Principle of fetal monitoring
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Principle of fetal monitoring Presentation Transcript

  • 1. PRINCIPLES OF FETAL MONITORING
    MohdHanafiRamlee
  • 2. I’M SORRY, I CAN’T INTERPRET SOME OF THE PICTURE HERE!!!BUT I’LL TRY MY BEST!!!
  • 3. AIMS OF FETAL MONITORING
    Assessment of fetal well-being especially in high-risk mother
    Assessments of fetal growth
    Identification of fetal abnormalities and condition in all stages of pregnancy
    Determination of gestational period
    To ensure a safe delivery
  • 4. Antenatal monitoring
    Labour monitoring
  • 5.
  • 6. WEIGHT GAIN
    • Cheap and simple method using weighing machine
    • 7. Mother should gain 0.5 kg/week during 2nd and early 3rd trimester  then, the rate of weight gain is plateaus off
    • 8. ↓: possibilities of IUGR, persistent nausea and vomiting or forced dieting
    • 9. ↑: PIH, renal disease and polyhydramnios.
  • SYMPHYSIOFUNDAL HEIGHT
    • At least 2 times weekly
    • 10. The centimeters should roughly correspond to the period of gestation
    • 11. ↑: polyhydramnios
    • 12. ↓: oligohydramnios
  • 13. FETAL KICK CHART
    Commonest methods – Cardiff ‘count to ten’
    Start count at 9am every morning
    Record the time taken for baby to move 10 times
    Normal fetal activity-little variation in time taken
    ↓ fetal activity [fetal compromise] - delay in time taken
    Benefit: detection of fetal compromise, more easier and cheap
    Limitation: Maternal anxiety is common, unsure of movement, is a crude guide and sometimes inconsistent
  • 14. A FAVOURABLE FETAL MOVEMENT CHART
    Day
    Patient’s Name
    Time (am/pm))
  • 15. AN UNFAVOURABLE FETAL MOVEMENT CHART
    Day
    Patient’s Name
    Time (am/pm))
  • 16.
  • 17.
  • 18. DIAGNOSTIC ULTRASOUND SCAN
    - 2 dimensional map of content of uterus.
    - Image constantly updated in real time and fetal cardiac and other movement can be studied.
    - < 12 weeks usage oftransvaginaltransducer.
    - > 12 weeks usage of abdominal transducer.
    - Good image depend on operator skill.
    - Disadvantages : Bio effects on cells, inducing heating.
  • 19. transvaginal -TRANDUCER - abdominal
  • 20. Age Assessment
    Early Problems
    Measurement
    Amniotic Fluid Volume
    Symmetry
    Umbilical Cord Abnormalities
    Growth
    Weight
    Invasive Procedure
    Anatomy
    Location
    Morphology
  • 21. EARLY PREGNANCY PROBLEMS
    - transvaginal ultrasound role in diagnosis of disorder in early pregnancy.
    E.g. miscarriage
    - fetus present, absent fetal heart
    E.g. ectopic pregnancy
    - absent of gestational sac within uterus
  • 22. FETAL MEASUREMENTS
  • 23. FETAL MEASUREMENT
    Common = relatively ‘spared’ in growth restriction
    Sensitive = organ that are sensitive to changes to any factor that cause IUGR [liver/spleen]
  • 24. CROWN-RUMP LENGTH
  • 25. CROWN-RUMP LENGTH
    Geatational sac
    Yolk sac
    Fetal pole
  • 26. BPD, HC LENGTH
    Biparietal diameter
    Head circumference
  • 27. BPD, HC LENGTH
  • 28. FEMUR LENGTH
    Femur length
  • 29. FEMUR LENGTH
  • 30. ABDOMINAL CIRCUMFERENCE
    Abdominal Circumference
  • 31. GESTATIONAL AGE ASSESSMENT
    CRL/BPD  these measurements are plotted on the normogram
    Predictions of gestational age by ultrasound scan before 20 weeks is more accurate than predictions from last menstrual period.
    Measurements are done at least 2 week apart
    Measurements are plotted in centile-charts against a normogram
  • 32. MEASUREMENT ON FETAL GROWTH CHART
  • 33. Consistent growth of
    Small fetus
  • 34. Slowed growth—
    fetal compromise
  • 35. FETAL SYMMETRY
    ↑HC: Hydrocephalus
    ↓HC: Microcephaly
    ↓FL: constitutional short stature, achondroplasia
    ↑AC: Diabetic pregnancy,
    ↓AC: triploidy / trisomy 18
    Asymmetry: IUGR
  • 36. PLACENTA
    Transvaginal scan: if the placenta covers the internal os major placenta praevia
    Mid pregnancy scan  low-lying placenta
    3rd pregnancy scan  minor placenta praevia
  • 37. OTHERS CONDITION
    Amniotic Fluid scan: commonly base on AFI [if <2cm: Oligohydramnious, >7cm: Polyhdramnious]
    Umbilical Cord: scan with colourdoppler [Nuchal displacement: common event associated with fetal distress]
    Invasive procedure: amniocentesis, chorionvillus sampling, cordocentesis, fetal bladder shunt therapy, fetoscopy and endoscope.
  • 38.
  • 39. AIMS OF ROUTINE ULTRASOUND SCAN
  • 40. Magnetic Resonance Imaging: useful when i) US images are not diagnostic or ii) suboptimal because of maternal obesity
  • 41.
  • 42. MRI
  • 43. 39
    AMNIOTIC FLUID
    • Produce: Kidneys & Lungs
    • 44. Remove: Fetal swallowing and blood
    • 45. Functions : Prevent mechanical injury, permit
    movement and lung development
    • 4 quadrant method (R/L hypocondrium R/L illiacfossa)
  • AMNIOTIC FLUID INDEX
    Liquor volume reflects the placental size, placental function and fetal metabolism
    Sum of all the maximum vertical pool of liquor from the 4 quadrant of the uterus
    In 3rd tri, normal AFI should be between 10 and 25cm
    AFI -below 5cm -oligohydramnios
    above 25cm -polyhydramnios
  • 46.
  • 47. DOPPLER ULTRASOUND
    • Measuring blood velocity in umbilical artery of fetus.
    • 48. Recorded in waveform pattern :
    • 49. Systolic - blood velocity speeds up.
    • 50. Diastolic - blood velocity slows down (depending amount resistant in arterial bed in placenta).
  • Doppler Umbilical Artery Waveforms
    Measure blood velocity in umbilical artery of fetus
    Recorded in waveform pattern showing a systolic & diastolic component
    During normal fetal life, diastolic flow in the umbilical artery↑ gradually (placental resistance falls) withgestation
    In placental damage/insufficiency- absent/reversed end diastolic flow which leads to fetal distress and intrauterine death.
  • 51. Doppler Uterine Artery Waveforms
    Assessment of uterine artery waveforms at 24th weeks’ gestation.
    Benefits: Even at absence of risk factors, severely abnormal waveforms identify 75% of pregnancies at risk of adverse neonatal outcome in early 3rd trimester.
    Limitations: Less effective at prediction of later problems.
  • 52.
  • 53.
  • 54.
  • 55.
  • 56. Principles of Fetal Monitoring
    49
    Cardiotocograph (CTG)
    • Computerized tracing of fetal heart rate pattern
    • 57. Sensitive
    • 58. Reflects physiological and pathological changes
  • Principles of Fetal Monitoring
    50
    CTG Parameters:
    Baseline heart rate :
    • Normally 110 – 160bpm
    • 59. <110 bpm = bradycardia
    • 60. >160 bpm = tachycardia
  • Principles of Fetal Monitoring
    51
    Baseline variability :
    • Reflects normal fetal autonomic nervous system.
    • 61. Modified by :
    • 62. Fetal sleep states and activity.
    • 63. Hypoxia.
    • 64. Fetal infection.
    • 65. Drugs e.g. opioids and hypnotics (reduce baseline variability).
    • 66. Baseline variability – 8 bpm and 2-6 times in
    a minute.
  • 67. Principles of Fetal Monitoring
    52
  • 68. Principles of Fetal Monitoring
    53
    Fetal heart rate (FHR) acceleration.
    • Increased baseline FHR at least 15 bpm lasting at least 15 seconds.
    • 69. Within 20 – 30 minutes CTG, 2 or more accelerations present define as reactive trace.
    • 70. Importance – fetal hypoxia
  • Principles of Fetal Monitoring
    54
    FHR deceleration
    • Transient reduction fetal heart rate of 15 bpm or > lasting more than 15 seconds.
    • 71. Type 1 deceleration
    nadir (lowest point) of deceleration coincides with the peak of uterine contraction
    • Type 2 deceleration
    nadir of deceleration lags behind and persist even after the peak of uterine contraction
    • Variable deceleration pattern
    nadir variable in depth and timing peak of contraction
  • 72. Principles of Fetal Monitoring
    55
  • 73. Principles of Fetal Monitoring
    56
  • 74. Principles of Fetal Monitoring
    57
  • 75.
  • 76. Meconium Stained Liquor
    Sign of fetal compromise
    Can only be diagnose during labour, or only after the membrane have been ruptured
    May be due to
    Intestinal hurry
    Spontaneous dilatation of anal
    sphincters
    Manifestations of foetal hypoxia.
  • 77. OTHERS MONITORING
    MohdHanafiRamlee
  • 78. Principles of Fetal Monitoring
    61
    Biochemical Screening
    Prenatal screening test:
    • Fetal nuchal - measurement of fluid filled translucency space on post. surface of fetal neck.
    - increase measurement associated with fetuses with major chromosomal abnormalities and sex chromosomal abnormalities (e.g. Down syndrome).
    • Maternal serum screening - neural tube defect and Downsyndrome.
  • Fetal Nuchal Translucency
    Principles of Fetal Monitoring
    62
  • 79. Principles of Fetal Monitoring
    63
    • Maternal full blood indices/electrophoresis – detect thalasemia.
    • 80. Sickledex test – sickle cell disease.
    • 81. Maternal blood group/rhesus antibodies.
    • 82. Maternal serum virology – CMV/toxoplasmosis/Rubella/parvovirus
    • 83. Serology for syphilis.
  • Principles of Fetal Monitoring
    64
    Maternal Serum Screening
    • 15 – 20 weeks of gestation.
    • 84. maternal serum alpha-fetoprotein (AFP) screening for neural tube defects (NTDs) and Down syndrome.
    • 85. Increase level - fetal open NTDs.
    • 86. Decrease level - Down syndrome.
    Screening test on Down syndrome:
    • maternal serum AFP.
    • 87. human beta-chorionic gonadotropin
    • 88. unconjugatedoestriol.
    • 89. advanced age – risk.
  • Biophysical Profile
  • 90. THANK YOU FOR YOUR ATTENTION