing of FHR with, usually,slow onset mid to end of the contraction andnadir more than 20 seconds after thepeak of the contraction and ending afterthe contraction
28 Prolonged Decelerations Decrease of FHR below the baseline of more than 15 bpm for longer than 90 seconds but less than 5 minutesIs pathological when crosses 2 contractions i.e 3 minsReduction in Oxygen transfer to placentaAssociated with poor neonatal outcome
30 Prolonged Decelerations CAUSES Cord prolapse.Maternal hypertensionUterine HypertoniaFollowed by a VE or ARM or SROM with High presenting part
31 Normal antenatal CTG trace The normal antenatal CTG is associated with a low probability of fetal compromise and has the following features:Baseline fetal heart rate (FHR) is between bpmVariability of FHR is between 5-25 bpmDecelerations are absent or earlyAccelerations x2 within 20 minutes
32 Non-reassuring CTG trace Is where any of the following is present:The presence of two or more features is considered abnormal as these may be associated with fetal compromise and require further actionBaseline FHR is between bpm or between bpmVariability of FHR is reduced (3-5 bpm for >40 minutes)
33 Abnormal CTG traceThe following features are very likely to be associated with significant fetal compromise and require further action-Two of the features described in non-reassuring CTG trace are present, ORBaseline FHR is <100 bpm or >170 bpmVariability is absent or <3 bpmVariability is sinusoidalDecelerations are prolonged for >3 minutes / late / have complicated variables
34 Process Preparation Determine indication for fetal monitoring Discuss fetal monitoring with the woman and obtain permission to commencePerform abdominal examination to determine lie and presentationGive the woman the opportunity to empty her bladderThe woman should be in an upright or lateral position (not supine)
35 Process PreparationCheck the accurate date and time has been set on the CTG machine, and paper speed is set at 1cm per minuteCTGs must be labelled with the mother’s name, her number and date / time of commencementMaternal heart rate must be recorded on the CTG at commencement of the CTG in order to differentiate between maternal and fetal heart rates
36 ASSESSING THE CTG USING DR C M BRAVADO Determine risk if the woman is a high or low obstetric risk. This sets the background for the interpretationC Assess the frequency and quality of Contractions per 10 minutes.M Assess fetal Movements, presence of Meconium and Maternal observationsBra Determine Baseline Rate and compare with earlier rate if possible.V Assess baseline Variability, is it normal, increased or reduced.A Are Accelerations present in response to fetal movements or contractionsD If Decelerations are present, what are their characteristics.O Give an overall classification for the CTGNormalSuspiciousPathological
37 FETAL SCALP BLOOD SAMPLING Useful in the presence of a non reassuring CTGA scalp blood sample for pH or lactate determinationSpecificity is high ( A normal value rules out asphyxia)The sensitivity and positive predictive value of a low scalp pH in identifying a newborn with Hypoxic-ischaemic encephalopathy is low
38 FETAL PULSE OXIMETRY Measures fetal oxygenation during labour It is performed using a sensor placed transcervically against the fetal cheekNormal values btw 35% and 65%Metabolic acidosis develops when the value falls below 30% for at least mins
39 CONCLUSIONThe well being of any pregnancy begins pre-conception with adequate counselling of mothers with medical conditionsPregnancy monitoring begins early in the gestationEarly and frequent prenatal care allows the care provider to screen the population to identify pregnancies at risk, afterall
40 “A NORMAL DELIVERY IS ONE IN WHICH THE MOTHER AND THE BABY ARE IN GOOD CONDITION REGARDLESS OF THE MODE OF DELIVERY”
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