0
INTRAPARTUM FETAL MONITORING   DR MANAL BEHERY Zagazig University, EGYPT
The three unique risk factors for fetus            during laborFactor of uterine contractionFactor of cord accidentFact...
Factor of uterine contraction Let us see what happen to oxygenation and blood supply of the fetal brain during a uterine ...
 De-oxy-Hb   0.79micromol/100Gm of brain Oxy –Hb 0.19 0.79micromol/100Gm of brain CerebralO2 saturation      9% Cerebr...
Fetal distress, birth asphxia are likely               to occur if The fetus is already compromised antenatally---even wi...
Factor of cord accident Only during labor cord prolaps ,presentation and entanglements (occult or overt) become apparent ...
Factor of head compression Some degree of compression is inevitable  during normal labor But Excessive compression over ...
Methods available for fetal monitering              in labor Intermittent auscultation CTG Fetal electrocardiography   ...
Important        definations Hypoxia: Decreased po2 level in tissues. Hypoxima: Decreased po2 level in blood. Acidosis:...
Aim of intrapertum fetal monitering 1- to detect the earliest stages of hypoxia or (hypoxic acidemia ) so therapy can be ...
What is Cardiotocography(CTG)? It is a paper record of the continuous FHR blotted simultaneously with a record of uterine...
External monitoringDoppler ultrasound transducer   FHRTocotransducer(contraction)
Internal monitoring
What is ‘’Admission test ‘’? Ideally every fetus every fetus should be screened by CTG for a short period (20 min) right ...
Interpreting FHR trace 4 components  Base   line FHR  Baseline   variability  Accelerations  Decelerations
Baseline FHR The dominant reading taken ≥10 min Normal baseline FHR 110-160(pbm) Controlled byatrialpacemaker
Tachycardia FHR>160 bpm
Baseline bradycardia FHR<110bpm
Baseline varibilityThe Oscaltatory pattern of FHR when  recorded on a graph.Short term(beat t0 beat) is the fluctuation...
Baseline varibility Short term variability(scalp electrode) Long term variability defined as 3-5 cycle/min
Baseline varibility
No variability (0-2   /   )  Minimal variability (3-4          /       )Moderate variability (11-25             /       )M...
Changes in fetal HRPeroidic changes: Occur with contractionEpisodic changes (non peroidic):do not occur with contraction
Accelaration Increase in FHR with contraction or  with other activities Can be periodic or episodic Increase15pbm last...
Accelaration
Decelerations                 DecelerationsTransient slowing ofFHR below thebaseline levelmore than 15 bpmand lasting for ...
Early Decelerations   Uniform   Synchronous with contraction (mirror    image)   Rarely fall below 110 (pbm)   Due to ...
Early Decelerations
Late Deceleration Uniform Start after peak of contraction Associated with decreasedVariability Reflect a baroreceptorr...
Late Deceleration
Repetitive late decelrationincreases risk of Umbilical artery acidosis Apgar score < 7 at 5 ms Cerebral palsy If assoc...
Variable Deceleration (the most                 common type) Varible in appearance and Timing. May be assoicated with   ...
Variable Deceleration
Prolonged Deceleration               deceleration A deceleration that lasts more than 90 seconds (but less than 10 minut...
Prolonged Deceleration
Sinusoidal pattern Regular Oscillation of the Baseline long-term  Variability resembling a Sine wave ,with no beat  to -b...
Sinusoidal pattern
What are the features of a normal               tracing? Baseline FHR 110-160 BPM Baseline Variability > 5 pbm (10-25) ...
Normal -Reassuring CTG
Interpertation of CTG Normal -Reassuring(R)-   CTG with all 4 Features Suspicious (equivocal)- one non reassuring catego...
Is Normal   CTGs always Reassuring? With normal CTC the chance of fetus to develop hypoxia is 1.5% due to unpredictable a...
Is NR CTGs always worrisome ?60% CTG in Labour have 1 abnormal featureOnly 15-20% of NR CTGs are pathological.High fals...
?? To reduce CS….
Consider these factors with abnormal                 CTG Clinical indication of doing CTG Abnormal patch of tracing from ...
Consider these factors with abnormal                 CTG Posture of patient during CTGo Supine position give abnormal tra...
Suspicious (Equivocal)CTG Do continuous monitoring for further development towards better or worse trace while institutin...
Correct reversible causes Change mother position from supine to left lateral position-----increase uterine blood flow Im...
Secondary tests of fetal well-being Vibro-acoustic stimulation Used as a substitute for scalp sampling when  CTG –is NR...
Fetal blood sampling If the pH >7.25 --- observe. If the pH 7.2 and 7.25---repeatedwithin 30 minutes. If the pH <7.2---...
 Scalp stimulation. Firm digital pressure Gentile pinch by atramatic Allis forceps Fetal pulse oximetry.
THANK YOU
Upcoming SlideShare
Loading in...5
×

Updated intrapartum monitoring

364

Published on

0 Comments
2 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
364
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
28
Comments
0
Likes
2
Embeds 0
No embeds

No notes for slide

Transcript of "Updated intrapartum monitoring"

  1. 1. INTRAPARTUM FETAL MONITORING DR MANAL BEHERY Zagazig University, EGYPT
  2. 2. The three unique risk factors for fetus during laborFactor of uterine contractionFactor of cord accidentFactor of head compression
  3. 3. Factor of uterine contraction Let us see what happen to oxygenation and blood supply of the fetal brain during a uterine contraction?
  4. 4.  De-oxy-Hb 0.79micromol/100Gm of brain Oxy –Hb 0.19 0.79micromol/100Gm of brain CerebralO2 saturation 9% Cerebral blood volume 0.33 ml/100Gm ofIn spite of this slightly worrying picture,Nothing harmful effect happen if fetus is healthy labor contraction are normal Placenta has adequate reserve
  5. 5. Fetal distress, birth asphxia are likely to occur if The fetus is already compromised antenatally---even with normal uterine contraction The uterine contraction are exaggerated------even with healthy fetus and adequate placental reserve
  6. 6. Factor of cord accident Only during labor cord prolaps ,presentation and entanglements (occult or overt) become apparent either by compression or stretch secondary to uterine contraction
  7. 7. Factor of head compression Some degree of compression is inevitable during normal labor But Excessive compression over long period causing supermouldingas in obstructed labor may cause fetal hypoxia
  8. 8. Methods available for fetal monitering in labor Intermittent auscultation CTG Fetal electrocardiography Scalp stimulation Vibroacoustic stimulation Fetal scalp sampling  PH determination Fetal pulse oximetry
  9. 9. Important definations Hypoxia: Decreased po2 level in tissues. Hypoxima: Decreased po2 level in blood. Acidosis: Decreased PH in tissues. Acidemia: Decreased PH in blood. Ashyxia: Hypoxia with acidosis.
  10. 10. Aim of intrapertum fetal monitering 1- to detect the earliest stages of hypoxia or (hypoxic acidemia ) so therapy can be directed to prevent asphyxia and asphyxial damage 2-To Improve perinatal morbidity & mortality
  11. 11. What is Cardiotocography(CTG)? It is a paper record of the continuous FHR blotted simultaneously with a record of uterine activity Ultrasound (cardio) transducer Tocotransducer
  12. 12. External monitoringDoppler ultrasound transducer FHRTocotransducer(contraction)
  13. 13. Internal monitoring
  14. 14. What is ‘’Admission test ‘’? Ideally every fetus every fetus should be screened by CTG for a short period (20 min) right on admission in labor.From nature of the trace determine Intensity of monitoring “Whether the case should be monitored clinically or by CTG”Duration and frequency of monitoring “Whether the case should be covered by CTG continuously or intermittently”
  15. 15. Interpreting FHR trace 4 components  Base line FHR  Baseline variability  Accelerations  Decelerations
  16. 16. Baseline FHR The dominant reading taken ≥10 min Normal baseline FHR 110-160(pbm) Controlled byatrialpacemaker
  17. 17. Tachycardia FHR>160 bpm
  18. 18. Baseline bradycardia FHR<110bpm
  19. 19. Baseline varibilityThe Oscaltatory pattern of FHR when recorded on a graph.Short term(beat t0 beat) is the fluctuation of HR over short intervalLong term is the fluctuation over long interval(≥2 min)Indicates mature fetal neurologic system
  20. 20. Baseline varibility Short term variability(scalp electrode) Long term variability defined as 3-5 cycle/min
  21. 21. Baseline varibility
  22. 22. No variability (0-2 / ) Minimal variability (3-4 / )Moderate variability (11-25 / )Mark variability (>25 / )
  23. 23. Changes in fetal HRPeroidic changes: Occur with contractionEpisodic changes (non peroidic):do not occur with contraction
  24. 24. Accelaration Increase in FHR with contraction or with other activities Can be periodic or episodic Increase15pbm lasting 15 sec Return to base line <2 min
  25. 25. Accelaration
  26. 26. Decelerations DecelerationsTransient slowing ofFHR below thebaseline levelmore than 15 bpmand lasting for 15 sec.or more.
  27. 27. Early Decelerations Uniform Synchronous with contraction (mirror image) Rarely fall below 110 (pbm) Due to head compression Should not be disregardedif they appear early in labor or Antenatal.
  28. 28. Early Decelerations
  29. 29. Late Deceleration Uniform Start after peak of contraction Associated with decreasedVariability Reflect a baroreceptorresponse Indicate fetal hypoxia
  30. 30. Late Deceleration
  31. 31. Repetitive late decelrationincreases risk of Umbilical artery acidosis Apgar score < 7 at 5 ms Cerebral palsy If associated withdecrease or loss of variability
  32. 32. Variable Deceleration (the most common type) Varible in appearance and Timing. May be assoicated with increased variability . Reflect umbilical cord compres Observed in up to 50% of NSTs compression• Of no clinical significance if non recurrent.
  33. 33. Variable Deceleration
  34. 34. Prolonged Deceleration deceleration A deceleration that lasts more than 90 seconds (but less than 10 minutes) Drop in FHR of 30 bpm or More Reduction in O2 transfer to placenta. Associated with poor neonatal outcome
  35. 35. Prolonged Deceleration
  36. 36. Sinusoidal pattern Regular Oscillation of the Baseline long-term Variability resembling a Sine wave ,with no beat to -beat Variability. Has fixed cycle of 3-5 pbm with amplitude of 5-15 bpm and above but not below the baseline. Should be viewed with suspicion as poor outcome has been seen (eg Feto-maternal haemorrhage)
  37. 37. Sinusoidal pattern
  38. 38. What are the features of a normal tracing? Baseline FHR 110-160 BPM Baseline Variability > 5 pbm (10-25) 2 Accelerations > 15 BPM > 15 sec / 20 min trace No decelrations
  39. 39. Normal -Reassuring CTG
  40. 40. Interpertation of CTG Normal -Reassuring(R)- CTG with all 4 Features Suspicious (equivocal)- one non reassuring category and reminder are reassuring Abnormsal -Non reasurring (NR) - 2 or more non-reassuring categories or one or more abnormal categories.
  41. 41. Is Normal CTGs always Reassuring? With normal CTC the chance of fetus to develop hypoxia is 1.5% due to unpredictable acute events So a normal CTG is always Reassuring
  42. 42. Is NR CTGs always worrisome ?60% CTG in Labour have 1 abnormal featureOnly 15-20% of NR CTGs are pathological.High false positive rate with unnecessary operative intervention for fetal distress.Thus NR CTG is not always worrisome.
  43. 43. ?? To reduce CS….
  44. 44. Consider these factors with abnormal CTG Clinical indication of doing CTG Abnormal patch of tracing from high risk case differ that from no risk case Maturity of the fetus Reduced variability and baseline tachycardia is conmen in preterm State of maternal pulseDrugs may cause maternal tachycardia– fetal tachycaedia Check blood pressure for hypotension in patients on Epidural
  45. 45. Consider these factors with abnormal CTG Posture of patient during CTGo Supine position give abnormal tracingo Some cord compression can get released by change posture and must be tried with variable deceleration Congenital fetal malformationColor Doppler of fetal heart to exclude congenital heart blockStage of labor and expected time of delivery Wether to deliver immediate or give sometime under close observation
  46. 46. Suspicious (Equivocal)CTG Do continuous monitoring for further development towards better or worse trace while instituting the corrective measures. Ideally check condition of fetus by FAS or FBS or scalp stimulation test. However ,if liquor is meconium stained --- Deliver immediately
  47. 47. Correct reversible causes Change mother position from supine to left lateral position-----increase uterine blood flow Improve maternal oxygenation—100% O2 by masKCorrect maternal hypotension –IV fluid Decrease or stop any oxytocin infusion Remove vaginal prostaglandins
  48. 48. Secondary tests of fetal well-being Vibro-acoustic stimulation Used as a substitute for scalp sampling when CTG –is NR Normal ----------if FHR acceleration > 15 bpm for 15 seconds within 15 seconds after the stimulation with prolonged fetal movements. Abnormal ----Only 50% have acidotic PH
  49. 49. Fetal blood sampling If the pH >7.25 --- observe. If the pH 7.2 and 7.25---repeatedwithin 30 minutes. If the pH <7.2----repeat immediately If pH still low -- Prompt delivery
  50. 50.  Scalp stimulation. Firm digital pressure Gentile pinch by atramatic Allis forceps Fetal pulse oximetry.
  51. 51. THANK YOU
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×