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Fetal_Monitoring.pptx
- 1. Fetal Monitoring Dr. AnjooAgarwal Professor Dept of Obs & gyn KGMU, Lucknow
- 2. Objectives • Understand aimsof fetal monitoring • Understand methods of fetal monitoring • Understand limitations of fetal monitoring
- 3. Aims of FetalMonitoring • Prevention of fetal death • Avoidance of unnecessary interventions ACOG, AAP 2012
- 4. • 23 yrsold woman G2P1+0 (1st FTND, A&H) presents at 38 wks pregnancy with C/o diminished fetal moments since 2 days. Q. How significant do you think the problem is & what should be your next step?
- 5. Significance • Diminished fetalactivity, may be a harbinger of impending fetal death Sadovsky, 1973
- 6. Low Risk vsHigh Risk • Any pregnancy may become high risk any time • C/o diminished fetal activity important in all cases
- 7. Role of Gestation? • Fetal activity starts at 7 wks • General body movements become organised 20-30 wks • Fetal movement maturation continues till 36 wks • Criteria for interpretation of tests varies with gestation • Fetal viability an important consideration
- 8. Methods of Assessment Antepartum: − DFMC − NST − CST − Biophysical Profile − Doppler Velocimetry Intrapartum: − External or Indirect − Internal or Direct − Fetal scalp blood sampling
- 9. DFMC • Cardiff “Countto 10” • One hour after each meal
- 10. NST • FHR Accelerationin response to fetal movements • Test of fetal condition Normal – reactive Abnormal – non reactive
- 11. Reactive NST • ≥32 weeks – 2 accelerations ≥ 15 bpm ≥ 15 sec during 20 min • < 32 wks – 2 accelerations ≥ 10 bpm ≥ 10 sec during 20 min
- 12. Fetal Heart RateAcceleration
- 13. Electronic Fetal Monitoring PatternDefinition Baseline • The mean FHR rounded to increments of 5 bpm during a 10 min segment, excluding − Periodic & episodic changes − Segment of baseline that differ by more than 25 bpm • The baseline must be for a minimum 2 min in any 10 min segment or the baseline for that time period is indeterminate. In this case, one may refer to the prior 10 min window to determine of baseline • Normal FHR baseline: 110 – 160 bpm • Tachycardia: FHR baseline > 160 bpm • Bradycardia: FHR baseline < 110 bpm • Fluctuations in the baseline FHR that are irregular in amplitude & frequency Baseline Variability • Variability is visually quantified as the amplitude of peak-to-trough in bpm − Absent – amplitude range undetectable − Minimal – amplitude range detectable but ≤ 5 bpm or fewer − Moderate – amplitude range 6-25 bpm − Marked – amplitude range > 25 bpm Acceleration • A visually apparent abrupt increase (onset to peak in < 30 sec) in the FHR • At 32 wks & beyond, an acceleration has a peak of 15 bpm or more have baseline, with a duration or more but less than 2 min from onset to return • Before 32 wks, an acceleration has a peak of 10 bpm or more above baseline, with a duration of ≥ 10 sec < 2 min from onset to return • Prolonged acceleration lasts ≥ 2 min but < 10 min • If an acceleration last 10 min, it is a baseline change • Visually apparent usually symmetrical gradual decrease & return of the FHR associated with a uterine contraction
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- 20. CST/OCT • Tests uteroplacentalfunction contraction stimulated by oxytocin infusion • Late decelerations indicate positive test
- 21. Biophysical Profile • Nonstresstest • Fetal breathing • Fetal movement • Fetal tone • Amniotic fluid volume
- 22. Modified Biophysical Profile •NST + AFI (cut off 5 cm)
- 23. Doppler Velocimetry • Umbilicalartery • MCA • Ductus Venosus
- 24. Umbilical Artery Doppler •Abnormal if – • S/D > 95% percentile for GA • Absent end diastolic flow – 10% PM • Reversed end diastolic flow – 33% PM • Utility only in FGR
- 25. MCA • Fetal Hypoxia→ brain sparing → ↑ Cerebro vascular resistance (RI) • Also useful in fetal anaemia where ↑ PSV
- 26. Ductus Venosus • Goodcorrelation with perinatal outcome • But by the time affected it is too late • Still in experimental stage
- 27. Final Recommendations • Startat 32-34 weeks in HR cases • Severe complications may require testing at 26-28 weeks • Repeat weekly/ every 7 days • Most commonly used – modified biophysical profile
- 28. MCQ NST is usedto test 1 uteroplacental bloodflow 2 fetal condition 3 response to uterine contractions 4 fetal anaemia
- 29. MCQ A 35 yrold G1 P0+0 presents at 34 wks with GDM. It is recommended that she be monitored by 1 weekly NST 2 DFMC 3 Daily doppler 4 all of the above
- 30. MCQ The acceleration ofFHR in NST should be of 1 at least 20 min duration 2 at least 20 sec duration 3 at least 15 sec duration 4 at least 15 min duration