Antepartum fetal surveillance aims to prevent fetal death and avoid unnecessary interventions. Methods include fetal movement count, uterine growth assessment, antepartum fetal heart rate testing like nonstress tests and contraction stress tests, biophysical profile, and Doppler velocimetry. Abnormal test results may indicate fetal compromise and require additional testing or delivery depending on gestational age. Multiple variables are assessed and scored in the biophysical profile to evaluate acute and chronic fetal well-being and guide management decisions.
Antepartum and intrapartum foetal monitoringrajeev sood
This document discusses various methods for assessing fetal well-being, including clinical assessment, ultrasound, non-stress tests (NST), biophysical profile (BPP), and more. It provides details on each method, including how they are performed, interpreted, and used to monitor high-risk pregnancies and detect issues with the fetus. The key methods discussed are NST, BPP, ultrasound measurements, and Doppler assessments. Clinical assessment includes factors like fundal height, fetal movement counting, and maternal weight gain.
The document discusses various diagnostic tests used in fetal monitoring including:
1. Non-stress tests (NST) which evaluate fetal heart rate patterns to assess oxygenation, neurological, and cardiac function. A reactive pattern indicates intact fetal well-being.
2. Biophysical profiles (BPP) which combine NST and ultrasound to assess fetal movements, tone, breathing and amniotic fluid in a standardized scoring system.
3. Doppler studies analyze umbilical and cerebral blood flow to identify compromised fetuses before problems occur. Reverse diastolic flow in the umbilical artery is ominous.
4. Amniocentesis tests amniotic fluid for genetic/infection screening or lung maturity
This document discusses various methods for assessing fetal wellbeing, including fetal movement counting, fetal heart rate monitoring, biophysical profile testing, and Doppler ultrasound. It provides details on different fetal heart rate patterns seen on cardiotocography and how to interpret them. Additionally, it explains the procedures and interpretations for non-stress tests, contraction stress tests, vibroacoustic stimulation, and biophysical profiles. The ideal goals for fetal testing are described as quick, easy to perform, reproducible results that can reliably identify compromised fetuses when intervention could improve outcomes, without false alarms for healthy fetuses.
Antenatal assessment physical well being /introduction and methodsBabitha Mathew
The tests used to monitor fetal health include fetal movement counts, the nonstress test, biophysical profile, modified biophysical profile, contraction stress test, and Doppler ultrasound exam of the umbilical artery.
The document discusses various methods for evaluating fetal lung maturity prior to delivery, including quantifying pulmonary surfactant components in amniotic fluid. The lecithin/sphingomyelin (L/S) ratio is the most common approach, where an L/S ratio of 2.0 or greater indicates maturity. Phosphatidylglycerol (PG) appears at 35 weeks and further ensures lung maturity. Tests help determine the risks of respiratory distress syndrome and guide management decisions.
This document discusses various methods of antepartum fetal assessment and surveillance. It provides definitions for terms like fetal death, live birth, antepartum vs intrapartum stillbirths. It then summarizes some of the key findings from literature on causes of antepartum fetal deaths. Specifically, it indicates that approximately 30% of antepartum deaths are due to asphyxia, 30% due to maternal complications, 15% due to congenital abnormalities, and 20% have no clear etiology. The document advocates that antepartum fetal assessment can help identify at-risk fetuses and reduce antenatal fetal deaths. It describes various tests that may be used like non-stress tests, bi
This document provides information on antepartum and intrapartum fetal surveillance. It discusses various testing modalities used in antepartum surveillance such as fetal movement counting, non-stress testing, biophysical profile, and Doppler velocimetry. It also describes parameters assessed in intrapartum surveillance including fetal heart rate monitoring patterns such as baseline rate, variability, accelerations, and decelerations. The goal of both antepartum and intrapartum surveillance is to detect fetal hypoxia and intervene early to prevent injury or death.
This document provides an overview of antepartum fetal surveillance methods. It discusses that the majority of fetal deaths occur in the antepartum period due to causes like fetal hypoxia, maternal complications, congenital malformations, and unexplained causes. The primary objective of antenatal fetal assessment is to avoid fetal death. It then describes various monitoring methods including clinical monitoring, special investigations like biochemical tests, cytogenetic tests, biophysical profiling, and Doppler ultrasound assessments of the fetus and amniotic fluid volume.
Antepartum and intrapartum foetal monitoringrajeev sood
This document discusses various methods for assessing fetal well-being, including clinical assessment, ultrasound, non-stress tests (NST), biophysical profile (BPP), and more. It provides details on each method, including how they are performed, interpreted, and used to monitor high-risk pregnancies and detect issues with the fetus. The key methods discussed are NST, BPP, ultrasound measurements, and Doppler assessments. Clinical assessment includes factors like fundal height, fetal movement counting, and maternal weight gain.
The document discusses various diagnostic tests used in fetal monitoring including:
1. Non-stress tests (NST) which evaluate fetal heart rate patterns to assess oxygenation, neurological, and cardiac function. A reactive pattern indicates intact fetal well-being.
2. Biophysical profiles (BPP) which combine NST and ultrasound to assess fetal movements, tone, breathing and amniotic fluid in a standardized scoring system.
3. Doppler studies analyze umbilical and cerebral blood flow to identify compromised fetuses before problems occur. Reverse diastolic flow in the umbilical artery is ominous.
4. Amniocentesis tests amniotic fluid for genetic/infection screening or lung maturity
This document discusses various methods for assessing fetal wellbeing, including fetal movement counting, fetal heart rate monitoring, biophysical profile testing, and Doppler ultrasound. It provides details on different fetal heart rate patterns seen on cardiotocography and how to interpret them. Additionally, it explains the procedures and interpretations for non-stress tests, contraction stress tests, vibroacoustic stimulation, and biophysical profiles. The ideal goals for fetal testing are described as quick, easy to perform, reproducible results that can reliably identify compromised fetuses when intervention could improve outcomes, without false alarms for healthy fetuses.
Antenatal assessment physical well being /introduction and methodsBabitha Mathew
The tests used to monitor fetal health include fetal movement counts, the nonstress test, biophysical profile, modified biophysical profile, contraction stress test, and Doppler ultrasound exam of the umbilical artery.
The document discusses various methods for evaluating fetal lung maturity prior to delivery, including quantifying pulmonary surfactant components in amniotic fluid. The lecithin/sphingomyelin (L/S) ratio is the most common approach, where an L/S ratio of 2.0 or greater indicates maturity. Phosphatidylglycerol (PG) appears at 35 weeks and further ensures lung maturity. Tests help determine the risks of respiratory distress syndrome and guide management decisions.
This document discusses various methods of antepartum fetal assessment and surveillance. It provides definitions for terms like fetal death, live birth, antepartum vs intrapartum stillbirths. It then summarizes some of the key findings from literature on causes of antepartum fetal deaths. Specifically, it indicates that approximately 30% of antepartum deaths are due to asphyxia, 30% due to maternal complications, 15% due to congenital abnormalities, and 20% have no clear etiology. The document advocates that antepartum fetal assessment can help identify at-risk fetuses and reduce antenatal fetal deaths. It describes various tests that may be used like non-stress tests, bi
This document provides information on antepartum and intrapartum fetal surveillance. It discusses various testing modalities used in antepartum surveillance such as fetal movement counting, non-stress testing, biophysical profile, and Doppler velocimetry. It also describes parameters assessed in intrapartum surveillance including fetal heart rate monitoring patterns such as baseline rate, variability, accelerations, and decelerations. The goal of both antepartum and intrapartum surveillance is to detect fetal hypoxia and intervene early to prevent injury or death.
This document provides an overview of antepartum fetal surveillance methods. It discusses that the majority of fetal deaths occur in the antepartum period due to causes like fetal hypoxia, maternal complications, congenital malformations, and unexplained causes. The primary objective of antenatal fetal assessment is to avoid fetal death. It then describes various monitoring methods including clinical monitoring, special investigations like biochemical tests, cytogenetic tests, biophysical profiling, and Doppler ultrasound assessments of the fetus and amniotic fluid volume.
This document discusses various methods for assessing fetal well-being, including fetal movement counting, fetal heart rate monitoring, biophysical profiling, and Doppler ultrasound. It provides details on techniques such as the non-stress test (NST), contraction stress test (CST), and biophysical profile (BPP). Each method is described, including how it is performed, interpreted, advantages, and disadvantages. The document emphasizes that no single test exists that can perfectly identify a compromised fetus at a stage when intervention improves outcomes, without also identifying healthy fetuses as abnormal.
This document discusses various methods of antepartum fetal surveillance including fetal movement counting, non-stress tests, contraction stress tests, biophysical profiles, and Doppler ultrasounds. It provides details on how each test is performed and interpreted, and what outcomes they can predict regarding fetal wellbeing and risk of complications. The goal of antepartum fetal surveillance is to monitor the fetus, identify any risks, and prevent fetal death or neonatal complications through timely medical intervention when needed.
This document discusses the case of a 31-year-old woman, G3P2, who presented at 12 weeks and 1 day post-amnenorrhea with a suspected molar pregnancy. Ultrasound findings showed multiple cysts in the uterine cavity with no fetal echo, and her hCG level was 7513 IU/ml. She was diagnosed with a leaking ectopic pregnancy and underwent a laparoscopic left salpingectomy. Intraoperatively, 700cc of hemoperitoneum was found along with a left tubal ectopic pregnancy, while the right fallopian tube and ovaries were normal. The patient was discharged well with advice on contraception.
The document discusses various methods for antenatal assessment of fetal well-being, including clinical monitoring, biophysical monitoring, and biochemical monitoring. Clinical monitoring includes assessing maternal weight gain, symphysis-fundal height, and blood pressure. Biophysical monitoring tests include non-stress tests, contraction stress tests, biophysical profiles, fetal movement monitoring, and Doppler ultrasound assessments. Biochemical monitoring includes analyzing levels of alpha-fetoprotein, pregnancy-associated plasma protein A, and human chorionic gonadotropin from maternal blood samples to screen for fetal abnormalities. Together, these various monitoring methods aim to assess fetal health and identify risks in order to optimize delivery timing and decrease perinatal morbidity and mortality.
10.Antenatal Assesment of fetal well being (10).pptxSunilYadav42766
Fetal assessment involves various biophysical tests and Doppler ultrasound exams to evaluate fetal well-being. Biophysical tests include fetal movement counting, non-stress tests to examine heart rate patterns, and biophysical profile scoring of 5 factors. Doppler of the umbilical artery assesses blood flow and can indicate placental insufficiency. Middle cerebral artery Doppler and ductus venosus exams evaluate the fetal circulatory response. Together these non-invasive tests provide information on the fetus's health and ability to tolerate stress.
This document provides an overview of various biophysical tests used to assess fetal wellbeing, including fetal movement count, FHR monitoring, cardiotocography, non-stress test, contraction stress test, amniotic fluid volume assessment, ultrasound, biophysical profile, modified biophysical profile, Doppler velocimetry, CT scan, and MRI scan. It describes the procedures, interpretations, and indications for each test. Overall, the document serves as a comprehensive reference for common biophysical assessments used in antenatal care.
- A 23-year-old woman at 38 weeks gestation presents with complaints of diminished fetal movement for 2 days. Diminished fetal movement can indicate impending fetal death so this is a significant concern. The next step should be to assess the fetus, such as with a non-stress test (NST).
- Fetal monitoring aims to prevent fetal death and avoid unnecessary interventions. Methods include daily fetal movement counts (DFMC), NST, contraction stress tests (CST), biophysical profiles, and Doppler velocimetry. Interpretation depends on gestational age and fetal viability.
- An NST evaluates fetal condition by looking for fetal heart rate accelerations in response to movement. For gestations over
Electronic fetal monitoring uses ultrasound to evaluate the fetal heart rate and assess fetal well-being. There are two types: external monitoring using a transducer on the abdomen and internal monitoring using a scalp electrode. Fetal heart rate patterns are categorized as normal, indeterminate, or abnormal based on the baseline rate, variability, and presence of decelerations. Continuous electronic fetal monitoring is recommended if certain maternal or fetal risk factors are present such as meconium, maternal fever, hypertension, or abnormal fetal heart rate patterns. Guidelines provide guidance on interpreting traces and appropriate management responses.
This document discusses various obstetric ultrasound indications and techniques. It covers:
1. Cervical length measurement and cerclage indications such as history of preterm labor or second trimester loss and cervical length <25mm.
2. Placenta praevia grading and indications for c-section if placenta is <2cm from internal os in third trimester.
3. Doppler ultrasound of the umbilical artery and middle cerebral artery for assessing fetal wellbeing and growth restriction. Abnormal Doppler indices suggest compromised fetal status.
4. Other assessments including biophysical profile, amniotic fluid volume, and techniques for conditions like preterm premature rupture of membranes.
This document discusses various methods of assessing fetal well-being during pregnancy, known as antepartum fetal monitoring. It describes tests such as fetal movement counting, non-stress tests, biophysical profiles, and Doppler velocimetry that evaluate factors like fetal heart rate, movement, tone and amniotic fluid to detect any complications. The goal is to allow intervention before fetal death or damage from hypoxia while avoiding unnecessary early delivery. Each test has benefits and limitations in accurately detecting issues with the placenta or fetus.
This document discusses antepartum fetal surveillance, which involves assessing fetal well-being before the onset of labor to prevent injury and death. Various techniques are described for monitoring the fetus, including fetal movement counting, non-stress tests to check for fetal heart rate accelerations, and biophysical profiles. Abnormal test results can indicate issues like hypoxemia or acidemia. Maternal conditions like diabetes or hypertension are common indications for increased surveillance. The physiology behind factors regulating the fetal heart rate is also explained.
This document provides information on various biophysical tests used to assess maternal and fetal health during pregnancy. It discusses ultrasound screening which can detect fetal anomalies and assess growth. The biophysical profile test evaluates 5 parameters - fetal movement, tone, breathing, heart rate and amniotic fluid - to detect signs of fetal stress. A non-stress test monitors fetal heart rate in response to movement. Together these tests screen for placental insufficiency and fetal well-being during high-risk pregnancies.
The biophysical profile (BPP) is a non-stress test used to assess fetal well-being. It involves ultrasound evaluation of fetal movement, breathing, muscle tone, and amniotic fluid volume, with scores ranging from 0-10. A score of 8 or higher is considered normal while lower scores indicate increased risk of fetal distress within a week. The BPP was developed in the 1980s and provides information about acute and chronic aspects of fetal oxygenation, with abnormal results requiring more frequent testing or delivery. Accuracy depends on proper administration and interpretation, and while observational studies support its use in high-risk pregnancies, randomized trials have not found clear benefits over non-stress testing alone.
This document discusses the evaluation and management of a 37-year-old pregnant female presenting with vaginal bleeding. The differential diagnosis includes placenta previa. Ultrasound confirms placenta previa. The types of placenta previa and risk factors are discussed. As the bleeding increases and vital signs deteriorate, urgent delivery by cesarean section is required to stabilize the patient.
4. FETAL SURVEILENCE AND INTRAPARTUM FETAL MONITORING - Copy.pptxDrHafashimanaEmmanue
This document discusses fetal surveillance techniques used during pregnancy and labor to monitor fetal well-being. It covers the goals of antenatal surveillance to prevent fetal death and unnecessary interventions. Techniques discussed include non-stress tests to monitor fetal heart rate patterns, biophysical profiles using ultrasound to assess fetal movements and breathing, and contraction stress tests using oxytocin to induce contractions. Indications for fetal surveillance include high-risk pregnancies complicated by conditions like diabetes or hypertension. Interpretation of test results and next steps are also outlined.
This document discusses two cases of high risk obstetrics. Case 1 involves a woman at 34 weeks gestation presenting with abdominal pain and bleeding. Her examination and investigations indicate signs of placental abruption. Case 2 involves a woman at 34.5 weeks gestation with a history of two previous cesarean sections and placenta previa diagnosed at 21 weeks. Her examination and ultrasound confirm placenta previa and possible placenta accreta. The document then discusses various questions related to the differential diagnosis, risk factors, complications, management, and delivery approach for conditions like placental abruption and placenta previa.
Fetal heart monitoring involves tracking the fetal heart rate and uterine contractions to evaluate fetal well-being during labor and delivery. There are two main types of monitoring - intermittent auscultation using a doppler and continuous electronic fetal monitoring. Fetal monitoring is indicated for high-risk pregnancies, labors, or when abnormalities arise. Patterns are analyzed for baseline heart rate, variability, accelerations, and decelerations in relation to contractions to assess fetal status as reassuring, non-reassuring, or abnormal requiring intervention. Future advances may provide additional options for fetal surveillance during childbirth.
This document discusses various antepartum fetal assessment tests including fetal movement counting, nonstress tests (NST), biophysical profiles (BPP), contraction stress tests (CST), and Doppler flow studies. The NST evaluates fetal heart rate patterns in response to movement or stimulation to assess well-being. The BPP comprehensively evaluates fetal tone, movement, breathing and amniotic fluid volume. The CST assesses fetal heart rate patterns during induced contractions to identify signs of distress. Doppler flow studies evaluate umbilical artery blood flow waveforms to identify signs of placental insufficiency. Together these tests aim to monitor fetal well-being during pregnancy and identify those in need of delivery.
This document discusses the assessment of fetal well-being through various antenatal monitoring techniques. It outlines the objectives of fetal monitoring as avoiding fetal death and ensuring growth. Common indications requiring monitoring include pregnancies with obstetric or medical complications. Components of assessment include clinical monitoring of maternal weight, blood pressure, uterine size and liquor volume. Antenatal tests described are fetal movement monitoring, the non-stress test (NST), contraction stress test (CST), biophysical profile, and Doppler ultrasonography of the umbilical artery blood flow. The NST and CST assess fetal heart rate patterns in response to movement or contractions respectively.
This document provides an overview of basic concepts in ultrasonography as it relates to obstetrics. It covers topics such as the physics of ultrasound, transducer types and movements, pelvic anatomy, early pregnancy ultrasound signs, and fetal assessment techniques such as biophysical profile scoring. The document outlines the key anatomical structures visualized in obstetric ultrasound exams and describes techniques for optimizing ultrasound images.
This document discusses benign breast conditions. It begins by outlining the objectives of describing risk factors, symptoms, and management of benign breast conditions, pre-cancerous lumps, malignant conditions, and breast infections. It then provides an overview of breast anatomy and physiology before examining specific benign conditions such as breast cysts, fibroadenomas, adenosis, mastitis, duct ectasia, fat necrosis, and other benign lumps. The signs and symptoms, diagnosis, and treatment of benign breast conditions are discussed in detail. Prevention methods like mammograms and breast self-exams are also outlined.
This document discusses various methods for assessing fetal well-being, including fetal movement counting, fetal heart rate monitoring, biophysical profiling, and Doppler ultrasound. It provides details on techniques such as the non-stress test (NST), contraction stress test (CST), and biophysical profile (BPP). Each method is described, including how it is performed, interpreted, advantages, and disadvantages. The document emphasizes that no single test exists that can perfectly identify a compromised fetus at a stage when intervention improves outcomes, without also identifying healthy fetuses as abnormal.
This document discusses various methods of antepartum fetal surveillance including fetal movement counting, non-stress tests, contraction stress tests, biophysical profiles, and Doppler ultrasounds. It provides details on how each test is performed and interpreted, and what outcomes they can predict regarding fetal wellbeing and risk of complications. The goal of antepartum fetal surveillance is to monitor the fetus, identify any risks, and prevent fetal death or neonatal complications through timely medical intervention when needed.
This document discusses the case of a 31-year-old woman, G3P2, who presented at 12 weeks and 1 day post-amnenorrhea with a suspected molar pregnancy. Ultrasound findings showed multiple cysts in the uterine cavity with no fetal echo, and her hCG level was 7513 IU/ml. She was diagnosed with a leaking ectopic pregnancy and underwent a laparoscopic left salpingectomy. Intraoperatively, 700cc of hemoperitoneum was found along with a left tubal ectopic pregnancy, while the right fallopian tube and ovaries were normal. The patient was discharged well with advice on contraception.
The document discusses various methods for antenatal assessment of fetal well-being, including clinical monitoring, biophysical monitoring, and biochemical monitoring. Clinical monitoring includes assessing maternal weight gain, symphysis-fundal height, and blood pressure. Biophysical monitoring tests include non-stress tests, contraction stress tests, biophysical profiles, fetal movement monitoring, and Doppler ultrasound assessments. Biochemical monitoring includes analyzing levels of alpha-fetoprotein, pregnancy-associated plasma protein A, and human chorionic gonadotropin from maternal blood samples to screen for fetal abnormalities. Together, these various monitoring methods aim to assess fetal health and identify risks in order to optimize delivery timing and decrease perinatal morbidity and mortality.
10.Antenatal Assesment of fetal well being (10).pptxSunilYadav42766
Fetal assessment involves various biophysical tests and Doppler ultrasound exams to evaluate fetal well-being. Biophysical tests include fetal movement counting, non-stress tests to examine heart rate patterns, and biophysical profile scoring of 5 factors. Doppler of the umbilical artery assesses blood flow and can indicate placental insufficiency. Middle cerebral artery Doppler and ductus venosus exams evaluate the fetal circulatory response. Together these non-invasive tests provide information on the fetus's health and ability to tolerate stress.
This document provides an overview of various biophysical tests used to assess fetal wellbeing, including fetal movement count, FHR monitoring, cardiotocography, non-stress test, contraction stress test, amniotic fluid volume assessment, ultrasound, biophysical profile, modified biophysical profile, Doppler velocimetry, CT scan, and MRI scan. It describes the procedures, interpretations, and indications for each test. Overall, the document serves as a comprehensive reference for common biophysical assessments used in antenatal care.
- A 23-year-old woman at 38 weeks gestation presents with complaints of diminished fetal movement for 2 days. Diminished fetal movement can indicate impending fetal death so this is a significant concern. The next step should be to assess the fetus, such as with a non-stress test (NST).
- Fetal monitoring aims to prevent fetal death and avoid unnecessary interventions. Methods include daily fetal movement counts (DFMC), NST, contraction stress tests (CST), biophysical profiles, and Doppler velocimetry. Interpretation depends on gestational age and fetal viability.
- An NST evaluates fetal condition by looking for fetal heart rate accelerations in response to movement. For gestations over
Electronic fetal monitoring uses ultrasound to evaluate the fetal heart rate and assess fetal well-being. There are two types: external monitoring using a transducer on the abdomen and internal monitoring using a scalp electrode. Fetal heart rate patterns are categorized as normal, indeterminate, or abnormal based on the baseline rate, variability, and presence of decelerations. Continuous electronic fetal monitoring is recommended if certain maternal or fetal risk factors are present such as meconium, maternal fever, hypertension, or abnormal fetal heart rate patterns. Guidelines provide guidance on interpreting traces and appropriate management responses.
This document discusses various obstetric ultrasound indications and techniques. It covers:
1. Cervical length measurement and cerclage indications such as history of preterm labor or second trimester loss and cervical length <25mm.
2. Placenta praevia grading and indications for c-section if placenta is <2cm from internal os in third trimester.
3. Doppler ultrasound of the umbilical artery and middle cerebral artery for assessing fetal wellbeing and growth restriction. Abnormal Doppler indices suggest compromised fetal status.
4. Other assessments including biophysical profile, amniotic fluid volume, and techniques for conditions like preterm premature rupture of membranes.
This document discusses various methods of assessing fetal well-being during pregnancy, known as antepartum fetal monitoring. It describes tests such as fetal movement counting, non-stress tests, biophysical profiles, and Doppler velocimetry that evaluate factors like fetal heart rate, movement, tone and amniotic fluid to detect any complications. The goal is to allow intervention before fetal death or damage from hypoxia while avoiding unnecessary early delivery. Each test has benefits and limitations in accurately detecting issues with the placenta or fetus.
This document discusses antepartum fetal surveillance, which involves assessing fetal well-being before the onset of labor to prevent injury and death. Various techniques are described for monitoring the fetus, including fetal movement counting, non-stress tests to check for fetal heart rate accelerations, and biophysical profiles. Abnormal test results can indicate issues like hypoxemia or acidemia. Maternal conditions like diabetes or hypertension are common indications for increased surveillance. The physiology behind factors regulating the fetal heart rate is also explained.
This document provides information on various biophysical tests used to assess maternal and fetal health during pregnancy. It discusses ultrasound screening which can detect fetal anomalies and assess growth. The biophysical profile test evaluates 5 parameters - fetal movement, tone, breathing, heart rate and amniotic fluid - to detect signs of fetal stress. A non-stress test monitors fetal heart rate in response to movement. Together these tests screen for placental insufficiency and fetal well-being during high-risk pregnancies.
The biophysical profile (BPP) is a non-stress test used to assess fetal well-being. It involves ultrasound evaluation of fetal movement, breathing, muscle tone, and amniotic fluid volume, with scores ranging from 0-10. A score of 8 or higher is considered normal while lower scores indicate increased risk of fetal distress within a week. The BPP was developed in the 1980s and provides information about acute and chronic aspects of fetal oxygenation, with abnormal results requiring more frequent testing or delivery. Accuracy depends on proper administration and interpretation, and while observational studies support its use in high-risk pregnancies, randomized trials have not found clear benefits over non-stress testing alone.
This document discusses the evaluation and management of a 37-year-old pregnant female presenting with vaginal bleeding. The differential diagnosis includes placenta previa. Ultrasound confirms placenta previa. The types of placenta previa and risk factors are discussed. As the bleeding increases and vital signs deteriorate, urgent delivery by cesarean section is required to stabilize the patient.
4. FETAL SURVEILENCE AND INTRAPARTUM FETAL MONITORING - Copy.pptxDrHafashimanaEmmanue
This document discusses fetal surveillance techniques used during pregnancy and labor to monitor fetal well-being. It covers the goals of antenatal surveillance to prevent fetal death and unnecessary interventions. Techniques discussed include non-stress tests to monitor fetal heart rate patterns, biophysical profiles using ultrasound to assess fetal movements and breathing, and contraction stress tests using oxytocin to induce contractions. Indications for fetal surveillance include high-risk pregnancies complicated by conditions like diabetes or hypertension. Interpretation of test results and next steps are also outlined.
This document discusses two cases of high risk obstetrics. Case 1 involves a woman at 34 weeks gestation presenting with abdominal pain and bleeding. Her examination and investigations indicate signs of placental abruption. Case 2 involves a woman at 34.5 weeks gestation with a history of two previous cesarean sections and placenta previa diagnosed at 21 weeks. Her examination and ultrasound confirm placenta previa and possible placenta accreta. The document then discusses various questions related to the differential diagnosis, risk factors, complications, management, and delivery approach for conditions like placental abruption and placenta previa.
Fetal heart monitoring involves tracking the fetal heart rate and uterine contractions to evaluate fetal well-being during labor and delivery. There are two main types of monitoring - intermittent auscultation using a doppler and continuous electronic fetal monitoring. Fetal monitoring is indicated for high-risk pregnancies, labors, or when abnormalities arise. Patterns are analyzed for baseline heart rate, variability, accelerations, and decelerations in relation to contractions to assess fetal status as reassuring, non-reassuring, or abnormal requiring intervention. Future advances may provide additional options for fetal surveillance during childbirth.
This document discusses various antepartum fetal assessment tests including fetal movement counting, nonstress tests (NST), biophysical profiles (BPP), contraction stress tests (CST), and Doppler flow studies. The NST evaluates fetal heart rate patterns in response to movement or stimulation to assess well-being. The BPP comprehensively evaluates fetal tone, movement, breathing and amniotic fluid volume. The CST assesses fetal heart rate patterns during induced contractions to identify signs of distress. Doppler flow studies evaluate umbilical artery blood flow waveforms to identify signs of placental insufficiency. Together these tests aim to monitor fetal well-being during pregnancy and identify those in need of delivery.
This document discusses the assessment of fetal well-being through various antenatal monitoring techniques. It outlines the objectives of fetal monitoring as avoiding fetal death and ensuring growth. Common indications requiring monitoring include pregnancies with obstetric or medical complications. Components of assessment include clinical monitoring of maternal weight, blood pressure, uterine size and liquor volume. Antenatal tests described are fetal movement monitoring, the non-stress test (NST), contraction stress test (CST), biophysical profile, and Doppler ultrasonography of the umbilical artery blood flow. The NST and CST assess fetal heart rate patterns in response to movement or contractions respectively.
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This document provides an overview of basic concepts in ultrasonography as it relates to obstetrics. It covers topics such as the physics of ultrasound, transducer types and movements, pelvic anatomy, early pregnancy ultrasound signs, and fetal assessment techniques such as biophysical profile scoring. The document outlines the key anatomical structures visualized in obstetric ultrasound exams and describes techniques for optimizing ultrasound images.
This document discusses benign breast conditions. It begins by outlining the objectives of describing risk factors, symptoms, and management of benign breast conditions, pre-cancerous lumps, malignant conditions, and breast infections. It then provides an overview of breast anatomy and physiology before examining specific benign conditions such as breast cysts, fibroadenomas, adenosis, mastitis, duct ectasia, fat necrosis, and other benign lumps. The signs and symptoms, diagnosis, and treatment of benign breast conditions are discussed in detail. Prevention methods like mammograms and breast self-exams are also outlined.
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Antepartum fetal surveillance aims to prevent fetal death and avoid unnecessary interventions. Methods include fetal movement count, uterine growth assessment, antepartum fetal heart rate testing like nonstress tests and contraction stress tests, biophysical profile, and Doppler velocimetry. Abnormal test results may indicate fetal compromise and require additional testing or delivery depending on gestational age. Multiple variables are assessed and scored in the biophysical profile to evaluate acute and chronic fetal well-being and oxygenation status. Normal test results predict good neonatal outcomes while abnormal results indicate increasing levels of suspected fetal acidosis requiring intervention.
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This article explores the potential for combining allopathy and homeopathy in India, examining the benefits, challenges, and the emerging field of integrative medicine.
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Benefits of Regular Exercise:
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The facial nerve, also known as cranial nerve VII, is one of the 12 cranial nerves originating from the brain. It's a mixed nerve, meaning it contains both sensory and motor fibres, and it plays a crucial role in controlling various facial muscles, as well as conveying sensory information from the taste buds on the anterior two-thirds of the tongue.
2. Introduction
• 80% fetal death occurs in the antepartum
period and many of the fetal deaths occur in
woman at risk for uteroplacental insufficiency
• Goals antepartum fetal surveillance
– Prevention of fetal death
– Avoidance of unnecessary interventions
2
By: Natnael A.
3. Indications
• Woman at high risk for uteroplacental
insufficiency
• Maternal chronic medical disorders
» DM, chronic HTN,chronic lung dx, renal/cardic dx etc
• Pregnancy related conditions: Postterm pregnancy, PIH,
multiple gestations, unexplainable previous perinatal death,
IUGR, Rh sensitized pregnancy, PROM,etc
• When other tests suggest fetal compromise:
decreased maternal perception of fetal
movement, suspected IUGR, oligohydramnios…
3
By: Natnael A.
4. Methods of antepartum fetal
surveillance
1) Fetal movement count
2) Assesment of uterine growth
3) Antepartum FHR testing
NST, CST
4) BPP
5) Doppler velocimetry
4
By: Natnael A.
5. Fetal movement
• Begins as early as 7th wk but becomes more
sophisticated and coordinated near term
• Usually 1st percieved by mother at 17-20wks
(quickening)
• mother can appreciate 50% of isolated limb
movements and 80% of trunk and limb movements
when correlated with U/S
• Fetal sleep-awake cycles are important determinants of
fetal activity; varies from 20-75 min
• Peaks b/n 9pm and 1am;a time when maternal glucose
levels are falling
5
By: Natnael A.
6. • Methods to quantify fetal movements
–Maternal subjective perception
–Visualization with u/s
–tocodynamometer
6
By: Natnael A.
7. • Maternal fetal movement count
Methods
Sadovsky et al.
• Fetal movement count for 30-60min ,2-3x daily
if <3movements/60min or no movement for >12hrs
further evaluation is indicated
Rayburn et al
• Count for at least 60min/day
<3 mov’ts /60min for two consecutive days may be a sign
of fetal compromise
7
By: Natnael A.
8. Cont’d
Cardiff count to ten (pearson and weaver)
at least 10 movements should be perceived in 12hrs
disadvantage: poor sensitivity
Factors that affect perception of fetal
movements:
• Maternal , placental ,fetal
8
By: Natnael A.
9. FH measurement
• Techniques
1) finger method
2) Tape measure techniques("McDonald measurement“)
– SFH in cm equals the GA best between 18 and 34
wks.
– Discrepancy of >2-3wks is considered abnormal Ix
9
By: Natnael A.
10. Antepartum FHR assessment
Two types FHR patterns
Reassuring
Nonreassuring
Regulation of FHR
FHR and its conduction systems develop b/n 3 and
6wks
Factors that regulate FHR become functional in
later GA
NS ( parasympathetic (PNS) and sympathetic
(SNS)) regulates the FHR patterns
10
By: Natnael A.
11. Cont’d
FHR changes result from moment to moment
autonomic modulations from medullary
cardiorespiratory centers in response to inputs
from
Chemoreceptor
Baroreceptor
Hormonal regulations
Blood volume controls
CNS activities ,such as arousal and sleeping
11
By: Natnael A.
12. Effects of GA on FHR
– The PNS exerts greater influence on FHR as GA advances (i.e
Slowing of FHR with advancing GA)
– FHR variability is rare before 24wks but its absence after 28
wks is abnormal
• Advancing GA is also associated with increased frequency and
amplitude of FHR acceleration, w/c are modulated by PNS
12
By: Natnael A.
13. Cardiovascular response to hypoxia
• Fetal oxygenation depends upon:
oAdequate maternal oxygenation
oUteroplacental blood flow and
oDistribution of oxygenated blood to fetal tissues
13
By: Natnael A.
14. Interpretation of FHR tracing
• Always needs to be interpreted in the context of:
the GA
Prior results of fetal assessment
Maternal conditions(including medications)
Fetal conditions(e.g IUGR, anaemia ,
arrhythmia)
14
By: Natnael A.
15. Antepartum FHR assessment…
• Currently, it’s generally performed in
pregnancies in which the risk of fetal death is
known to be ed:
Pregnancies at risk uteroplacental insufficiencies
Fetal disorders, or any other condition potentially
associated with increased risk of fetal death
15
By: Natnael A.
16. Nonstress test (NST)
• A short term indicator of fetal acid-base status
• It’s the most widely used primary testing
method of fetal well being assessment
• FHR accelerations occur during fetal
movement
• Can be initiated when the fetal neurological
maturity enables FHR accelerations to
occur(typically at 26-28wks) the fetus is
believed to be at ed risk of death
16
By: Natnael A.
17. Advantage:
Cheap, simple, and can be performed in any
setting
No direct maternal or fetal risks
disadv.: high FP rate( 50-60%)
17
By: Natnael A.
18. How to do NST
• Patient in lateral tilt position
• FHR tracing is observed for 40min;using
Doppler or CTG
• Healthy fetuses display normal oscillations
and fluctuations of the baseline FHR
• Absence of FHR accelerations seems to depict
CNS depression caused by hypoxia, drugs
,fetal sleep or congenital anomalies
18
By: Natnael A.
19. Interpretation
A. Reactive NST:
If there is ≥2 FHR acceleration that peak at least
by 15bpm above baseline ,each lasting ≥15 sec,
and all occurring within 20min of beginning of the
test
Prior to 32wks >2 accelerations of atleast 10bpm,
lasting ≥10sec over 20min interval
Fetal death within 1wk of reactive NST =3-5/1000
19
By: Natnael A.
20. Cont’d
B. Non-reactive NST
If criteria for reactivity are not met over 40min
Can be sign of fetal hypoxemia or acidosis
Other causes:(benign and temporary)
Maternal drugs(e.g smoking,…)
Fetal sleep or
Fetal congenital anomalies or fetal
immaturity
20
By: Natnael A.
21. Management of nonreactive NST
Options
Performing additional tests(eg. BPP, Doppler
velocimetry)
Modifying factors responsible for abnormal
test results if possible(eg. Correction of
maternal hypotension,…)
Delivery if term -fetal hypoxemia cannot be
definitively excluded
21
By: Natnael A.
22. Contraction stress test
• A test of uteroplacental function
• FHR uterine contractions are recorded
simultaneously with external monitor
• Contraction is induced either with oxytocin or
nipple stimulation ( at least 3/10’/40’’ )
22
By: Natnael A.
23. Interpretation
Negative: no late/significant variable deceleration
Positive: late deceleration following ≥50% of
cont.(even if inadequate cont.)
Equivocal-suspicious: intermittent late dece. or
significant variable dece.
equivocal- hyperstimulatory : FHR dece. that
occur in the presence of cont. more frequent
than every 2min. Or lasting >90sec
Unsatisfactory: fewer than 3cont.in 10min
23
By: Natnael A.
24. Cont’d
+ve CST may indicate ed fetal reserve correlates with 20-
40% incidence of abn. FHR patterns during labor
Equivocal-suspicious test with repetitive variable dece. is also
associated with abn.FHR patterns in labor
If result is suspicious, suggests hyperstimulation or
unsatisfactory repeat after 24hrs
b/c of high FP rate, +ve CST should be supported by BPP
-Ve CST ,repeat weekly
24
By: Natnael A.
26. cont’d
Advantages:
Not affected by maternal drug ingestion
Not GA dependent
Disadv.
Expensive
Time consuming
Invasive(needs iv line)
Potentially risky b/c cont. is induced
26
By: Natnael A.
27. FETAL BIOPHYSICAL PROFILE (BPP)
• Refers to the sonographic assessment of 5
discrete biophysical variables:
Fetal tone
Fetal movement
Fetal breathing movement
Results of NST
AF volumes
27
By: Natnael A.
28. Cont’d
• Activities that 1st appear in fetal development
(FT, FM) are the last to disappear and activities
that appear last (NST, FBM) are the 1st to
disappear in case of hypoxia acidosis.
– FT=7.5-8.5wks
– FM=9wks
– FBM=20-21wks
– NST=24-28wks(but most reliable after 32wks)
28
By: Natnael A.
29. Cont’d
• Acute variables
FT, FBM, FM,NST
Expandable in times of stress since they are
energy dependent fetal O2 requirement
the most O2 sensitive centers are the
cardioregulatory neurones controlling the
coupling of FM FHR acceleration and FB center
neurones
29
By: Natnael A.
30. Cont’d
• Chronic variable
AFV
Fetal urine production primarily depends on renal
perfusion
Hypoxemia redistribution of COP to the major
organsurine production oligohydramnios
It takes 15days for a fetus to progress from
normal to abnormal AFV(in absence of ROM)
23days to develop severe oligohydramnios
30
By: Natnael A.
31. BPP scoring
COMPONENTS SCORE 2 SCORE O
NST/FHB reactive Non-reactive
FBM ≥1 episode of breathing
≥30sec within 30min
<30sec breathing within
30min
FM ≥3 discrete body or limb
mov’t within 30min
<3 discrete movement
FT ≥1 episode of extremity
extension subsequent
return to flexion
No episode of
extension/flexion
AFV Largest single vertical
pocket >2cm
Largest single vertical
pocket ≤2cm
31
By: Natnael A.
32. BPP score,interpretation Mx
BPP score interpretation Recommended Mx
10 normal No intervention, repeat
test(wkly/2x wk)
8/10(NST not done)
8/10AFV Suspect asphyxia delivery
6 Possible asphyxia •AFV delivery
•Normal AFV , GA> 36wks
deliver if Cx is favorable
If GA<36wks repeat test,
if ≤6 deliver
But if >6 repeat as per
protocol
4 Probable asphyxia Repeat test same day, if
BPP ≤6 deliver
0-2 Chronic Fetal asphyxia deliver
32
By: Natnael A.
33. • Normal variables are highly predictive of a good
neonatal outcome
• Each abnormal variables may be associated with a
Fetal Pulse rate
• If the NST is reactive, do not need the u/s parameters
of the BPP, only the AFV would add additional
information
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By: Natnael A.
34. Clinical utility
• BPP is non-invasive, easily applied and highly accurate means
of predicting the presence of fetal acidemia
• Risk of fetal death within 1wk of a normal test was 0.8/1000
of women tested .
34
By: Natnael A.
35. Cont’d
• Modified BPP
developed to simplify the examination and
reduce the time necessary to complete testing
Combination of AFI and NST
The rate of stillbirth within 1 wk of a normal test
is the same as with the standard BPP
35
By: Natnael A.
36. Factors affecting test results
• Administration of antenatal corticosteroids
can be associated with transient FHR changes (a decrease in
variability) that typically return to baseline by day 4 after
treatment.
fetal breathing and body movement
• subclinical infection- controversial
may be associated with absence of FBM
Preterm labor may be associated with absence of FB.
36
By: Natnael A.
37. Doppler velocimetry
• Doppler U/S is a noninvasive technique to assess blood flow
(volume, rate) in fetal or maternal circulations umbilical A,
ductus venosus,….
• Maternal uterine artery Doppler velocimetry has also been
evaluated in efforts to predict placental dysfunction
• Doppler velocimetry is recommended as the primary
surveillance tool for monitoring pregnancies complicated
with IUGR due to uteroplacental insufficiency
37
By: Natnael A.
38. Indications frequency of testing
• Woman with high risk factor for fetal acidaemia
should undergo antepartum FS with eg.NST,
BPP…
• May be initiated as early as 26 wks but more
appropriate at 32-34wks
• Reassuring test should be repeated periodically
(weekly/2x wk)until delivery when high risk
condition persists
• Normal antepartum testing doesn’t preclude the
need for intrapartum fetal monitoring
38
By: Natnael A.
Cont.amniotic fl. pressure myometrial pressure exceeds collapsing pressure for vessels crossing through Ux muscle ,ultimately ing bl flow to intervillous space if there is U-P insufficiency late FHR dec.