This document discusses antenatal fetal surveillance, which involves assessing fetal well-being during pregnancy to ensure delivery of a healthy newborn. It outlines various indications for surveillance including maternal conditions like hypertension and diabetes, as well as fetal conditions like growth restriction. Methods of surveillance discussed include biochemical tests of maternal serum, ultrasound, MRI, amniocentesis, and clinical assessment of fetal growth through maternal weight gain and abdominal exams. The goal of surveillance is to monitor high-risk pregnancies and detect issues that could impact the fetus.
Cephalopelvic disproportion (CPD) is a pregnancy complication that may interferes with vaginal delivery; making it dangerous or impossible and requires caeserean section.
Cephalopelvic disproportion (CPD) is a pregnancy complication that may interferes with vaginal delivery; making it dangerous or impossible and requires caeserean section.
Majority of fetal deaths occur in the antepartum period.
There is progressive decline in maternal deaths all over the world. Currently more interest is focused to evaluate the fetal health. The primary objective of antenatal assessment is to avoid fetal death.
AN ANALYSIS OF OUTCOMES IN TWIN PREGNANCIES WITH ACTIVE FETAL SURVEILLANCE AN...Apollo Hospitals
The incidence of multiple gestations is increasing with
increasing maternal age and use of assisted reproduction
techniques. Selective fetal reduction of multifetal pregnancies is now widely practiced to reduce the higher order multiples to twins based on evidence from nonrandomised studies which suggests that this will improve the perinatal outcome. The proportion of twin pregnancies with unique fetal and maternal problems is therefore increasing. Optimising maternal, fetal and perinatal outcomes in twin pregnancies continues to be a formidable challenge in the present day clinical practice.
Hello everyone
This presentation will give a insight into the recent advances in fetal therapy. Hope it might help you
Thanking you
Dr Ankit gupta
MD Pediatrics
Kims karad
Mandeep Kaur. Associate Professor in a Nursing College.
Modalities of diagnosis of pregnancy. It includes routine personal tests and other pregnancy tests. RH test, Alpha Protein test, Triple test, Fetal Ultrasound, CFTS, Amniocentesis, CVS, Non-Stress Test, And Other so many tests , Contraction Stress Test, Fetal Bio physical Profile,
USMLE GENERAL EMBRYOLOGY 018 Prenatal Diagnostic Prenatal Diagnostic Proce...AHMED ASHOUR
Prenatal diagnostic procedures are medical tests performed during pregnancy to assess the health of the fetus.
These procedures are typically recommended when there is an increased risk of certain genetic or chromosomal disorders, or when there are concerns about the baby's development.
It's important to note that these procedures carry some level of risk, and decisions regarding their use should be made after careful consideration of the potential benefits and drawbacks.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
ICH Guidelines for Pharmacovigilance.pdfNEHA GUPTA
The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Explore our infographic on 'Essential Metrics for Palliative Care Management' which highlights key performance indicators crucial for enhancing the quality and efficiency of palliative care services.
This visual guide breaks down important metrics across four categories: Patient-Centered Metrics, Care Efficiency Metrics, Quality of Life Metrics, and Staff Metrics. Each section is designed to help healthcare professionals monitor and improve care delivery for patients facing serious illnesses. Understand how to implement these metrics in your palliative care practices for better outcomes and higher satisfaction levels.
2. DefinitionDefinition
Antenatal fetal surveillance is assessmentAntenatal fetal surveillance is assessment
of fetal wellbeing in antepartum period toof fetal wellbeing in antepartum period to
ensure delivery of healthy neonate.ensure delivery of healthy neonate.
5. Aims of Fetal MonitoringAims of Fetal Monitoring
Assuming satisfactory growth & wellbeing ofAssuming satisfactory growth & wellbeing of
fetus & mother throughout pregnancyfetus & mother throughout pregnancy
Screening high risk cases & adverse maternalScreening high risk cases & adverse maternal
and/or intrauterine factors which affect the fetusand/or intrauterine factors which affect the fetus
Detecting early congenital anomalies and inbornDetecting early congenital anomalies and inborn
metabolic disorders to decide early terminationmetabolic disorders to decide early termination
6. Objectives of Fetal SurveillanceObjectives of Fetal Surveillance
To determine gestational ageTo determine gestational age
To discover fetal congenital anomaliesTo discover fetal congenital anomalies
To detect abnormalities of fetal growthTo detect abnormalities of fetal growth
To detect & determine the severity of acute &To detect & determine the severity of acute &
chronic fetal hypoxiachronic fetal hypoxia
7. Initiation of antepartum fetalInitiation of antepartum fetal
surveillancesurveillance
EARLY PREGNANCYEARLY PREGNANCY
LATE PREGNANCYLATE PREGNANCY
11. BiochemicalBiochemical
A. Material serum alpha foeto protein
It is the onco protein
It is produced by yolk sac & foetal liver.
The highest level of the AFP in foetal serum &
amniotic fluid .
Material serum level peak around 32 weeks .
MSAP screening can be done between 15 - 21
weeks gestation (17 weeks is ideal)
12. MSAFP elevated at
Wrong gestational age
Open neural tube defect of the foetus
Multiple pregnancy
IUF
Anterior abdominal wall defects
Renal anomalies
MSAFP is low at
Trisomies (Down syndrome)
Gestational trophoblastic diseases
neural tube defect
13. B. Triple test
It is combined biochemical test which includes
MSFP, HCG & UE3 (unconjugated oestriol) .
It is used for detection of down syndrome .
In an affected pregnancy level of MSAFP & UE3
tend to be low while that the HCG is high .
It is performed at 15-18 weeks .
14. C. Coomb’s test
Coomb’s test is used for Rh incompatibility.
if the coomb’ test is greater than 1:8 to 1:16 thann,
amniocentesis is done for diagnosis of need for
intrauterine transfusion.
It is used to detect presence or absence of the
material antibodies on fetal red cells .
if there are no antibodies , the blood is retested at
28 & 34 weeks of pregnancy.
15. D. Acetyl choline esterase(AchE)
It is elevated in most cases of open neural tube
defects , it has got better diagnostic value than
AFP.
E. Inhibin A
It is dimetric glycoprotein . it is produced by the
corus luteum & the placenta
.
serum level of the inhibin A is raised in the women
carrying a foetus with down syndrome
16.
17. A. Florescence in Situ Hybridization(FISH)
FISH, or Fluorescence In Situ Hybridization, is a diagnostic
prenatal test which looks for a few common chromosomal
abnormalities mainly limited to Trisomy 13 (Patau syndrome),
Trisomy 18 (Edward’s syndrome) and Trisomy 21 (Down
syndrome) .
FISH does not have false positive results. If the fetal cells
contain certain chromosomal abnormalities, this will be apparent
with the FISH test.
The only exception might be if the parent has a chromosomal
abnormality and the fetal cells were contaminated with parental
cells.
18.
B. DNA amplification using the polymerace chain
reaction[PCR]
It provides the convenient & efficient means of
making millions of copies of a sort DNA sequence
heating cooling cycles are used to denature to DNA
& then build new widely used for assessing genetic
variation , for diagnosing genetic disease & for
forensic purpose.
It can be made directly from fetus by
amniocentesis
chorionic villi sampling
chrordiocentesis.
20. Indications
Genetic testing- Genetic amniocentesis done to
detect certain conditions, such as Down syndrome.
Fetal lung testing- To determine whether the
baby's lungs are mature enough for birth.
Diagnosis of fetal infection- To evaluate a baby
for infection or other illness. The procedure also can
be done to evaluate the severity of anemia in babies
who have Rh sensitization — an uncommon
condition in which a mother's immune system
produces antibodies against a specific protein on the
surface of the baby's blood cells.
26. Chorionic villus sampling does not detect:
Neural tube defects
Rh incompatibility
Complications:
foetal loss (1-2%) , oromandibular limb deformities ,
vaginal bleeding, limb reduction defects are high
when CVS are less then 10 week of the gestation
CVS when performed between 10-12 weeks are
safe and accurate as that of the of the aminocentesis
28. Fetal Blood Sampling
Cordocentsis ( percutaneous umbilical blood
sampling )
Direct access to the fetal circulation during the
second and third trimesters is now possible through
PUBS . It is the most widely used method for fetal
blood sampling and transfusion
PUBS is now the route of choice for intrauterine
transfusion for severely anemic fetuses; it can start as
early as 19 weeks
38. CLINICAL
The clinical assessment to done to assess the foetal
growth.
It can be done by following methods:-
Maternal weight gain
Blood pressure
Assessment of size of uterus & height of fundus
Clinical assessment of liquor
Edema of feet
Abdominal girth in last trimester
39. 1.Maternal weight gain:1.Maternal weight gain:
In second half of pregnancy: average weight
gain is 1 kg/fortnight.
Excess weight gain: Could be 1st
sign of pre-
eclampsia.
If weight gain less than normal, stationary or
falling: Look for IUGR
40. 2. Blood pressure:
Initial recording of BP prior to 12 weeks helps to
differentiate pre-existing chronic hypertension from
pregnancy induced hypertension.
Hypertension, pre-existing or pregnancy induced
may impair fetal growthh.
41. 3. Assessment of size of uterus & height of
fundus:
Top of fundus is measured from superior border of
symphysis pubis (bladder should be empty) using a
tape.
After 24 weeks of pregnancy, distance measured in
cm normally corresponds to period of gestation in
weeks
42. 4.Clininical4.Clininical assessment ofassessment of
liquorliquor
The normal range of aminioticThe normal range of aminiotic
fluid volume (AFI) is wide butfluid volume (AFI) is wide but
the approximate volumes are:the approximate volumes are:
- 500 ml at 18 weeks- 500 ml at 18 weeks
- 800 ml at 34 weeks.- 800 ml at 34 weeks.
- 600 ml at term.- 600 ml at term.
Clinical assessment is unreliable.Clinical assessment is unreliable.
Objective assessment depends on USGObjective assessment depends on USG
to measure:to measure:
- deepest vertical pool (DVP).- deepest vertical pool (DVP).
- Amniotic fluid- Amniotic fluid index (AFI).index (AFI).
44. BIOCHEMICAL
These test are mainly done for assessment of
pulmonary maturity.
1. Shake test or Bubble test (Clement’s):
Based on ability of pulmonary surfactant to form a
foam or bubble on shaking which remains stable for
at least 15 minutes.
Increasing dilutions of amniotic fluid are mixed with
96 % ethanol, shaken for 15 seconds and inspected
after 15 minutes for the presence of a complete ring
of bubbles at the meniscus. Indicates maturity of the
fetal lungs.
45. 2. Foam Stability Index (FSI) :
Based on surfactant detection by shake test.
Serial dilutions of amniotic fluid to quantitate amount of
surfactant present.
FSI >47 virtually excludes risk of RDS.
OTHER TEST
3. Presence of phosphatidyl glycerol[PG]
4. Saturated phosophatidly choline
5. Amniotic fluid optical density
6. Florescence polarization
47. BIOPHYSICAL
It is the screening test for the utero-placental insufficiency .
The fetal biophysical activities is initiated , modulated &
regulated by the fetal nervous system .
The fetal CNS is very much sensitive to diminished
oxygenation.
48. Fetal Movement CountFetal Movement Count
1. Fetal movement monitoring1. Fetal movement monitoring
Cardif ‘count 10’ formulaCardif ‘count 10’ formula::
Mother counts fetal movements starting at 9 am.Mother counts fetal movements starting at 9 am.
Counting ends when 10 movements are perceived.Counting ends when 10 movements are perceived.
Report to physician if:Report to physician if:
– (i) less than 10 movements occur during 12 hours on(i) less than 10 movements occur during 12 hours on
2 successive days or2 successive days or
– (ii) no movement is perceived even after 12 hours in a(ii) no movement is perceived even after 12 hours in a
single day.single day.
49. Daily fetal movement count (DFMC):Daily fetal movement count (DFMC):
One hour duration each in morning, noon andOne hour duration each in morning, noon and
evening. (Total 1+1+1 = 3 hours)evening. (Total 1+1+1 = 3 hours)
Total counts multiplied by four gives daily (12 hour)Total counts multiplied by four gives daily (12 hour)
fetal movement count (DFMC).fetal movement count (DFMC).
If there is diminution of number of ‘kicks’ to less thanIf there is diminution of number of ‘kicks’ to less than
10 in 12 hours (or less than 3 in each hour), it10 in 12 hours (or less than 3 in each hour), it
indicates fetal compromise.indicates fetal compromise.
50. Nonstress Testing(NST)
A test monitors the fetal heart rate in response to fetal
movements in order to assess the integrity of fetal central
nervous system & cardio vascular system.
The non – stress test(NST) involves application of the fetal
monitor to record the fetal heart rate.
The mother is instructed to push a marker button when she
feels the fetus move. The marker button when she feels the
fetus move.
The marker button indicates movement as it occurred in
relationship to the fetal heart rate.
With sufficient placental functioning ,the fetus should
demonstrate an acceleration in heart rate with movement, in
the same way that the adult experiences increased heart rate
with exercises.
51. Purpose
To assess the fetal ability to cope with
continuation of a high risk pregnancy.
To determine the project ability of a fetus to
withstand the stress of labour.
To assess the fetal status in women for whom
contraction stress test is contraindicated such
as previous caesarean section,or preterm
labour.
52. IndicationsIndications
Indications(Maternal)
Post dated Pregnancy
Rh Senstization
Material age 35 or more
Chronic renal disease
Hypertension
Collagen disease
Sickle cell disease
Diabetes
Premature rupture of
membrances
History of still birth
Trauma
Indications (Fetal)
Decreased fetal
movements
Intrauterine growth
retardation(IUGR)
Fetal evaluation after
amniocentesis
Oligohydramnios/polyhyd
ramnios
53. Result
Reactive non stress test(normal/negative)
Reactive indiacates a healthy fetus .
The result requires two or more FHR accelerations of at
least 15 beats per minutes , lasting at least 15 sec from the
beginning of the acceleration to the end , in association to
the end , in association with fetal movement during a 20 –
minute period.
Nonreactive nonstress test(abnormal)
No acceleration or accelerations of less than 15 beats per
min or lasting less than 15 sec in duration occur be
interpretated because of the poor quality of the FHR tracing.
54. 3. Contraction stress Tests
A contraction stress test is a test performed during
pregnancy to verify whether or not the unborn baby’s heart is
strong enough to withstand labour.
It uses drugs or nipple stimulation to make the uterus
temporarily contract in order to replicate labor contractions .
The test is typically only used if the unborn baby has has
abnormal results during other pregnancy health examinations
A contraction stress test(CST) can reveal whether your baby
has an abnormal heart rate during contractions- a distinct
pattern of slowing heartbeats during & immediately following a
contraction-that may indicate distress .
55. CSTCST
Oxytocin drip started at 0.5 mU/min, double inOxytocin drip started at 0.5 mU/min, double in
every 15-20 min interval till 3 contractions lastingevery 15-20 min interval till 3 contractions lasting
for 40-60 sec occur in 10 minfor 40-60 sec occur in 10 min
Time taken 1½ - 2 hrsTime taken 1½ - 2 hrs
No hypoxiaNo hypoxia →→ FHR pattern uncharged duringFHR pattern uncharged during
contractioncontraction
HypoxiaHypoxia →→ FHR slows down with decelerationFHR slows down with deceleration
– Late deceleration is significantLate deceleration is significant
56. Indications
IUGR
Postmaturity
Hypertensive disorders of pregnancy
Diabetes mellitus
Women with nonreactive NST
Contraindications
Third trimester bleeding
Incompetent cervix
Multiple gestation
Previous classical uterine incision
History of preterm labour
Premature rupture of membranes.
57. Result:
Negative contraction stress test (normal):
A negative result is represented by late or variabal
decelerations of the fetal rate.
Positive result : is represented by late or variable
declarations of the fetal heart with 50 % or more of the
contractions in the absence of hyperstimulation of the
uterus.
Equivocal: An equivocal result contain decelerations but
with less than 50% of the contractions ,or the uterine
activity shows the hyperstimulation of the uterus.
Unsatisfactory: An unsatisfactory result means that
adequate uterine contractions cannot be achieved or the
fetal heart rate tracing is not of sufficient quality for
adequate intervention
58. 5. FETAL CARDIOCOGRAPHY
It is a technical means of recording the fetal heartbeat & the uterine
contractions during pregnancy,typically in the third trimester .
The machine used to perform the monitoring is called a cardiotocography,
more commonly known as an electronic fetal monitor(EFM)
External measurement - means taping or strapping the two sensors to the
abdomen measures the tension of the maternal abdominal wall – an indirect
measure of the intrauterine pressure.
Internal measurement- requires a certain degree of cervical dilatation , as
it involves inserting a pressure catheter into the ulterine cavity , as well as
attaching a scalp electrode to the fetal head to adequately measure the
electric activity of the fetal heart to adequately measure the electric activity
of the fetal heart
59. Effect on management :
The use of cardiotography reduces the rate of
seizures in the newborn , but there is no clear
benefit in the prevention of cerebral palsy , perinatal
death and other complication of labour .
In contrast labour monitored by CTG is slightly more
likely to result in instrumenet delivery ( forceps or
vacuum extraction ) or caesarean section
60. 5.The biophysical profile ( BPP ) :
Has 5 components
1. Fetal movement
2 .Fetal tone
3 .Fetal breathing
4 .Amniotic fluid volume
5 .Fetal heart rate
61. VariableVariable Score – 2Score – 2 Score – 0Score – 0
Fetal reactivityFetal reactivity
> 2 FHR> 2 FHR
accelerationacceleration
No or < 2No or < 2
accelerationacceleration
Fetal breathingFetal breathing
movementmovement
At least 1 of > 30At least 1 of > 30
secsec
No FBM or < 30 secNo FBM or < 30 sec
Fetal movementFetal movement
(Gross body(Gross body
movement)movement)
> 3 discrete GBM> 3 discrete GBM < 2 or nil< 2 or nil
Fetal toneFetal tone
At least one episodeAt least one episode
of limb flexion toof limb flexion to
rapid extensionrapid extension
No limb movement orNo limb movement or
slow flexionslow flexion
Amniotic fluid volAmniotic fluid vol
> 1 pocket of > 1 cm> 1 pocket of > 1 cm
depth in twodepth in two
perpendicular planeperpendicular plane
Largest pocket < 1Largest pocket < 1
cm in twocm in two
perpendicular planesperpendicular planes
62. InterpretationInterpretation
Score – 10Score – 10 →→
– Conservative managementConservative management
– Repeat after 1 wk or after 3 days in IUGR, diabetes,Repeat after 1 wk or after 3 days in IUGR, diabetes,
postmaturitypostmaturity
Score – 8Score – 8 →→
– Liqour normal, manage as beforeLiqour normal, manage as before
– If less or postmaturityIf less or postmaturity →→ DeliverDeliver
Score – 6Score – 6 →→ EquivocalEquivocal
– Repeat test after 24 hrsRepeat test after 24 hrs
– If sameIf same →→ DeliverDeliver
Score – 4 or lessScore – 4 or less →→ AbnormalAbnormal
– Immediate delivery except when fetus is grossly immatureImmediate delivery except when fetus is grossly immature
Modified BPSModified BPS →→ Placental grading considerPlacental grading consider
– If premature agingIf premature aging →→ Fetal compromiseFetal compromise
63. 6.Fetal Monitering by Fetal Scalp Blood
Sampling
Fetal Scalp blood sampling is done when CTG shows
persistant abnormal trace.
It is used in the high risk cases of delivery.
Significance of fetal scalp blood PH
Normal 7.25-7.35
Border line 7.25-7.30
Abnormal below 7.20 delivery is done for fetal
asphyxia.
64. Doppler UltrasonographyDoppler Ultrasonography
UterineUterine
UmbilicalUmbilical
Internal carotid arteryInternal carotid artery
Cerebral vesselsCerebral vessels
Peak systolic & end diastolic blood flowPeak systolic & end diastolic blood flow
measuredmeasured
Systolic: Diastolic < 3 is normal in umbilical &Systolic: Diastolic < 3 is normal in umbilical &
uterine arteryuterine artery
Lack of diastolic component or reversal diastolicLack of diastolic component or reversal diastolic
blood flow is ominous sign.blood flow is ominous sign.
65. 7. Amniocentesis in Late Pregnancy7. Amniocentesis in Late Pregnancy
Pulmonary maturityPulmonary maturity
Assessment of severity of Rh-isoimmunisationAssessment of severity of Rh-isoimmunisation
Maturity of fetus by Nile blue testMaturity of fetus by Nile blue test
Orange cells > 50% mature fetusOrange cells > 50% mature fetus
66. 8.Other test8.Other test
Assessment of severity of Rh-
isoimmunisation:
It is done by amniocentesis for
estimation of bilirubin in the amniotic fluid
by spectophometric analysis.
Assesment of aminotic fluid leakage:
It can be done by fern test,nitrazine test,apt
test.