This document discusses evidence-based approaches to antenatal Doppler fetal surveillance. It begins by outlining the objectives and aims of fetal surveillance, including identifying fetuses at risk of hypoxia and improving perinatal outcomes. It then describes various methods of fetal surveillance, including daily fetal movement counts, non-stress tests, biophysical profiles, and Doppler velocimetry. The document discusses the indications and measurements of Doppler indices for the uterine, umbilical, and middle cerebral arteries. It reviews recent evidence showing that Doppler ultrasound in high-risk pregnancies can reduce perinatal deaths and interventions without increasing them in low-risk pregnancies. The document concludes by emphasizing that not all pregnancies require surveillance and that monitoring
The document summarizes key points from the Neonatal Resuscitation Program (NRP) 8th edition. It discusses improvements to teamwork and communication during resuscitation. It provides clinical guidance on ventilation, temperature management, medications and other aspects of resuscitation. The document emphasizes preparation, effective communication, and ongoing quality improvement to optimize neonatal outcomes.
This document discusses various methods used to monitor fetal well-being during labor, including fetal heart rate monitoring, fetal blood sampling, fetal pulse oximetry, fetal electrocardiography, and ultrasound. It provides details on interpreting fetal heart rate patterns, the results of fetal blood sampling, and evidence regarding electronic fetal monitoring versus intermittent auscultation. While electronic fetal monitoring has increased cesarean rates compared to intermittent auscultation, studies have not found it reduces hypoxic ischemic encephalopathy or cerebral palsy rates.
This document summarizes the key points from the 2020 American Heart Association (AHA) neonatal resuscitation guidelines presented by Dr. K. Navnitha Reddy. It discusses questions that should be asked before every birth, clinical findings of abnormal transition, perinatal risk factors that increase the need for resuscitation, and recommendations regarding delayed cord clamping, routine suctioning, initiating CPR, vascular access route, and skin-to-skin care. Topics from previous guidelines that saw no changes are also listed. The document concludes by citing the sources for the 2020 AHA neonatal resuscitation guidelines.
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 summarizes various diagnostic fetal assessment tests, including chorionic villous sampling, triple or quad screening, ultrasound, placental grading, amniocentesis, cordocentesis, amnioreduction, fetal MRI, fetal echocardiogram, and vibroaccoustic stimulation. It describes what each test is, how it is performed, what it can detect, risks, timing considerations, and references for further information. The goal of these tests is to evaluate the health and development of the fetus during pregnancy.
The non-stress test (NST) is a simple, non-invasive test performed on pregnancies over 28 weeks of gestation to monitor the fetus's heart rate and movement. During a NST, belts are attached to the mother's abdomen to measure fetal heart rate and contractions while movement and heart rate reactivity are monitored for 20-40 minutes. A NST may indicate if the fetus is receiving enough oxygen or show signs of fetal distress. The test poses no risks to the mother or baby. A reactive NST result means blood flow and oxygen to the fetus are adequate, while a nonreactive result requires additional testing to determine the cause.
This document discusses various methods of antenatal fetal surveillance to monitor fetal well-being and detect any issues. It describes clinical tests like fundal height measurements, biochemical tests like estriol levels, and biophysical tests like fetal movement counts and non-stress tests. The aim is to determine gestational age, check for fetal anomalies, detect growth abnormalities, and identify acute or chronic fetal hypoxia through regular surveillance. This monitoring is especially important for high-risk pregnancies.
The document summarizes key points from the Neonatal Resuscitation Program (NRP) 8th edition. It discusses improvements to teamwork and communication during resuscitation. It provides clinical guidance on ventilation, temperature management, medications and other aspects of resuscitation. The document emphasizes preparation, effective communication, and ongoing quality improvement to optimize neonatal outcomes.
This document discusses various methods used to monitor fetal well-being during labor, including fetal heart rate monitoring, fetal blood sampling, fetal pulse oximetry, fetal electrocardiography, and ultrasound. It provides details on interpreting fetal heart rate patterns, the results of fetal blood sampling, and evidence regarding electronic fetal monitoring versus intermittent auscultation. While electronic fetal monitoring has increased cesarean rates compared to intermittent auscultation, studies have not found it reduces hypoxic ischemic encephalopathy or cerebral palsy rates.
This document summarizes the key points from the 2020 American Heart Association (AHA) neonatal resuscitation guidelines presented by Dr. K. Navnitha Reddy. It discusses questions that should be asked before every birth, clinical findings of abnormal transition, perinatal risk factors that increase the need for resuscitation, and recommendations regarding delayed cord clamping, routine suctioning, initiating CPR, vascular access route, and skin-to-skin care. Topics from previous guidelines that saw no changes are also listed. The document concludes by citing the sources for the 2020 AHA neonatal resuscitation guidelines.
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 summarizes various diagnostic fetal assessment tests, including chorionic villous sampling, triple or quad screening, ultrasound, placental grading, amniocentesis, cordocentesis, amnioreduction, fetal MRI, fetal echocardiogram, and vibroaccoustic stimulation. It describes what each test is, how it is performed, what it can detect, risks, timing considerations, and references for further information. The goal of these tests is to evaluate the health and development of the fetus during pregnancy.
The non-stress test (NST) is a simple, non-invasive test performed on pregnancies over 28 weeks of gestation to monitor the fetus's heart rate and movement. During a NST, belts are attached to the mother's abdomen to measure fetal heart rate and contractions while movement and heart rate reactivity are monitored for 20-40 minutes. A NST may indicate if the fetus is receiving enough oxygen or show signs of fetal distress. The test poses no risks to the mother or baby. A reactive NST result means blood flow and oxygen to the fetus are adequate, while a nonreactive result requires additional testing to determine the cause.
This document discusses various methods of antenatal fetal surveillance to monitor fetal well-being and detect any issues. It describes clinical tests like fundal height measurements, biochemical tests like estriol levels, and biophysical tests like fetal movement counts and non-stress tests. The aim is to determine gestational age, check for fetal anomalies, detect growth abnormalities, and identify acute or chronic fetal hypoxia through regular surveillance. This monitoring is especially important for high-risk pregnancies.
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.
This document provides an overview of fetal surveillance techniques used in antepartum and intrapartum periods. In the antepartum section, it discusses various risk factors for fetal death and different testing modalities used for surveillance including maternal fetal movement assessment, contraction stress testing, non-stress testing, biophysical profile, Doppler velocimetry, and their predictive values. The intrapartum section covers the physiological basis for fetal heart rate monitoring during labor, different monitoring methods like intermittent auscultation and continuous electronic monitoring, and parameters assessed from the monitoring including baseline rate, variability, accelerations, and decelerations.
Assessment of fetal wellbeing in pregnancy and labour 716
This document provides recommendations for antepartum and intrapartum fetal monitoring techniques based on evidence from studies and clinical experience. It summarizes various techniques for antepartum surveillance including fetal movement counting, non-stress tests, biophysical profiles, and Doppler assessments. For intrapartum monitoring, it recommends that intermittent auscultation be used for most low-risk pregnancies, while electronic fetal monitoring is appropriate for high-risk cases. It also provides guidance on interpreting fetal heart rate tracings and responding to atypical patterns through scalp stimulation or blood sampling. The overall goal is to prevent fetal injury through optimal timing of delivery while also avoiding unnecessary interventions.
This document provides an overview of antepartum fetal assessment. It discusses the history and importance of assessing fetal well-being during pregnancy. A variety of assessment methods are described, including clinical assessment of fetal movement, ultrasound to evaluate fetal growth and anatomy, non-stress tests to monitor fetal heart rate, and biophysical profiles which combine multiple tests for a thorough evaluation of fetal status. The document outlines indications for increased surveillance and management protocols based on test results. The goal of antepartum assessment is early detection of at-risk fetuses to improve neonatal outcomes.
This document summarizes antepartum fetal assessment techniques. It describes the aims of fetal monitoring as ensuring fetal growth and well-being. Various clinical evaluation methods are outlined, including fetal movements, breathing, biophysical profile, amniotic fluid volume, and Doppler velocimetry. Specific tests like non-stress tests and contraction stress tests are also defined. The document provides details on interpreting test results and guidelines for testing frequency from organizations like ACOG. The overall purpose is to screen for high-risk factors affecting the fetus and guide management to improve perinatal outcomes.
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.
Assessment of fetal wellbeing in pregnancy and labour jaipur716
This document provides recommendations for antepartum and intrapartum fetal monitoring techniques. It discusses various techniques for antepartum surveillance including fetal movement counting, non-stress tests, biophysical profiles, and Doppler assessments of the uterine and umbilical arteries. It notes that while electronic fetal monitoring (EFM) is commonly used in labor, there is no evidence it improves outcomes compared to intermittent auscultation and it is associated with higher rates of intervention. The document provides 14 recommendations for various fetal monitoring techniques addressing their appropriate use, interpretation, and management responses.
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 summarizes various methods used for antepartum fetal surveillance, including fetal movement count, nonstress test (NST), vibroacoustic stimulation test (VAST), contraction stress test (CST), nipple stimulation test, assessment of amniotic fluid volume using amniotic fluid index (AFI) and single deepest pocket (SDP), and biophysical profile (BPP). It describes what each test assesses, how it is performed, and what normal and abnormal results indicate.
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.
This document discusses various methods for assessing fetal well-being in late pregnancy, including biophysical and biochemical tests such as fetal movement counts, non-stress tests, fetal cardiotocography, ultrasounds of umbilical artery blood flow, and contraction stress tests using nipple stimulation to evaluate fetal heart rate patterns during uterine contractions. The results of these tests can indicate fetal well-being, stress, or compromise and help guide obstetric management decisions.
We use a machine known as a fetal monitor to do a non-stress test. A non-stress test (NST) looks at your baby's heart rate over time (usually 20 to 30 minutes, but sometimes up to an hour). The monitor has two sensors that are placed on your belly with two belts that go around your waist.
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 provides guidelines for the optimal management of women who experience reduced fetal movements (RFM). It discusses:
1) Performing a history and examination to check for fetal viability, assess risk factors, and exclude complications like preeclampsia.
2) Using cardiotocography and ultrasound scanning when needed to check for fetal wellbeing and growth issues.
3) Providing additional surveillance and testing for women with recurrent RFM or RFM before 28 weeks, while reassuring low-risk women.
4) Documenting all assessments, advice, and plans for follow-up in the patient's records. The goal is to evaluate the fetus, identify at-risk pregnancies, and reassure women when the
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 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 discusses antepartum fetal assessment. It begins by defining antepartum fetal surveillance as the assessment of fetal well-being before labor onset. The goals are early detection of at-risk fetuses to allow timely management and avoiding unnecessary interventions. It then lists various maternal, fetal, and pregnancy conditions that warrant fetal surveillance. The document goes on to describe multiple methods of antepartum assessment including ultrasound, non-stress tests, biophysical profiles, and Doppler studies. It provides details on interpreting and acting on the results of these tests to monitor fetal health and determine need for delivery.
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.
The document discusses antepartum fetal monitoring techniques used to assess fetal well-being, including fetal movement counting, assessment of uterine growth, antepartum fetal heart rate testing (nonstress test), biophysical profile, and Doppler velocimetry. It describes how uteroplacental insufficiency can lead to a theoretical scheme of fetal deterioration and outlines conditions that place the fetus at risk. Details are provided on performing and interpreting the nonstress test used to detect fetal distress.
Biophysical and biophysical well beingManu Aravind
This document discusses various biophysical principles and tests used to assess fetal well-being, including fetal movement count, non-stress test, biophysical profile, cardiotocography, contraction stress test, ultrasound, and Doppler. It provides details on how each test is performed, what they assess, and how results are interpreted. The goal is screening for utero-placental insufficiency and fetal compromise or chronic asphyxia. Ultrasound is also used to evaluate fetal anatomy and growth, amniotic fluid, and detect any abnormalities.
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
The document discusses various methods for fetal monitoring during pregnancy. It describes the aims of fetal monitoring including assessing fetal well-being, growth, abnormalities, and gestational age. Common monitoring methods discussed include weight gain monitoring, fundal height measurements, fetal kick counts, diagnostic ultrasound scans, and cardiotocography. The document provides details on various ultrasound measurements and assessments that can be made including fetal anatomy, growth, amniotic fluid, umbilical cord doppler, and biophysical screening tests.
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.
This document provides an overview of fetal surveillance techniques used in antepartum and intrapartum periods. In the antepartum section, it discusses various risk factors for fetal death and different testing modalities used for surveillance including maternal fetal movement assessment, contraction stress testing, non-stress testing, biophysical profile, Doppler velocimetry, and their predictive values. The intrapartum section covers the physiological basis for fetal heart rate monitoring during labor, different monitoring methods like intermittent auscultation and continuous electronic monitoring, and parameters assessed from the monitoring including baseline rate, variability, accelerations, and decelerations.
Assessment of fetal wellbeing in pregnancy and labour 716
This document provides recommendations for antepartum and intrapartum fetal monitoring techniques based on evidence from studies and clinical experience. It summarizes various techniques for antepartum surveillance including fetal movement counting, non-stress tests, biophysical profiles, and Doppler assessments. For intrapartum monitoring, it recommends that intermittent auscultation be used for most low-risk pregnancies, while electronic fetal monitoring is appropriate for high-risk cases. It also provides guidance on interpreting fetal heart rate tracings and responding to atypical patterns through scalp stimulation or blood sampling. The overall goal is to prevent fetal injury through optimal timing of delivery while also avoiding unnecessary interventions.
This document provides an overview of antepartum fetal assessment. It discusses the history and importance of assessing fetal well-being during pregnancy. A variety of assessment methods are described, including clinical assessment of fetal movement, ultrasound to evaluate fetal growth and anatomy, non-stress tests to monitor fetal heart rate, and biophysical profiles which combine multiple tests for a thorough evaluation of fetal status. The document outlines indications for increased surveillance and management protocols based on test results. The goal of antepartum assessment is early detection of at-risk fetuses to improve neonatal outcomes.
This document summarizes antepartum fetal assessment techniques. It describes the aims of fetal monitoring as ensuring fetal growth and well-being. Various clinical evaluation methods are outlined, including fetal movements, breathing, biophysical profile, amniotic fluid volume, and Doppler velocimetry. Specific tests like non-stress tests and contraction stress tests are also defined. The document provides details on interpreting test results and guidelines for testing frequency from organizations like ACOG. The overall purpose is to screen for high-risk factors affecting the fetus and guide management to improve perinatal outcomes.
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.
Assessment of fetal wellbeing in pregnancy and labour jaipur716
This document provides recommendations for antepartum and intrapartum fetal monitoring techniques. It discusses various techniques for antepartum surveillance including fetal movement counting, non-stress tests, biophysical profiles, and Doppler assessments of the uterine and umbilical arteries. It notes that while electronic fetal monitoring (EFM) is commonly used in labor, there is no evidence it improves outcomes compared to intermittent auscultation and it is associated with higher rates of intervention. The document provides 14 recommendations for various fetal monitoring techniques addressing their appropriate use, interpretation, and management responses.
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 summarizes various methods used for antepartum fetal surveillance, including fetal movement count, nonstress test (NST), vibroacoustic stimulation test (VAST), contraction stress test (CST), nipple stimulation test, assessment of amniotic fluid volume using amniotic fluid index (AFI) and single deepest pocket (SDP), and biophysical profile (BPP). It describes what each test assesses, how it is performed, and what normal and abnormal results indicate.
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.
This document discusses various methods for assessing fetal well-being in late pregnancy, including biophysical and biochemical tests such as fetal movement counts, non-stress tests, fetal cardiotocography, ultrasounds of umbilical artery blood flow, and contraction stress tests using nipple stimulation to evaluate fetal heart rate patterns during uterine contractions. The results of these tests can indicate fetal well-being, stress, or compromise and help guide obstetric management decisions.
We use a machine known as a fetal monitor to do a non-stress test. A non-stress test (NST) looks at your baby's heart rate over time (usually 20 to 30 minutes, but sometimes up to an hour). The monitor has two sensors that are placed on your belly with two belts that go around your waist.
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 provides guidelines for the optimal management of women who experience reduced fetal movements (RFM). It discusses:
1) Performing a history and examination to check for fetal viability, assess risk factors, and exclude complications like preeclampsia.
2) Using cardiotocography and ultrasound scanning when needed to check for fetal wellbeing and growth issues.
3) Providing additional surveillance and testing for women with recurrent RFM or RFM before 28 weeks, while reassuring low-risk women.
4) Documenting all assessments, advice, and plans for follow-up in the patient's records. The goal is to evaluate the fetus, identify at-risk pregnancies, and reassure women when the
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 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 discusses antepartum fetal assessment. It begins by defining antepartum fetal surveillance as the assessment of fetal well-being before labor onset. The goals are early detection of at-risk fetuses to allow timely management and avoiding unnecessary interventions. It then lists various maternal, fetal, and pregnancy conditions that warrant fetal surveillance. The document goes on to describe multiple methods of antepartum assessment including ultrasound, non-stress tests, biophysical profiles, and Doppler studies. It provides details on interpreting and acting on the results of these tests to monitor fetal health and determine need for delivery.
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.
The document discusses antepartum fetal monitoring techniques used to assess fetal well-being, including fetal movement counting, assessment of uterine growth, antepartum fetal heart rate testing (nonstress test), biophysical profile, and Doppler velocimetry. It describes how uteroplacental insufficiency can lead to a theoretical scheme of fetal deterioration and outlines conditions that place the fetus at risk. Details are provided on performing and interpreting the nonstress test used to detect fetal distress.
Biophysical and biophysical well beingManu Aravind
This document discusses various biophysical principles and tests used to assess fetal well-being, including fetal movement count, non-stress test, biophysical profile, cardiotocography, contraction stress test, ultrasound, and Doppler. It provides details on how each test is performed, what they assess, and how results are interpreted. The goal is screening for utero-placental insufficiency and fetal compromise or chronic asphyxia. Ultrasound is also used to evaluate fetal anatomy and growth, amniotic fluid, and detect any abnormalities.
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
The document discusses various methods for fetal monitoring during pregnancy. It describes the aims of fetal monitoring including assessing fetal well-being, growth, abnormalities, and gestational age. Common monitoring methods discussed include weight gain monitoring, fundal height measurements, fetal kick counts, diagnostic ultrasound scans, and cardiotocography. The document provides details on various ultrasound measurements and assessments that can be made including fetal anatomy, growth, amniotic fluid, umbilical cord doppler, and biophysical screening tests.
The document discusses various methods for fetal monitoring during pregnancy. It describes the aims of fetal monitoring including assessing fetal well-being, growth, abnormalities, and gestational age. Common monitoring methods discussed include weight gain monitoring, fundal height measurements, fetal kick counts, diagnostic ultrasound scans, and cardiotocography. The document provides details on various ultrasound measurements and assessments that can be made including fetal anatomy, growth, amniotic fluid, umbilical cord doppler, and biophysical screening tests.
This document provides information about intra-uterine growth retardation (IUGR). It begins with general and specific objectives of the topic. IUGR is defined as fetal growth restriction, and can be classified as symmetrical or asymmetrical based on onset and organ size. Causes include maternal, fetal, placental and unknown factors. Diagnosis involves ultrasound to measure head circumference, abdominal circumference, femur length and amniotic fluid. Complications for the fetus include hypoxia, acidosis, hypoglycemia and multi-organ failure. Long term risks include delayed development and metabolic syndrome in adulthood.
Intrauterine growth restriction (IUGR) refers to failure of the fetus to reach growth potential and is associated with increased morbidity and mortality. It affects 3-10% of pregnancies and is a major contributor to stillbirths and perinatal mortality. IUGR can be symmetrical, affecting head, length and weight proportionally, or asymmetrical, affecting weight more than length and head. Causes include fetal abnormalities, infections, placental dysfunction, and maternal conditions like hypertension, malnutrition and smoking. Diagnosis involves serial ultrasounds to monitor fetal growth and Doppler studies to assess placental function. Management focuses on treating underlying maternal conditions, monitoring fetal wellbeing, and delivery planning if indicated.
This case report describes the diagnosis and management of a fetus with a left-sided diaphragmatic hernia detected on ultrasound at 23 weeks gestation. Diaphragmatic hernias occur when abdominal organs protrude into the chest cavity through a defect in the diaphragm. The fetus was monitored closely with serial ultrasounds and delivered via cesarean section at 36 weeks for pre-eclampsia. The newborn was referred to the neonatal intensive care unit for surgery and management of pulmonary issues associated with the condition.
This document provides guidelines on the use of fetal Doppler in obstetrics from the Society of Obstetricians and Gynaecologists of Canada.
1. Umbilical artery Doppler should be used to assess the fetal-placental circulation in pregnancies with suspected severe placental insufficiency.
2. Reduced, absent, or reversed umbilical artery end-diastolic flow indicates the need for enhanced fetal surveillance or delivery, depending on gestational age and other factors. If delivery is delayed for fetal lung maturity, intensive surveillance is recommended until delivery for those with reversed end-diastolic flow.
3. Umbilical artery Doppler should not be used
This document discusses strategies to prevent kernicterus, a type of brain damage caused by severe neonatal jaundice. It identifies several key areas for improvement, including better lactation support, follow-up within 48 hours of discharge, and parent education. A systems-approach is recommended to optimize newborn jaundice management through improved identification of at-risk newborns, characterization of jaundice levels, and community surveillance to achieve safety standards and prevent future cases of kernicterus.
SCREENING OF HIGH RISK PREGNANCY NEWER MODALITIES OF_110313.pptxRDiJ1
This document discusses screening methods for high-risk pregnancies. It defines screening as identifying apparently healthy individuals at increased disease risk. High-risk pregnancies are those with increased maternal, fetal, or newborn morbidity/mortality risks due to complicating factors. Screening assessments evaluate medical histories and examine for risk factors like young/elderly primigravidas, medical conditions, obstetric histories, and other maternal conditions. Newer screening modalities include biochemical tests, cytogenetic tests, non-invasive methods like ultrasound and NSTs, and invasive methods like CVS and amniocentesis.
This document discusses intrauterine growth restriction (IUGR), including definitions, health burden, classification, etiology, pathophysiology, screening, prevention, diagnosis, interventions, management, and long-term outcomes. IUGR is defined as a fetus that does not achieve expected in utero growth potential due to genetic or environmental factors. It affects about 10% of live births and is a leading cause of perinatal morbidity and mortality. Causes include fetal, maternal, placental, and environmental factors. Screening involves ultrasound and Doppler assessments. Management involves timing of delivery based on gestational age and severity. IUGR is associated with short and long-term complications.
This document discusses prenatal diagnosis and fetal surveillance techniques. It defines prenatal diagnosis as identifying structural or functional abnormalities in the developing fetus using invasive and non-invasive methods. The objectives of prenatal diagnosis and fetal surveillance are to identify risks to the fetus, monitor fetal well-being, and develop management plans. A variety of screening tests, diagnostic tests, monitoring techniques, and therapies for identified issues are described. Ethical considerations for accepting or declining fetal therapies are also outlined.
Intrauterine Growth Restriction (IUGR) is defined as failure of the fetus to reach growth potential and is associated with increased morbidity and mortality. It affects 3-10% of pregnancies and increases perinatal mortality rate by 5-20 times. Causes include fetal, placental and maternal factors like infections, structural anomalies, vascular diseases, nutritional deficiencies, and thrombophilias. Diagnosis involves assessing risk factors, fetal measurements and Doppler ultrasound. Management focuses on treating underlying causes, fetal monitoring, timing of delivery and neonatal care. Complications include stillbirth, fetal distress, hypoglycemia and long term risks of metabolic and neurological disorders. Prognosis depends on gestational age and prematurity, with increased
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 intrauterine growth restriction (IUGR), including definitions, causes, detection methods, and management. Key points include:
- IUGR, or small for gestational age (SGA), affects 10-15% of fetuses and is caused by placental insufficiency restricting nutrients/oxygen to the fetus.
- Ultrasound is used to monitor fetal growth parameters like abdominal circumference and estimated fetal weight against customized charts. Doppler ultrasound of umbilical and uterine arteries can also indicate placental insufficiency.
- If IUGR is detected, careful surveillance is required using biophysical profile, amniotic fluid volume, and Doppler ultrasound to determine optimal delivery timing weighing fetal vs. maternal
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.
IVF Pregnancy -Is it different? A presentation by Dr Laxmi Shrikhande the leading IVF specialist in India
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Similar to approach to evidence based antenatal Fetal survelliance (20)
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approach to evidence based antenatal Fetal survelliance
1. Evidence Based Approach To
Antenatal Doppler Fetal
Surveillance
DR PRAMAN KUSHWAH
DrNB NEONATOLOGY RESIDENT
NICE HOSPITAL, HYDERABAD
2. Objectives
1. Aim of fetal surveliiance
2. Methods of fetal survelliance
3. Indication for fetal survelliance
4. Fetal Doppler in fetal survelliance – Indices and
Measurements
5. Uterine, Umbilical and Middle cerebral artery Doppler
6. Recent Evidences
3. Aim Of Fetal Surveillance
• Identifying fetus at greater risk of hypoxia
• Minimizing the morbidity by optimizing the timing of delivery
• Improving perinatal outcomes by decreasing stillbirths and perinatal asphyxia
• Improve long term neurologic outcomes by timely intervention
• Relies on fetal biophysical parameters (eg. heart rate and movement) that are
sensitive to hypoxemia and acidemia
• FIGO recommends to begin at 24-28 weeks in high risk patients.
4. Daily Fetal Movement Count
Non Stress Test
Contraction stress test
Manning score or biophysical profile
Doppler Velocimetry
Methods Of Fetal Surveillance
Cardiff Method : Count of 10 fetal movements in 12 hours
Designed to evaluate FHR response to maternal uterine contractions
Describes fetal heart rate acceleration to fetal movement as a sign of fetal health
5. Biophysical Profile
Non Stress Test
• At least one episode continuing for more than 30
seconds
Fetal Breathing
movements
• At least 3 limb or body movements
Gross Body Movements
• An episode of active extension with return to flexion
of a limb or trunk OR opening or closing of the hand
Fetal Muscle Tone
• At least one cord and limb-free fluid pocket which is
2 cm by 2 cm in two measurements at right angles.
Amniotic fluid volume
Manning et al, 1980
6. Fanaroff and Martin’s Neonatal-Perinatal Medicine, Diseases of the fetus and infant, 10th edition
7. Fetal Doppler In Antenatal Surveillance
•For evaluation of high-risk pregnancies especially, FGR is suspected with EFW <
10th centile.
•Doppler sonography has both diagnostic and predictive value in fetus with
potential FGR.
•Doppler USG of fetal vessels can identify the SGA from true FGR fetus, thus
avoiding iatrogenic prematurity and additional antenatal testing.
8. Objective : To assess the effects on obstetric practice and pregnancy outcome of routine fetal
and umbilical Doppler ultrasound in unselected and low-risk pregnancies.
Population : Included five trials that recruited 14,624 women, with data analysed for 14,185
women.
Result : No group differences noted for the review’s primary outcomes of perinatal death and
neonatal morbidity. Routine fetal and umbilical Doppler ultrasound examination in low-risk or
unselected populations did not result in increased antenatal, obstetric and neonatal
interventions.
Cochrane Database of Systematic Reviews 2015, Issue 4. Art. No.: CD001450.
9. • Objective: To assess the effects of Doppler ultrasound used in high-risk pregnancies on
obstetric care and fetal outcomes
• Selection criteria: Nineteen trials involving 10,667 women were included (high risk
pregnancies) were included, compared the use of Doppler ultrasound of the umbilical
artery of the unborn baby with no Doppler or with cardiotocography (CTG).
• Results: The use of Doppler ultrasound in high-risk pregnancy was associated with a
reduction in perinatal deaths (29%) with fewer inductions of labour and fewer caesarean
sections. No difference was found in operative vaginal births nor in Apgar scores less than
seven at five minutes
Cochrane Database of Systematic Reviews 2017, Issue 6. Art. No.: CD007529.
10. Pathophysiological Basis Of Antenatal Doppler
Doppler Velocimetry for Fetal Surveillance: Adverse Perinatal Outcome and Fetal Hypoxia. Dev Maulik, Reinaldo Figueroa. 2006
Fetus responds to chronic hypoxemia with a detectable sequence of
biophysical changes
Physiological adaptation → physiological decompensation
DU may not identify fetuses at risk of death from an acute hypoxemic
insult, such as a complete placental abruption.
11. Stress
Chronic respiratory and nutritive insufficiency
Primary adaptive response
Decreased fetal growth rate
Secondary adaptive response
Fetal energy conservation – decr. HR reactivity, fetal movement
Circulatory redistribution – doppler changes
Fetal growth preferred over placental growth
Increased efficiency of placental exchange
Polycythemia
Fetal Response To Chronic Intrauterine Hypoxia
12. Stress
Chronic respiratory and nutritive insufficiency
Primary adaptive response
Decreased fetal growth rate
Secondary adaptive response
Fetal energy conservation – dec HR reactivity, fetal movement
Circulatory redistribution – doppler changes
Fetal growth preferred over placental growth
Increased efficiency of placental exchange
Polycythemia
Progressive decompensation
Hypoxia respiratory acidosis metabolic acidosis
High impedance in fetoplacental and systemic circulation– AEDF in UA
Declining AFI Oligohydramnios
Loss of fetal movement, HR variability
Persistent late de-accelerations
Death
Doppler Velocimetry for Fetal Surveillance: Adverse Perinatal Outcome and Fetal Hypoxia. Dev Maulik, Reinaldo Figueroa. 2006
13. Doppler USG - History
• DU was successfully introduced in OBG in 1977.
• Fitzgerald et al. were the first to report noninvasive demonstration of the umbilical
cord (UC) blood flow pattern and suggested that the umbilical artery (UA) waveforms
could be abnormal in fetuses with intrauterine growth-restriction (IUGR).
14. Doppler Velocimetry - Uses
• Non-invasive measurement of blood flow in maternal and fetal blood vessels
• Assesses uteroplacental blood flow and fetal physiological responses.
• DU waveforms- not only reflect blood velocity but also presence and direction of
flow, velocity profile, flow volume, and impedance.
15. Doppler Indices
• Angle-independent, doppler indices mentioned below were developed for flow
velocimetry to avoid inter- and intra-observer variation
18. Uterine Artery Doppler
• Uterine artery re-modelling is the hallmark of successful placentation.
• In normal pregnancy, placental trophoblast cells invade the inner third of the
myometrium optimizing delivery of oxygen and nutrients to the fetus.
• Significant increase in uterine artery compliance increased flow in diastole.
• In preeclampsia failure of trophoblast invasion of the uterine muscular wall
spiral arteries retain the muscle elastic coating impedance to blood flow persists.
• PI > 95th or persistent diastolic notch done in 2nd trimester predict pre-eclampsia
and IUGR
Uterine artery Doppler flow studies in obstetric practice Journal of Prenatal Medicine 2010; 4 (4): 59-62
19. Normal uterine artery at 12 weeks shows
relatively high resistance, absent notching
Normal mid-trimester uterine artery, increased
diastolic flow
Normal third trimester uterine artery, very low
resistance
High resistance with persistent notching may be
normal in first trimester, not in this 24-week
gestation USG
Very high resistance, marked notching, absent
diastolic velocities in a woman with lupus,
proteinuric pre-eclampsia, and severe IUGR at
28 weeks
20. Umbilical Artery Doppler
• Umbilical artery (UA)- most easily measured parameter
• Measure of fetal systemic and placental vascular impedance.
• Placentas with abnormal UA doppler have slender capillaries with decreased
capillary loops in gas-exchanging terminal villi.
• Maternal or placental conditions that obliterate small muscular arteries in the
placental tertiary stem villi result in a progressive decrease in end-diastolic flow in
the umbilical artery Doppler waveform until absent.
• REDF has been shown to be associated with obliteration of >70% of placental
tertiary villi.
Doppler Imaging Ultrasonography in Assessment of Fetal Well-being NeoReviews Vol.5 No.6 June 2004
Antenatal tests of fetal wellbeing. Seminars in Fetal & Neonatal Medicine 20 (2015) 138e143
21. Umbilical Artery Doppler
Normal umbilical artery at 18 weeks shows
relatively high resistance, but consistent diastolic
flow
Normal umbilical artery at 36 weeks, low
resistance, generous diastolic flow
High resistance, diastolic velocity low
Absent end-diastolic velocity (AEDV)
Reversed diastolic velocity (REDV) in severe
intrauterine growth restriction (IUGR)
22. Abnormal UA Doppler
1. Prediction of fetal hypoxia and acidosis especially if AEDF
2. A/REDF higher adverse perinatal outcomes, increased perinatal mortality upto
28% and increased requirement of intensive care.
3. Higher prevalence of doppler abnormalities seen in chromosomal disorders
(especially trisomy 13, 18, and 21) and congenital anomalies.
4. Many studies have shown that abnormal doppler findings esp A/REDF are
associated with long term neurodevelopmental impairment.
Baschat AA, Viscardi RM, Hussey-Gardner B, et al. Infant neurodevelopment following fetal growth restriction: relationship with
antepartum surveillance parameters. Ultrasound Obstet Gynecol 2009;33:44–50.
23. MCA Doppler
1) To detect evidence of redistribution of fetal
blood flow to the brain in cases of placental
insufficiency, fetal hypoxia, and associated
fetal growth restriction
2) To detect increased blood flow to the brain in
cases of fetal anemia.
24. MCA Doppler And IUGR
• MCA resistance is normally high throughout gestation.
• Increased MCA diastolic velocity in FGR i.e. ‘brain-sparing’ effect secondary to
hypoxia- induced cerebrovascular dilation
• Represents a deterioration in placental respiratory function decrease in PI.
• These compensatory changes are sequential
• Depend on the maintenance of adequate cardiac output.
• When IUGR becomes terminal, falling cardiac function may result in the regression
of MCA flow, so- called ‘pseudo - normalization’
25. Normal middle cerebral artery (MCA) at term –
normal peak systolic velocity (58 cm/s), high
resistance, low end-diastolic velocity.
‘Brain sparing’ MCA – lower peak, much higher
diastolic velocity suggests cerebro-vasodilation
Anemic fetus with retained high resistance,
elevated peak systolic velocity (77 cm/s).
26. Cerebroplacental Ratio
• The CPR is calculated as the ratio of doppler index (pulsatility index (PI), resistance
index (RI), or systolic/diastolic ratio (S/D)) of the MCA by that of the UA. Most
commonly PI is used.
• High UA PI values and low MCA PI values are associated with adverse outcomes.
• Low CPR (<1) risk of adverse perinatal outcome.
Cerebro-placental Ratio = Middle Cerebral Artery PI
Umbilical Artery PI
Predictive accuracy of cerebroplacental ratio for adverse perinatal and neurodevelopmental outcomes in suspected fetal growth restriction:
systematic review and meta-analysis. Ultrasound Obstet Gynecol 2018; 52: 430–441.
27. MCA Doppler And Fetal Anemia
• MCA PSV (Peak Systolic Velocity) risk of Rh disease or anemia due to parvovirus
B19.
• Raised PSV but antibody is negative acute or chronic feto-maternal haemorrhage
• For Rh sensitization – done as early as 16-18 weeks, repeated 1-2 weeks interval
• The sensitivity of increased MCA PSV for the prediction of mod-severe anemia was
100% either in the presence or absence of hydrops, with a false positive rate of 12%.
28. Fetal Anemia
Fetal anemia progresses (decreased viscosity)
Right and left ventricular output increases by 45%, heart rate unchanged
Fetal blood vessel cross sectional area unchanged
Poiseuille’s law (velocity directly proportional to flow) (flow=velocity X cross
sectional area)
Increased flow
Normal Fetal anemia
29.
30. GRIT (Growth Restriction Intervention Trial)
• Population: 69 hospitals in 13 European countries, 1997-2003. 587 babies, 24-36 weeks
gestation with IUGR and abnormal doppler.
• Aim: Aim was to compare the effect of delivering early to avoid intrauterine hypoxia, to
delaying delivery for as long as possible, in order to gain maturity
• Result: Median time-to-delivery interval - 0.9 days in immediate group and 4.9 days in
delay group. Total deaths prior to discharge were 29 (10%) in the immediate group versus
27 (9%) in the delay group.
31. Lancet 2004; 364: 513–2
Conclusion : At 2 years of age, there is a trend towards more disability in the immediate delivery group,
but no overall difference in Griffiths DQ.
32. TRUFFLE trial
• (P) Trial of Umbilical and Fetal Flow in Europe 20 European perinatal centers, 2005 – 2010.
Women with a singleton fetus, 26–32 weeks, AC < 10th percentile and UA PI >95th percentile
• (I) AIM: To assess whether changes in the fetal ductus venosus Doppler waveform (DV)
could be used as indications for delivery instead of cardiotocography short-term variation
(STV)
• 3 armed RCT:
Group 1: control - current standard of care: timing of delivery based on CTG low STV(red HR)
Group 2a: Early ductus venosus changes (PI > 95th centile)
Group 2b: Late ductus venosus changes (absent a-wave)
Lancet 2015; 385: 2162–72
33. TRUFFLE trial
• (O) Primary outcome: Survival without cerebral palsy or neurosensory impairment, or a
Bayley III developmental score of less than 85, at 2 years of age
• Result :The proportion of infants surviving without neuro-impairment did not differ
between the CTG STV (111 [77%] of 144 infants with known outcome), DV p95 (119 [84%] of
142), and DV no A (133 [85%] of 157) groups (ptrend=0·09)
Concluded : The proportion of infants who survived without neurodevelopmental impairment between the
three groups did not differ; neurodevelopmental impairment was least frequent in survivors randomly
assigned to the DV no A group compared with those in the CTG STV group (p trend across the three groups of
0·004). Their findings support waiting for late ductus venosus changes before delivery because no increase in
hypoxia mediated deaths occurred and neuro-impairment is less frequent than when delivery is based on
computerised CTG changes.
34.
35. Take home message
• All Pregnancies do not require Antepartum fetal surveillance with doppler
• High risk pregnancies should be identified timely and appropriate fetal monitoring should be
initiated
• Early and late onset FGR have different pathophysiology and different findings on fetal surveillance
• Umbilical Artery dopplers have limited role in late onset FGR.
• Monitoring should be based on integration of Doppler, BPP, NST rather than one test alone.
• Timing of delivery should be individualized for each patient.