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Principle of fetal monitoringPresentation Transcript
PRINCIPLES OF FETAL MONITORING MohdHanafiRamlee
I’M SORRY, I CAN’T INTERPRET SOME OF THE PICTURE HERE!!!BUT I’LL TRY MY BEST!!!
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
Mother should gain 0.5 kg/week during 2nd and early 3rd trimester then, the rate of weight gain is plateaus off
↓: possibilities of IUGR, persistent nausea and vomiting or forced dieting
↑: PIH, renal disease and polyhydramnios.
At least 2 times weekly
The centimeters should roughly correspond to the period of gestation
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
A FAVOURABLE FETAL MOVEMENT CHART Day Patient’s Name Time (am/pm))
AN UNFAVOURABLE FETAL MOVEMENT CHART Day Patient’s Name Time (am/pm))
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.
transvaginal -TRANDUCER - abdominal
Age Assessment Early Problems Measurement Amniotic Fluid Volume Symmetry Umbilical Cord Abnormalities Growth Weight Invasive Procedure Anatomy Location Morphology
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
FETAL MEASUREMENT Common = relatively ‘spared’ in growth restriction Sensitive = organ that are sensitive to changes to any factor that cause IUGR [liver/spleen]
CROWN-RUMP LENGTH Geatational sac Yolk sac Fetal pole
BPD, HC LENGTH Biparietal diameter Head circumference
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
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
Measuring blood velocity in umbilical artery of fetus.
Recorded in waveform pattern :
Systolic - blood velocity speeds up.
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.
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.
Principles of Fetal Monitoring 49 Cardiotocograph (CTG)
Computerized tracing of fetal heart rate pattern
Reflects physiological and pathological changes
Increased baseline FHR at least 15 bpm lasting at least 15 seconds.
Within 20 – 30 minutes CTG, 2 or more accelerations present define as reactive trace.
Importance – fetal hypoxia
Principles of Fetal Monitoring 54 FHR deceleration
Transient reduction fetal heart rate of 15 bpm or > lasting more than 15 seconds.
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
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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.