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.
A forceps delivery is a type of assisted delivery. Instrumental delivery refers to any delivery process which is assisted by vaginal operations. It is an art, which should be learnt by all obstetricians for optimum maternal and perinatal outcome.
When fetal head is delivered, but shoulders are stuck and cannot be delivered it is known as shoulder dystocia.
The anterior shoulder becomes trapped behind on the symphysis pubis, whilst the posterior shoulder may be in the hollow of the sacrum or high above the sacral promontory.
Majority of fetal deaths occur in the antepartum period.
There is progressive decline in maternal deaths all over the world. Currently more interest is focused to evaluate the fetal health. The primary objective of antenatal assessment is to avoid fetal death.
A forceps delivery is a type of assisted delivery. Instrumental delivery refers to any delivery process which is assisted by vaginal operations. It is an art, which should be learnt by all obstetricians for optimum maternal and perinatal outcome.
When fetal head is delivered, but shoulders are stuck and cannot be delivered it is known as shoulder dystocia.
The anterior shoulder becomes trapped behind on the symphysis pubis, whilst the posterior shoulder may be in the hollow of the sacrum or high above the sacral promontory.
Majority of fetal deaths occur in the antepartum period.
There is progressive decline in maternal deaths all over the world. Currently more interest is focused to evaluate the fetal health. The primary objective of antenatal assessment is to avoid fetal death.
High risk approach in maternal and child healthShrooti Shah
High risk pregnancy is defined as one which is complicated by factor or factors that adversely affects the pregnancy outcome –maternal or perinatal or both.The risk factors may be pre-existing prior to or at the time of first antenatal visit or may develop subsequently in the ongoing pregnancy labour or puerperium.
Over 50 percent of all maternal complications and 60 percent of all primary caesarean sections arise from the high risk group of cases.
Obstetrical Ultrasound• Introduced in the late 1950’s ultrasonography is a safe, non- invasive, accurate and cost-effective means to investigate the fetus• Computer generated system that uses sound waves integrated through real time scanners placed in contact with a gel medium to the maternal abdomen• The information from different reflections are reconstructed to provide a continuous picture of the moving fetus on the monitor screen
ultrasonography in obstetrics, usg in obstetrics, ultrasound in obstetrics, doppler in obstetrics, usg doppler in obstetrics, signs in ultrasound, anomaly scan, pregnancy scan, ultrasound in pregnancy,
According to the International Federation of Gynaecology and Obstetrics (FIGO), prolonged pregnancy is defined as any pregnancy that exceeds 42wks (294 days) from the first day of the LMP in a woman with regular 28-day cycles.
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.
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1. Guide & Evaluated by:
Mrs. Amirtha Gowri.,M.Sc(N)
Mrs.Vijayalaxmi.,M.Sc(N)
Faculty of Nursing
Presented by:
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1st
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2. Biophysical Principles
Biophysical profile is a screening test for utero-
placental insufficiency.
Fetal biophysical activities are initiated
modulated and regulated through fetal nervous
system
3. Biophysical tests
Fetal movement count
Cardiotocography
Non-stress test
Fetal biophysical profile
Doppler ultrasound
Vibro acoustic stimulation test
Contraction stress test(CST)
4. Fetal Movement Count
Two method
Cardif “count 10” formula:
○ The fetal movement starting at 9.A.M, the counting
comes to an end as soon as 10 movements.
○ Lessthan 10 movements- in 12hrs on 2 successive
days
○ No movements is perceived even after 12hrs in a
single day.
5. Daily Fetal Movement Count(DFMC)
Three counts each of one hour duration(morning, noon
and evening) are recommended.
The total counts are multiplied by 4 gives daily (12
hours).
Kick – is lessthan 3 in each hour-indicates fetal
compromise.
The count should be performed starting daily at 28
weeks of pregnancy.
Maternal hypoglycaemia- associated with increased
fetal movement.
Maternal perception of fetal movements may be
reduced with fetal sleep.
6. Non-Stress test
Continuous electronic monitoring of the fetal heart rate along with
recording of fetal movement
Fetal heart rate acceleration with fetal movements – indicates
healthy fetus.
Reactive- two or more acceleration morethan 15 beats per minute
above the baseline and longer than 15 seconds- 20 minutes
observation
Non-Reactive- absence of any fetal reactivity.
The test to be started after 30 weeks twice weekly.
Vibro Acoustic stimulation- assess the fetal sleep starts from quiet
to active sleep indicates a reactive fetus- harmless.
7. Fetal Biophysical Profile(BPP)
Consists of NST and ultrasonographically determined amniotic fluid
index. BIO PHYSICAL SCORING
Parameters Minimal Normal Criteria Score
Non stress test
Fetal Breating movment
Gross body Movment
Fetal Muscle Tone
Amniotic Fluid
INTERPRETATION
No fetal Asphyxia
Chronic Asphyxia
Chronic Asphyxia
Certain Asphyxia
Reactive Pattern
Lepisode lasting> 30 Sec
3 discrete body / Limb movments
1 episode of extension(Limb/
trunk)with return of flexion
1 Pocket Measuring 2cm in 2
perpendicular planes
MANAGEMENT
At weekly intervals
>36 weeks deliver
<30 weeks repeat testing in 4-6 Hrs
≤ 120 min persistent score ≤ 4
2
2
2
2
2
8-10
6
4
2
8. Fetal Cardiotocography(CTG)
Two method
External – continuous tracing of FHR
Internal – fetal ECG tracing is made by applying a
spiral pointed scalp electrode to the fetal scalp after
rupturing the membrane.
○ Intra uterine pressure could be simultaneously
measured by passing a catheter inside the uterine cavity.
○ Advantages – can detect hypoxia
○ Drawbacks – trained personnel required .,instruments
are expensive
9. Interpretation of an intra partumInterpretation of an intra partum
cardio tocographcardio tocograph
Character Normal Suspicious Abnormal
Baseline FHR
Baseline
variability
Acceleration
Deceleration
110-150 BPM
10-25 bpm
2 in 20 min
None or early
<110 bpm or
>150 bpm
<5 bpm for
>40min
None in 40 min
Variable <60
bpm for <60 sec
>150 bpm or <110 bpm with
decleration or variability < 5 bpm.
<5 bpm for >90 min or Sinusoidal
pattern
None in 40 min
Variable >60 bpm for >60 sec or
repetitive late deceleration or
bradycardia > 3 min
10. Contraction Stress Test(CST)
Asses fetal well-being during pregnancy where there is
alteration in FHR in response to uterine contractions.
Indications:
Intrauterine growth restriction
Post maturity
Procedure:
Oxytocin infusion is started –initial rate of infusion 1ml
stepped up at the intervals of 20 minutes.
Using hand to palpate the hardening of the uterus
during contracting auscultation of FHR/1 minute – 1 to
2 hours. To perform the test.
11. Interpretation of CST
Positive – persistent late deceleration of FHR
Negative – no late deceleration
Suspicious – inconsistent
Unsatisfactory – poor quality of recording.
Hyperstimulation – deceleration of FHR with uterine
contraction lasting >90 seconds.
Nipple stimulation test – rubbing the nipple through
her clothes for 10 minutes and it takes less time
compared to CST.
12. Ultrasonography
The audible range of frequency greater than 2MHz
(cycles per second).
Sonar- “sound navigation and ranging”
Introduced – Ian Donald – Glasgow- 1958.
Methods
Through abdominal transducers – 3 to 5 MHz.
Vaginal transducers – 5 to 7 MHz.
B mode – brightness mode (2-D) images are obtained.
M mode – to study the moving organs, a wave pattern in
the presence of motion eg. Fetal heart.
13. I.Trimester.
Intrauterine Gastational Sac:
Yolk sac- 7000 mIU/ml
Embryo – 11000mIU/ml
Gestational sac – eccentric in position within the
endometrium of fundus
Double decidua sign – decidua and the chorion which
appears as the two distinct layers of the wall of the
gestation sac.
GS should increased by 1.1mm in diameter per day
15. Nuchal translucency
Increased fetal nuchal skin thickness >3mm by TVS –
strong marker for chromosomal anomalies.(Tri –
21,18,13)
Gastational age.
The four methods of fetal age estimation
○ Determination of gestational sac dimension(at about 8 weeks)
○ Measurement of crown-rump length(7 to 12 weeks)
○ Measurement of biparietal diameter (after 12 weeks)
○ Measurement of femur length (12 weeks)
○ The average increase in the biparietal diameter beyond 34 weeks is
1.7mm per week
○ When the HC/AC ratio is elevated (>1.0) after 34 weeks IUGR is
Suspected.
○ A measurement of biparietal diameter of 9.8cm indicates maturity.
16. Mid Trimester
Fetal Growth-is calculated on the basis of an
accurate gestational age and is expressed in
percentiles – normal fetal weight should be between
the 10th
and 90th
percentiles weight less than 10th
percentile is considered small for gestational
age(SGA) whereas more than 90th
percentile is large
for gestational age.
Indication
Fetal viability, number, gestational age
Aminiotic fluid volume
Placental location and maturity
17. Neural tube defects(NTD)
Cranial abnormalities
Anencephaly
Choroid plexus cysts
Spinal anomalies
Fetal heart
Fetal abdomen & abdominal wall
Omphalocele
Hydrops fetalis
Fetal gender identification- detection of the testes within the
scrotum in the third trimester.
18. Placenta & umblical cord
Placenta is a echogenic discoid mass
Placental thickness at term about 30mm- more
than 45mm at any period of gestation-
abnormal
Placenta of multifetal pregnancy:
Dizygotic twins have always diamniotic, dichorionic
placenta(DiDi)-twin peak sign.
19. Third Trimester
Estimated fetal weight is determined FL, AC
and BPD.
Growth profile- IUGR- the HC is maintained but
the AC falls off around 30 weeks the HC:AC is
therefore elevated.
21. Doppler
Doppler velocimetry of the umbilical artery.
The umbilical artery doppler waveform is to measure
the peak systolic(s), peak diastolic(D) and mean(M)
values from these values S/D ratio and the pulsatility
index(P.I)[P.I=(S-D)/M] are calculated.
Normal pregnancy the S/D ratio and the pulsatility
index decrease as the gestational age advances
In higher values S/D and P.I mean reduced diastolic
velocities and increased placental vascular
resistance(IUGR)
22. Continued..
Doppler velocimetry of the umbilical vein:
Normally umbilical venous flow is monophasic
Umbilical venous pulsation are often associated with raised
CVP and cardiac failure and increased perinatal mortality.
Reduced diastolic flow indicates high resistance in the
down stream vessel and low tissue perfusion. Presence of
“notch” in the early diastole waveform also indicates high
resistance to the flow.
Presence of notch in the uterine artery when confrimed
bilaterally at 24 weeks indicates the possible development
of pre-eclampsia & fetal growth restriction
23. Biochemical
Maternal serum alpha feto protein(MSAP)
Alfa feto protein is a oncofetal protein(Molecular Weight
70,000)
MSAP level is elevated in a number of conditions
1. wrong gestational age
2. Open neural tube defects
3. IUFD
4. Anterior abdominal wall defects
5. Renal anomalies
24. Triple Test
combined MSAFP, HCG and UE3(Unconjugated
Oestriol)
It is used to detect Down’s Syndrome
ACETYL CHOLINE ESTERASE
Amniotic fluid level is elevated in open neural tube
defects
25. Amniocentesis
The deliberate puncture of the amniotic
fluid sac per abdomen
Diagnostic – 14-16 weeks Genetic
disorders
Therapeutic- Induction of Abortion by
instillation of chemicals in hypertonic
saline
26. Chorionic villus sampling
Performed for prenatal diagnosis of
genetic disorders
Performed 10-12 weeks of gestation
The removal of a small tissue specimen
from the fetal portions of the placenta
27. Percutaneous umbilical Blood
sampling OR cordocentesis
Fetal blood sampling and transfusion
Usually done after 18 weeks gestation
Values
Haematological- Fetal anaemia
Fetal Infection – Toxoplasmosis, viralinfections
Fetal blood gas- Growth restrictions
Fetal therapy – Blood transfusion, drug
therapy
28. Fetal pulmonary maturity
Confirmation of lung maturation
Assessment of severity of RH –iso
immunisation
Bilirubin in the amniotic fluid by specto
phometric analysis