The document provides guidelines for interpreting intrapartum fetal heart rate tracings using the NICHD nomenclature system, which classifies tracings as Category I, II, or III based on characteristics such as baseline rate, variability, and presence of decelerations. Category I tracings are normal, Category II indeterminate, and Category III abnormal and predictive of fetal acidosis. The guidelines aim to standardize interpretation of tracings and guide clinical management.
Hydrops fetalis: Immune and nonimmune fetal hydrops Hale Teka Raya
This document discusses hydrops fetalis, which refers to edema of the fetus. There are two main types - immune and nonimmune hydrops. Immune hydrops is caused by red blood cell alloimmunization due to the formation of antibodies against fetal red blood cell antigens. This can cause hemolytic anemia and hydrops fetalis in the fetus. Nonimmune hydrops has many possible causes including genetic, structural, and infectious etiologies. The diagnosis and management of hydrops fetalis depends on determining the underlying cause through various diagnostic tests and the gestational age and condition of the fetus.
The document discusses various aspects of fetal heart rate monitoring including:
1. Types of fetal heart rate tests including NST, CST, and acoustic stimulation test.
2. Components of fetal heart rate tracings including baseline rate, variability, accelerations, and decelerations.
3. Interpretation of normal, suspicious, and abnormal fetal heart rate tracing patterns.
4. Management recommendations based on the interpretation including continued monitoring, amniotomy, or discontinuing labor stimulating agents.
The document discusses the interpretation and management of CTG (cardiotocography). It describes the steps to interpret a CTG tracing, including evaluating the fetal heart rate baseline, variability, accelerations, decelerations and their correlation with uterine contractions. It provides a structured DR C BRA VADO method to categorize CTG tracings as normal, suspicious or pathological. The management strategies for each category are then outlined, such as continued monitoring, additional tests like fetal scalp blood pH, or expedited delivery depending on the severity of the CTG abnormalities. Specific situations like the second stage of labor, placental abruption or fetal abnormalities are also addressed.
This document provides information about fetal cardiotocography (CTG), including:
1. CTG can be performed from 28 weeks of gestation as that is when the fetal autonomic nervous system is mature.
2. Normal CTG findings include a baseline heart rate between 110-160 bpm, variability between 5-25 bpm, and an absence of or early decelerations with at least 2 accelerations in 20 minutes.
3. Abnormal findings include bradycardia (<110 bpm), tachycardia (>160 bpm), decreased variability (<5 bpm), and late or variable decelerations which can indicate fetal hypoxia or distress.
This document discusses chorioamnionitis (intra-amniotic infection), including its pathogenesis, risk factors, clinical findings, diagnosis, and evaluation. Chorioamnionitis occurs when pathogens ascend from the vagina and infect the amniotic fluid and fetal membranes. It complicates 40-70% of preterm births and 1-4% of term births. Diagnosis is based on maternal fever and may include leukocytosis, fetal tachycardia, and uterine tenderness. Evaluation of amniotic fluid can confirm infection through culture, Gram stain, or glucose/white blood cell counts. Histologic examination after birth also helps diagnosis.
The document discusses thalassemia in pregnancy according to 2014 guidelines from the Royal College of Obstetricians and Gynaecologists (RCOG). It defines thalassemia as a quantitative disorder of globin chain production affecting either the alpha or beta globin chain. It describes the epidemiology, genetics, types (alpha and beta thalassemia), complications, and management both outside and during pregnancy. The RCOG guidelines provide recommendations for preconception care, antenatal care, intrapartum care, postpartum care, booking appointments, and schedule of antenatal appointments for women with thalassemia.
USG AND DOPPLER IN DIAGNOSIS AND MANAGEMENT OF IUGRshiv lasune
This document discusses the use of ultrasound and Doppler in the diagnosis and management of intrauterine growth restriction (IUGR). It defines small for gestational age (SGA) as a fetus below the 10th percentile and describes how Doppler of the umbilical artery can help identify fetuses with IUGR, monitor disease progression, and predict outcomes. Doppler of other fetal vessels like the middle cerebral artery and ductus venosus can further evaluate the fetus and help guide management decisions. Together, Doppler studies provide both diagnostic and prognostic information useful in the care of growth restricted fetuses.
Hydrops fetalis: Immune and nonimmune fetal hydrops Hale Teka Raya
This document discusses hydrops fetalis, which refers to edema of the fetus. There are two main types - immune and nonimmune hydrops. Immune hydrops is caused by red blood cell alloimmunization due to the formation of antibodies against fetal red blood cell antigens. This can cause hemolytic anemia and hydrops fetalis in the fetus. Nonimmune hydrops has many possible causes including genetic, structural, and infectious etiologies. The diagnosis and management of hydrops fetalis depends on determining the underlying cause through various diagnostic tests and the gestational age and condition of the fetus.
The document discusses various aspects of fetal heart rate monitoring including:
1. Types of fetal heart rate tests including NST, CST, and acoustic stimulation test.
2. Components of fetal heart rate tracings including baseline rate, variability, accelerations, and decelerations.
3. Interpretation of normal, suspicious, and abnormal fetal heart rate tracing patterns.
4. Management recommendations based on the interpretation including continued monitoring, amniotomy, or discontinuing labor stimulating agents.
The document discusses the interpretation and management of CTG (cardiotocography). It describes the steps to interpret a CTG tracing, including evaluating the fetal heart rate baseline, variability, accelerations, decelerations and their correlation with uterine contractions. It provides a structured DR C BRA VADO method to categorize CTG tracings as normal, suspicious or pathological. The management strategies for each category are then outlined, such as continued monitoring, additional tests like fetal scalp blood pH, or expedited delivery depending on the severity of the CTG abnormalities. Specific situations like the second stage of labor, placental abruption or fetal abnormalities are also addressed.
This document provides information about fetal cardiotocography (CTG), including:
1. CTG can be performed from 28 weeks of gestation as that is when the fetal autonomic nervous system is mature.
2. Normal CTG findings include a baseline heart rate between 110-160 bpm, variability between 5-25 bpm, and an absence of or early decelerations with at least 2 accelerations in 20 minutes.
3. Abnormal findings include bradycardia (<110 bpm), tachycardia (>160 bpm), decreased variability (<5 bpm), and late or variable decelerations which can indicate fetal hypoxia or distress.
This document discusses chorioamnionitis (intra-amniotic infection), including its pathogenesis, risk factors, clinical findings, diagnosis, and evaluation. Chorioamnionitis occurs when pathogens ascend from the vagina and infect the amniotic fluid and fetal membranes. It complicates 40-70% of preterm births and 1-4% of term births. Diagnosis is based on maternal fever and may include leukocytosis, fetal tachycardia, and uterine tenderness. Evaluation of amniotic fluid can confirm infection through culture, Gram stain, or glucose/white blood cell counts. Histologic examination after birth also helps diagnosis.
The document discusses thalassemia in pregnancy according to 2014 guidelines from the Royal College of Obstetricians and Gynaecologists (RCOG). It defines thalassemia as a quantitative disorder of globin chain production affecting either the alpha or beta globin chain. It describes the epidemiology, genetics, types (alpha and beta thalassemia), complications, and management both outside and during pregnancy. The RCOG guidelines provide recommendations for preconception care, antenatal care, intrapartum care, postpartum care, booking appointments, and schedule of antenatal appointments for women with thalassemia.
USG AND DOPPLER IN DIAGNOSIS AND MANAGEMENT OF IUGRshiv lasune
This document discusses the use of ultrasound and Doppler in the diagnosis and management of intrauterine growth restriction (IUGR). It defines small for gestational age (SGA) as a fetus below the 10th percentile and describes how Doppler of the umbilical artery can help identify fetuses with IUGR, monitor disease progression, and predict outcomes. Doppler of other fetal vessels like the middle cerebral artery and ductus venosus can further evaluate the fetus and help guide management decisions. Together, Doppler studies provide both diagnostic and prognostic information useful in the care of growth restricted fetuses.
This document discusses cardiotocography (CTG), which monitors fetal heart rate and uterine contractions during pregnancy. CTG is performed in the third trimester using external transducers on the abdomen or internal monitors during labor. Recordings are interpreted using the DR C BRAVADO method: defining risk, assessing contractions, baseline rate, variability, accelerations, decelerations, and the overall impression. Abnormal findings like late decelerations or a sinusoidal pattern indicate fetal distress requiring emergency measures.
This document discusses thrombocytopenia during pregnancy. It lists various potential causes including gestational thrombocytopenia, ITP, preeclampsia, and others. Gestational thrombocytopenia is the most common cause, affecting around 75% of cases. ITP occurs in around 1-2 per 10,000 pregnancies and is diagnosed after ruling out other causes. The document outlines clinical features, pathogenesis, diagnosis, effects on pregnancy, and management approaches for both conditions. It emphasizes that bleeding is unlikely with platelet counts above 50x109/L and risk of neonatal issues is generally low with ITP. Treatment involves corticosteroids, IVIg, or platelet transfusions as needed.
This document summarizes a case study of a 24-year-old pregnant woman who is 33 weeks pregnant with intrauterine growth restriction (IUGR). An ultrasound revealed she has a single umbilical artery. Her previous pregnancy involved hydrocephalus and a meningomyelocele. The single umbilical artery was further examined with color Doppler which showed altered Doppler parameters, likely due to the reduced size of the single artery and reduced resistance. IUGR and associated abnormalities can also impact Doppler assessment. The fetus showed measures close to the lower limit of standard deviation, suggestive of IUGR. Associated IUGR was observed. Normal umbilical cords contain two umbilical arteries and one vein, while single umbilical arteries
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 classifying heart function in pregnant women using the New York Heart Association grading system, which places patients into four classes based on functional capacity and symptoms. It then discusses mortality risks associated with different cardiac lesions, dividing them into low, moderate, and high risk categories. It notes prognosis depends on functional status and NYHA class. Clinical criteria for diagnosing cardiac disease during pregnancy include diastolic murmurs, severe systolic murmurs, heart enlargement on x-ray, and severe arrhythmias. Finally, it lists some cardiac conditions that pose prohibitively high risks and may warrant termination of pregnancy.
Non-immune hydrops (NIH) is an abnormal accumulation of fluid in fetal compartments including skin, lungs, heart, and abdomen. It can be caused by over 100 factors including cardiac issues, genetic syndromes, infections, and tumors. Making a diagnosis involves detailed ultrasound, fetal echocardiogram, amniocentesis, and potentially fetal blood sampling to identify the underlying cause through tests like karyotyping, metabolic screening, and infection panels. Management involves counseling and supportive care, with long term outcomes dependent on the specific condition causing the NIH.
This document discusses the interpretation of various types of Doppler ultrasound during pregnancy. It describes:
1. Umbilical artery Doppler which can detect placental hypoxia and increased resistance, predicting abnormal outcomes. Abnormal readings include increased resistance index and absent/reversed end diastolic flow.
2. Middle cerebral artery Doppler which can detect fetal anemia by increased blood flow to the brain. It is also used to time delivery of growth restricted infants.
3. Ductus venosus Doppler which has moderate predictive value for growth restriction in preterm infants.
4. Uterine artery Doppler has limited use in predicting fetal growth restriction but can identify maternal causes by abnormal readings.
This document defines key terms related to fetal assessment during labor such as acidosis, asphyxia, and fetal distress. It outlines the goals and methods of intrapartum fetal assessment including clinical examination, intermittent auscultation of the fetal heart rate, continuous electronic fetal monitoring, fetal scalp blood sampling, and APGAR scoring. Patterns of fetal heart rate tracings are categorized as reassuring, non-reassuring, or ominous. Meconium in the amniotic fluid is discussed as a sign of possible intrapartum fetal asphyxia. Methods to diagnose asphyxia include fetal heart rate patterns, scalp stimulation response, and scalp blood gas analysis. Steps for intrauterine fetal res
1) Congenital adrenal hyperplasia (CAH) is a group of disorders caused by deficiencies in cortisol biosynthesis. This leads to excess production of androgens, causing virilization in females and precocious puberty in males.
2) The most common type is 21-hydroxylase deficiency, which accounts for 95% of CAH cases. It can present as the severe salt-wasting form or the milder simple virilizing form.
3) Diagnosis is based on elevated 17-hydroxyprogesterone levels in the presence of clinical signs. Genetic testing can confirm the type of enzyme deficiency causing CAH.
Rhesus isoimmunization occurs when an Rh-negative mother carries an Rh-positive baby and fetal-maternal hemorrhage of Rh-positive fetal red blood cells into the mother's circulation triggers the formation of anti-D antibodies. This can sensitize the mother and cause hemolytic anemia in subsequent Rh-positive pregnancies if the anti-D antibodies cross the placenta and destroy fetal red blood cells. Administering RhoGAM (anti-D immunoglobulin) to the mother during and after pregnancy can prevent sensitization by neutralizing any Rh-positive fetal red blood cells that enter her circulation. Close monitoring and medical management is required for sensitized Rh-negative mothers to prevent harm to
This document discusses intrapartum fetal heart rate (FHR) monitoring. It finds that while continuous electronic FHR monitoring increases cesarean rates compared to intermittent auscultation, neither approach improves neonatal outcomes. For low-risk women, routine electronic monitoring is not recommended. High-risk pregnancies should be continuously monitored. FHR patterns are categorized as reassuring, nonreassuring, or indeterminate. Nonreassuring patterns may indicate fetal acidosis and require interventions like oxygen, fluids, or discontinuing uterotonic drugs.
Gestational diabetes can cause complications in infants due to hyperglycemia transferring through the placenta. Infants of diabetic mothers (IDMs) are at risk for birth defects if hyperglycemia occurs early in pregnancy during organ development. Later hyperglycemia increases risks for macrosomia, hypoglycemia, and other issues. IDMs require careful monitoring and treatment of potential complications in the neonatal period such as hypoglycemia, hypocalcemia, respiratory distress, and cardiomyopathy. Long term, IDMs have increased risk of obesity, diabetes, and developmental or cognitive delays.
This document provides guidelines for the management of hypertensive disorders during pregnancy, including pre-eclampsia. It discusses the epidemiology, risks, classification, pathophysiology, and management based on NICE guidelines. Key points include: hypertension complicates 10% of pregnancies, pre-eclampsia 2-8%; it is a leading cause of maternal death; risks include prematurity, fetal growth restriction, and maternal organ damage; treatment involves hospitalization, blood pressure monitoring, antihypertensive medications, timing of birth depending on gestational age and severity of symptoms.
Sickle cell anemia is an autosome linked recessive trait that can be transmitted from parents to the offspring when
both the partners are carrier for the gene (or heterozygous). The disease is controlled by a single pair of allele, HbA
and HbS. Out of the three possible genotypes only homozygous individuals for HbS (HbS, HbS) show the diseased phenotype. The ability to predict the clinical course of SCD during pregnancy is difficult. It is mandatory to follow up the patient closely from the very beginning i.e. from preconception to antenatal till labor. SCD is associated with both maternal and fetal complications and is associated with an increased incidence of perinatal mortality, premature
labor, fetal growth restriction and acute painful crises during pregnancy.
1) The document discusses the mechanism of labor in breech presentations, which involves the birth of the buttocks in the first stage, shoulders in the second stage, and head in the third stage.
2) It describes the types of breech presentations and factors that predispose to breech, as well as techniques for diagnosing and managing breech presentations through vaginal delivery or cesarean section.
3) Complications of breech delivery are outlined for both mother and baby, including increased risks of trauma, asphyxia, and need for operative intervention like cesarean section.
This document provides information on intrapartum fetal monitoring techniques including fetal heart rate monitoring, indications for continuous electronic fetal monitoring, interpretation of fetal heart rate patterns, and management of non-reassuring fetal status. It discusses techniques like intermittent auscultation, electronic fetal monitoring, fetal scalp pH testing, pulse oximetry, and lactate testing. The goal of intrapartum monitoring is timely identification and rescue of fetuses at risk for neonatal morbidity from hypoxic insult during labor and delivery.
This document discusses various patterns seen on cardiotocography (CTG) monitoring of fetal heart rate. It describes normal baseline heart rate ranges and variability. It also defines different periodic changes seen such as accelerations and decelerations including early decelerations, late decelerations, variable decelerations and prolonged decelerations. Various abnormal patterns are also described such as tachycardia, bradycardia, reduced variability and sinusoidal patterns. Causes and clinical significance of these findings are discussed.
1. Fetal assessment during labor involves monitoring amniotic fluid and the fetal heart rate. Amniotic fluid is assessed for color and clarity while the fetal heart rate is the primary assessment.
2. Fetal heart rate is monitored either intermittently by listening with a fetoscope every 15-30 minutes during the active phase of labor, or continuously through electronic fetal monitoring. Electronic monitoring can be external or internal.
3. Normal fetal heart rate is between 120-160 beats per minute with moderate variability. Abnormal patterns including tachycardia, bradycardia, minimal variability or late decelerations may indicate fetal distress requiring changes to the labor process or expedited delivery.
1. The document provides an overview of the CooperSurgical Fetal Monitor model F9, including its buttons and functions, components, benefits, and guidelines for use and care.
2. It describes the monitor's touchscreen display, large color monitor, ultrasound transducer, and software features for transferring data.
3. The document also outlines the National Institute of Child Health and Human Development categories for normal, indeterminate, and abnormal fetal heart rate patterns and general measures for each category.
This document discusses cardiotocography (CTG), which monitors fetal heart rate and uterine contractions during pregnancy. CTG is performed in the third trimester using external transducers on the abdomen or internal monitors during labor. Recordings are interpreted using the DR C BRAVADO method: defining risk, assessing contractions, baseline rate, variability, accelerations, decelerations, and the overall impression. Abnormal findings like late decelerations or a sinusoidal pattern indicate fetal distress requiring emergency measures.
This document discusses thrombocytopenia during pregnancy. It lists various potential causes including gestational thrombocytopenia, ITP, preeclampsia, and others. Gestational thrombocytopenia is the most common cause, affecting around 75% of cases. ITP occurs in around 1-2 per 10,000 pregnancies and is diagnosed after ruling out other causes. The document outlines clinical features, pathogenesis, diagnosis, effects on pregnancy, and management approaches for both conditions. It emphasizes that bleeding is unlikely with platelet counts above 50x109/L and risk of neonatal issues is generally low with ITP. Treatment involves corticosteroids, IVIg, or platelet transfusions as needed.
This document summarizes a case study of a 24-year-old pregnant woman who is 33 weeks pregnant with intrauterine growth restriction (IUGR). An ultrasound revealed she has a single umbilical artery. Her previous pregnancy involved hydrocephalus and a meningomyelocele. The single umbilical artery was further examined with color Doppler which showed altered Doppler parameters, likely due to the reduced size of the single artery and reduced resistance. IUGR and associated abnormalities can also impact Doppler assessment. The fetus showed measures close to the lower limit of standard deviation, suggestive of IUGR. Associated IUGR was observed. Normal umbilical cords contain two umbilical arteries and one vein, while single umbilical arteries
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 classifying heart function in pregnant women using the New York Heart Association grading system, which places patients into four classes based on functional capacity and symptoms. It then discusses mortality risks associated with different cardiac lesions, dividing them into low, moderate, and high risk categories. It notes prognosis depends on functional status and NYHA class. Clinical criteria for diagnosing cardiac disease during pregnancy include diastolic murmurs, severe systolic murmurs, heart enlargement on x-ray, and severe arrhythmias. Finally, it lists some cardiac conditions that pose prohibitively high risks and may warrant termination of pregnancy.
Non-immune hydrops (NIH) is an abnormal accumulation of fluid in fetal compartments including skin, lungs, heart, and abdomen. It can be caused by over 100 factors including cardiac issues, genetic syndromes, infections, and tumors. Making a diagnosis involves detailed ultrasound, fetal echocardiogram, amniocentesis, and potentially fetal blood sampling to identify the underlying cause through tests like karyotyping, metabolic screening, and infection panels. Management involves counseling and supportive care, with long term outcomes dependent on the specific condition causing the NIH.
This document discusses the interpretation of various types of Doppler ultrasound during pregnancy. It describes:
1. Umbilical artery Doppler which can detect placental hypoxia and increased resistance, predicting abnormal outcomes. Abnormal readings include increased resistance index and absent/reversed end diastolic flow.
2. Middle cerebral artery Doppler which can detect fetal anemia by increased blood flow to the brain. It is also used to time delivery of growth restricted infants.
3. Ductus venosus Doppler which has moderate predictive value for growth restriction in preterm infants.
4. Uterine artery Doppler has limited use in predicting fetal growth restriction but can identify maternal causes by abnormal readings.
This document defines key terms related to fetal assessment during labor such as acidosis, asphyxia, and fetal distress. It outlines the goals and methods of intrapartum fetal assessment including clinical examination, intermittent auscultation of the fetal heart rate, continuous electronic fetal monitoring, fetal scalp blood sampling, and APGAR scoring. Patterns of fetal heart rate tracings are categorized as reassuring, non-reassuring, or ominous. Meconium in the amniotic fluid is discussed as a sign of possible intrapartum fetal asphyxia. Methods to diagnose asphyxia include fetal heart rate patterns, scalp stimulation response, and scalp blood gas analysis. Steps for intrauterine fetal res
1) Congenital adrenal hyperplasia (CAH) is a group of disorders caused by deficiencies in cortisol biosynthesis. This leads to excess production of androgens, causing virilization in females and precocious puberty in males.
2) The most common type is 21-hydroxylase deficiency, which accounts for 95% of CAH cases. It can present as the severe salt-wasting form or the milder simple virilizing form.
3) Diagnosis is based on elevated 17-hydroxyprogesterone levels in the presence of clinical signs. Genetic testing can confirm the type of enzyme deficiency causing CAH.
Rhesus isoimmunization occurs when an Rh-negative mother carries an Rh-positive baby and fetal-maternal hemorrhage of Rh-positive fetal red blood cells into the mother's circulation triggers the formation of anti-D antibodies. This can sensitize the mother and cause hemolytic anemia in subsequent Rh-positive pregnancies if the anti-D antibodies cross the placenta and destroy fetal red blood cells. Administering RhoGAM (anti-D immunoglobulin) to the mother during and after pregnancy can prevent sensitization by neutralizing any Rh-positive fetal red blood cells that enter her circulation. Close monitoring and medical management is required for sensitized Rh-negative mothers to prevent harm to
This document discusses intrapartum fetal heart rate (FHR) monitoring. It finds that while continuous electronic FHR monitoring increases cesarean rates compared to intermittent auscultation, neither approach improves neonatal outcomes. For low-risk women, routine electronic monitoring is not recommended. High-risk pregnancies should be continuously monitored. FHR patterns are categorized as reassuring, nonreassuring, or indeterminate. Nonreassuring patterns may indicate fetal acidosis and require interventions like oxygen, fluids, or discontinuing uterotonic drugs.
Gestational diabetes can cause complications in infants due to hyperglycemia transferring through the placenta. Infants of diabetic mothers (IDMs) are at risk for birth defects if hyperglycemia occurs early in pregnancy during organ development. Later hyperglycemia increases risks for macrosomia, hypoglycemia, and other issues. IDMs require careful monitoring and treatment of potential complications in the neonatal period such as hypoglycemia, hypocalcemia, respiratory distress, and cardiomyopathy. Long term, IDMs have increased risk of obesity, diabetes, and developmental or cognitive delays.
This document provides guidelines for the management of hypertensive disorders during pregnancy, including pre-eclampsia. It discusses the epidemiology, risks, classification, pathophysiology, and management based on NICE guidelines. Key points include: hypertension complicates 10% of pregnancies, pre-eclampsia 2-8%; it is a leading cause of maternal death; risks include prematurity, fetal growth restriction, and maternal organ damage; treatment involves hospitalization, blood pressure monitoring, antihypertensive medications, timing of birth depending on gestational age and severity of symptoms.
Sickle cell anemia is an autosome linked recessive trait that can be transmitted from parents to the offspring when
both the partners are carrier for the gene (or heterozygous). The disease is controlled by a single pair of allele, HbA
and HbS. Out of the three possible genotypes only homozygous individuals for HbS (HbS, HbS) show the diseased phenotype. The ability to predict the clinical course of SCD during pregnancy is difficult. It is mandatory to follow up the patient closely from the very beginning i.e. from preconception to antenatal till labor. SCD is associated with both maternal and fetal complications and is associated with an increased incidence of perinatal mortality, premature
labor, fetal growth restriction and acute painful crises during pregnancy.
1) The document discusses the mechanism of labor in breech presentations, which involves the birth of the buttocks in the first stage, shoulders in the second stage, and head in the third stage.
2) It describes the types of breech presentations and factors that predispose to breech, as well as techniques for diagnosing and managing breech presentations through vaginal delivery or cesarean section.
3) Complications of breech delivery are outlined for both mother and baby, including increased risks of trauma, asphyxia, and need for operative intervention like cesarean section.
This document provides information on intrapartum fetal monitoring techniques including fetal heart rate monitoring, indications for continuous electronic fetal monitoring, interpretation of fetal heart rate patterns, and management of non-reassuring fetal status. It discusses techniques like intermittent auscultation, electronic fetal monitoring, fetal scalp pH testing, pulse oximetry, and lactate testing. The goal of intrapartum monitoring is timely identification and rescue of fetuses at risk for neonatal morbidity from hypoxic insult during labor and delivery.
This document discusses various patterns seen on cardiotocography (CTG) monitoring of fetal heart rate. It describes normal baseline heart rate ranges and variability. It also defines different periodic changes seen such as accelerations and decelerations including early decelerations, late decelerations, variable decelerations and prolonged decelerations. Various abnormal patterns are also described such as tachycardia, bradycardia, reduced variability and sinusoidal patterns. Causes and clinical significance of these findings are discussed.
1. Fetal assessment during labor involves monitoring amniotic fluid and the fetal heart rate. Amniotic fluid is assessed for color and clarity while the fetal heart rate is the primary assessment.
2. Fetal heart rate is monitored either intermittently by listening with a fetoscope every 15-30 minutes during the active phase of labor, or continuously through electronic fetal monitoring. Electronic monitoring can be external or internal.
3. Normal fetal heart rate is between 120-160 beats per minute with moderate variability. Abnormal patterns including tachycardia, bradycardia, minimal variability or late decelerations may indicate fetal distress requiring changes to the labor process or expedited delivery.
1. The document provides an overview of the CooperSurgical Fetal Monitor model F9, including its buttons and functions, components, benefits, and guidelines for use and care.
2. It describes the monitor's touchscreen display, large color monitor, ultrasound transducer, and software features for transferring data.
3. The document also outlines the National Institute of Child Health and Human Development categories for normal, indeterminate, and abnormal fetal heart rate patterns and general measures for each category.
The document provides an overview of electronic fetal monitoring, including:
1. It defines the objectives of explaining fetal heart rate patterns using standard terminology and identifying normal and abnormal patterns on fetal heart rate tracings.
2. It reviews elements of the fetal heart rate tracing like baseline rate, variability, accelerations, and decelerations using standard definitions from NICHD.
3. It provides examples of fetal heart rate tracings and asks the reader to interpret them using the described terminology.
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.
Este documento resume las indicaciones y protocolos para la vigilancia electrónica intraparto. Describe los beneficios de la vigilancia como la disminución de mortalidad perinatal y convulsiones neonatales, e indica las condiciones maternas y fetales que requieren monitoreo. Explica los patrones normales y anormales de la frecuencia cardiaca fetal y las acciones requeridas para cada categoría.
CTG involves monitoring the fetal heart rate and uterine contractions during pregnancy using ultrasound and sensors placed on the maternal abdomen. It allows indirect assessment of fetal well-being but cannot directly measure oxygen levels or pH. The trace is analyzed based on baseline heart rate, variability, presence of accelerations or decelerations, and characteristics of uterine contractions. CTG interpretation involves categorizing the trace as normal, non-reassuring, or abnormal based on these features and guiding appropriate clinical management.
This document discusses different methods of fetal monitoring during labor, including electronic fetal monitoring (EFM) and intermittent auscultation. While EFM is commonly used, it has high rates of false positives and variable interpretations. Intermittent auscultation is a simpler, less invasive method that is well-liked by patients and may reduce rates of cesarean section. The document also questions whether EFM has been proven to effectively prevent brain damage, as its central hypotheses have never been tested. It argues intermittent auscultation is an acceptable alternative for low-risk patients. The document provides guidelines for appropriate fetal monitoring and interpreting EFM tracings.
1) Abnormal uterine action refers to any deviation from normal uterine contractions that can affect the progress of labor. It is one of the leading causes of dystocia or difficult labor.
2) Some types of abnormal uterine action include excessive contractions, abnormal polarity, uterine inertia, spastic lower segment, constriction rings, and generalized tonic contractions.
3) Management depends on the specific type but may include oxytocin stimulation of contractions, artificial rupture of membranes, operative vaginal delivery, or caesarean section if needed to deliver the baby safely. Close monitoring of maternal and fetal wellbeing is important.
Fetal surveillance during labor is essential to monitor for hypoxia and acidosis. Methods of monitoring include auscultation, external and internal electronic fetal monitoring. Fetal heart rate patterns provide information on oxygenation through assessment of baseline rate, variability and periodic changes in response to contractions. Abnormal patterns like late decelerations suggest interventions may be needed like changing position or accelerating delivery. Meconium staining and non-reactive heart rates also indicate possible distress. Fetal blood sampling helps assess acidosis risk to guide management.
Neonatal case presentation on hypoxic ischemic encephalopathySara Zakir
This document contains the medical history and examination findings of a 15-day-old female infant admitted with seizures for 1 day and poor feeding for 1 day. The baby was born via C-section at 38 weeks due to breech presentation and had a history of birth asphyxia. On examination, the baby had increased tone, brisk reflexes, and incomplete Moro reflex. Differential diagnoses included hypoxic ischemic encephalopathy, meningitis, and sepsis. Investigations revealed mild anemia and thrombocytosis. Imaging showed brain edema and grade 2 intraventricular hemorrhage. The baby was diagnosed with hypoxic ischemic encephalopathy secondary to birth asphyxia and treated conservatively.
This document discusses intrapartum fetal assessment using continuous electronic fetal monitoring (CTG). It describes how to interpret CTG readings, including baseline heart rate, variability, accelerations, decelerations, and patterns. Normal CTG findings are reassuring of fetal wellbeing. Non-reassuring findings require closer monitoring and investigation of potential issues. Abnormal findings indicate high risk of fetal hypoxia or acidosis and may require expedited delivery. The document provides guidelines for clinical management based on CTG categorization.
This document summarizes abnormal labor and dystocia. It defines difficult labor as abnormal slow progress and lists the main indications as prolonged latent phase, protraction disorders of the active phase, and arrest disorders of the active phase. It evaluates labor based on cervical dilation and fetal descent, using Friedman's curve as a guideline. It then describes the main types of abnormal labor patterns and dystocia, which can be due to abnormalities of power (uterine dysfunction), passage (pelvic abnormalities), or passenger (fetal malpositions and sizes).
This 6-step tutorial explains how to sign up for a Slideshare account. It instructs users to open a browser and go to Slideshare's website, click the signup link, choose a signup option of Facebook, LinkedIn, or email, fill in a security CAPTCHA and agree to terms of service, confirm the email sent by Slideshare, and then they are ready to use the site.
This document provides guidance on interpreting cardiotocography (CTG) readings during labor and delivery. It discusses how to prepare for and perform CTG monitoring, including setting up the machine, positioning the patient, and differentiating the maternal and fetal heart rates. It then describes how to interpret various features of the CTG tracing such as the baseline fetal heart rate, variability, accelerations, decelerations, and overall patterns. Recommendations are provided on the actions to take based on whether the CTG reading is normal, suspicious, or pathological.
El documento proporciona información sobre el monitoreo fetal intraparto. En resumen: (1) El monitoreo fetal intraparto tiene como objetivo identificar oportunamente el riesgo de hipoxia fetal para prevenir la asfixia fetal. (2) Existen diferentes métodos de monitoreo como el monitoreo electrónico continuo de la frecuencia cardiaca fetal y la auscultación intermitente. (3) Los patrones de mal pronóstico incluyen la taquicardia, bradicardia, variabilidad silente y el patrón sinusoidal.
Non stress test gynaecology presentationsarathrajum17
The document summarizes the key aspects of non-stress tests (NSTs) used to monitor fetal heart rate (FHR) patterns during pregnancy. It describes how NSTs use Doppler ultrasound to externally monitor FHR. It defines normal and abnormal FHR patterns including baseline rate, variability, accelerations, decelerations, and other periodic changes. It discusses how different FHR patterns may indicate issues like cord compression, fetal distress, or placental insufficiency. It also outlines guidelines for normal NST results and follow-up based on findings.
CTG - Cardiotocography or Non stress test
A nonstress test is a screening test used in pregnancy to assess fetal status by means of the fetal heart rate and its responsiveness.
A cardiotocograph is used to monitor the fetal heart rate and presence or absence of uterine contractions. The test is typically termed "reactive" or "nonreactive".
CTG Interpretation, evidence based approach
Cardiotocography (CTG) or electronic fetal monitoring (EFM) is the most widely used technique for assessing fetal wellbeing in labour in the developed world. The primary purpose of fetal surveillance by CTG is to prevent adverse fetal outcomes. Continuous electronic foetal monitoring is recommended to assure fetal wellbeing in labour in high risk pregnant women. Understanding pathophysiology of fetal heart rate variation will help appropriate interpretation of the CTG.
Features & classification of CTG according to RCOG will be demonstrated in this presentation with sufficient trace demonstration.
Cardiotocography (CTG) is a method of continuously monitoring the fetal heart rate and uterine contractions via ultrasound transducers placed on the mother's abdomen. CTG provides information on the fetal heart rate, its variability, and patterns of accelerations and decelerations which can indicate fetal well-being or distress. Different deceleration patterns such as early, late, and variable decelerations are associated with specific causes like head compression, decreased blood flow to the placenta, or umbilical cord compression, respectively. Interpretation of the CTG tracing is important for timely decisions regarding labor management and delivery.
- 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
This document provides information on how to read and interpret a cardiotocography (CTG), which is a graphic recording of the fetal heart rate and uterine contractions. It discusses the components of a CTG apparatus and how to prepare for a CTG. It describes how to assess various characteristics of a CTG tracing using the DR C BRAVADO method, including determining risk, contractions, baseline rate, variability, accelerations, decelerations, and providing an overall assessment. It also discusses conservative techniques that can be used in response to certain CTG tracings and mentions tele-CTG as a potential cost-effective alternative.
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.
PHYSIOLOGY OF DOING CTG gynaecology.pptxsarathrajum17
1) Cardiotocography (CTG) involves using Doppler ultrasound to record the fetal heartbeat and uterine contractions during pregnancy. This allows monitoring of fetal well-being and identification of hypoxia.
2) Fetal heart rate is detected through the maternal abdominal wall using ultrasound waves. Patterns in the heartbeat like baseline rate, variability, accelerations, and decelerations provide information about fetal oxygen levels.
3) Late decelerations that begin after uterine contractions peak suggest hypoxia, while early decelerations coinciding with peaks are generally benign due to vagal stimulation from head compression.
This document provides guidance on evaluating and managing intrapartum fetal heart rate tracings based on a three-tiered categorization system. Category I tracings are normal and require routine surveillance. Category II tracings require more frequent evaluation and potential corrective measures, with the presence of accelerations or variability helping to determine risk of acidemia. Category III tracings indicate the highest risk and preparations for delivery. Specific patterns like variable decelerations are managed initially with positioning and potentially amnioinfusion, while recurrent late decelerations require measures to improve uteroplacental perfusion. Intrapartum tachycardia requires evaluating for underlying causes.
ELECTRONIC FETAL MONITORING CARDIOTOCOGRAPH IN THE MANAGEMENT OF LABOURAbeldanIntlSchool
The use of cardiotocogragh in obstetric practice is a sure way for early identification of fetal compromise. Thus there is need for regular and structured training of labour ward staff to ensure proper use of this technology, thereby decreasing perinatal mobidity and mortality.
Cardiotocography (CTG) involves recording the fetal heartbeat and uterine contractions on a graph. It is used to assess fetal wellbeing and monitor uterine activity. Two transducers are placed on the mother's abdomen to measure fetal heart rate and uterine contractions. Features of the CTG tracing including baseline heart rate, variability, accelerations, and decelerations are analyzed to determine if the tracing is reassuring, suspicious, or abnormal. While a normal CTG provides a high level of reassurance for fetal wellbeing, an abnormal CTG does not always indicate fetal distress.
Syncope is a transient loss of consciousness due to transient global cerebral hypoperfusion. It is characterized by rapid onset, short duration, and spontaneous recovery. The most common causes are reflex-mediated syncope and orthostatic hypotension, which account for one-third of syncopal episodes. Evaluation involves detailed history taking and physical examination, including orthostatic vital signs and carotid sinus massage. Tilt table testing can be used to confirm neurogenic causes when initial evaluation is insufficient.
This document discusses cardiotocography (CTG), which is a method for electronic fetal monitoring. It outlines the basic patterns seen on a CTG including baseline heart rate, variability, accelerations, and decelerations. It then describes how to interpret each component of a CTG reading based on whether findings are reassuring, non-reassuring, or abnormal. Management recommendations are provided depending on the CTG category of normal, suspicious, pathological, or need for urgent intervention. Conservative measures that can be tried include changing the mother's position, giving intravenous fluids, and reducing uterine contractions.
Cardiotocography (CTG) is a technique used in pregnancy to monitor the fetal heart rate and uterine contractions. It involves using ultrasound to monitor the fetal heart rate and a transducer on the abdomen to monitor uterine contractions. When interpreting a CTG, risk factors are assessed and various characteristics of the fetal heart rate and contractions are evaluated, including baseline heart rate, variability, accelerations, and decelerations. An overall impression is determined based on these factors to assess whether the CTG tracing is reassuring, non-reassuring, or abnormal. An abnormal CTG may indicate fetal distress requiring further investigation or intervention.
This document provides guidance on cardiotocography (CTG), which assesses fetal well-being by monitoring the fetal heart rate and uterine contractions. It outlines the indications for CTG, how to perform and interpret a CTG, management based on CTG findings, and conservative measures that can be tried to improve abnormal tracings before expediting delivery. Key aspects of CTG include assessing the baseline heart rate, variability, accelerations, decelerations, and developing an overall impression of normal, suspicious, or pathological to guide management decisions.
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.
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.
Disorders of autonomic nervous system neurologykotaNeurologyKota
This document provides an overview of disorders of the autonomic nervous system. It begins with definitions and classifications of ANS disorders. It then describes several key tests used to assess autonomic function, including heart rate and blood pressure responses to changes in posture, respiration, and sustained hand grip. Additional tests involve sweat response to heat and tests of pupillary function. Differing patterns of abnormalities in these tests can localize lesions to the preganglionic, ganglionic or postganglionic levels of the ANS. Management may involve non-pharmacological or pharmacological approaches.
Kpsc diabetes in pregnancy pathway 8.6.2012Babak Jebelli
The document outlines guidelines for managing diabetes in pregnancy across medical centers. It discusses:
1. Individual centers being graded on compliance with performing HbA1c tests on all prenatal patients and FBS tests for GDM patients at 6 weeks postpartum. Bonuses may be tied to these performance measures.
2. Risk stratification of patients into low, medium, and high risk groups based on diabetes history and control. This determines interventions like medication management and fetal monitoring.
3. Screening all prenatal patients for GDM risk and providing diabetes education. High risk patients receive early glucose testing while low risk patients are tested at 24-28 weeks.
4. Postpartum follow-up
The document discusses issues with the current scheduling system including too many changes and vague requests. It proposes implementing scheduled cesarean sections on call days to improve efficiency by ensuring the primary surgeon performs the surgery and eliminating wasted time. This could add 30 hours of clinic access per month. Some providers argue they are too busy, but deliveries have decreased so scheduling cesareans this way could help protect staffing levels. No more than 2 cesareans would be scheduled per provider per call day.
This document provides guidelines for managing twin pregnancies, including determining chorionicity and amnioticity. It recommends that all twins undergo an NT ultrasound before 14 weeks to validate chorionicity/amnionicity and detect early complications. Management of monochorionic twins requires more intensive surveillance due to increased risks of complications affecting fetal growth and well-being. Dichorionic twins generally require less frequent monitoring while monochorionic twins should be monitored more closely, with delivery planned before 37 weeks.
New Progesterone Guideline for Preterm labor and incidental shortened cervixBabak Jebelli
This document summarizes recommendations for using progesterone to prevent preterm birth based on a woman's history and cervical length. It recommends 17-hydroxyprogesterone caproate injections weekly from 16-20 weeks until 36 weeks for women with a prior spontaneous preterm birth. For women without a prior preterm birth but an incidental short cervical length of 10-20mm before 24 weeks, it recommends daily vaginal progesterone until 36 weeks. Safety follow-up of children exposed to 17-hydroxyprogesterone caproate in clinical trials found no differences compared to placebo.
The document discusses improving patient satisfaction scores related to communication about medications at Riverside Medical Center's maternity service. The goal is to increase the HCAHPS medication communication score from 66% to 75% by December 2012 and 85% by June 2013. This will be achieved through education of providers, patients, and staff. Providers will be educated on medications through meetings and flashcards. Patients will receive verbal and written information about new medications. Staff will track medication discussions on patient care boards. Progress will be measured through education documentation and eventual HCAHPS scores.
Hcahps score trends in the past 4 yearsBabak Jebelli
This document shows trends in patient experience scores over 4 years from 2008-2012 at KP Riverside Medical Center based on the HCAHPS survey. The line graphs depict scores for various measures related to nurse and doctor communication, responsiveness of staff, pain management, medication communication, discharge processes, cleanliness and quietness. Scores fluctuate over time but generally remain between 60-90% for most measures.
This document discusses coccidioidomycosis (Valley fever) during pregnancy. It notes that the infection is more severe when acquired during pregnancy, especially in the third trimester, and that the use of azole antifungals during pregnancy can be teratogenic. It reviews literature on cases of coccidioidomycosis in pregnancy and the effect of sex hormones on fungal growth. It also discusses the risk of birth defects from azole exposure during pregnancy, specifically the Antley-Bixler syndrome. The document provides recommendations for managing coccidioidomycosis in pregnant women based on their infection status and trimester.
Von Willebrand disease is the most common inherited bleeding disorder caused by mutations that decrease or impair von Willebrand factor, which promotes platelet adhesion and clotting. It ranges from mild to severe. Type I is the most common form with a quantitative deficiency, while type II has qualitative defects affecting function. Treatment involves desmopressin, which releases stored VWF, or VWF replacement for refractory or severe cases. Careful management is needed around procedures and delivery to maintain adequate VWF and factor VIII levels through replacement to prevent bleeding.
The document provides guidelines for evaluating and managing patients with influenza-like illness (ILI) during pregnancy. It describes the symptoms of ILI and H1N1 flu. Patients with mild ILI symptoms and no risk factors can be treated as outpatients, while those with concerning signs, comorbidities, or symptom progression warrant further evaluation and treatment including Tamiflu and possible hospitalization.
This document discusses the management of postpartum hemorrhage (PPH). It defines PPH and risk factors. It outlines the roles and responsibilities of the nursing team in responding to a PPH. It also details the differential diagnosis, initial resuscitation steps, and therapeutic escalation based on the severity of bleeding and patient's response to treatment. The goal is to recognize and treat PPH early through decisive clinical response and prevent complications like shock.
Late preterm infants born between 34 0/7 and 36 6/7 weeks have higher rates of morbidity than full term infants. During the initial birth hospitalization, late preterm infants are more likely to experience conditions like temperature instability, hypoglycemia, respiratory distress, and jaundice. The risks are even higher for late preterm infants whose mothers have complications like hypertension, diabetes, bleeding, or infections. Readmission rates within the first year are also higher, around 15%, for late preterm infants compared to full term infants. Late preterm infants also have higher mortality rates within the first year of life and are at greater risk for long-term neurodevelopmental issues.
The document summarizes key findings from a review of literature on polycystic ovary syndrome (PCOS). It finds that the most consistent predictors of PCOS are hyperandrogenemia (high levels of "male" hormones) in 60-80% of cases, hirsutism (excess hair growth) in 60% of cases, and polycystic ovaries in 75% of cases. It also discusses debates around definitions of PCOS and relationships with insulin resistance.
This document provides guidelines for induction of labor, including:
1. Recommending inpatient and outpatient Cytotec inductions arrive at 7:00 PM to facilitate admission/discharge decisions and additional Cytotec doses if needed.
2. Inpatient Pitocin-only inductions should arrive at 6:00 AM to start Pitocin before 7:00 AM.
3. Favorable criteria for induction include a modified Bishop score of 6 or more and cervical dilation of 3-4 cm for nulliparous patients.
Hyperemesis Gravidarum is a condition characterized by persistent and severe nausea and vomiting during pregnancy. It can lead to weight loss of 5% or more of the woman's pre-pregnancy weight and the presence of ketones in the urine. Potential causes include multiple gestation, trophoblastic disease, or genetic conditions like trisomy 21. Treatment focuses on managing symptoms, avoiding triggers, dietary changes, medications like antihistamines, phenothiazines, and serotonin antagonists. Intravenous fluids and supplementation of vitamins and minerals may be needed to address nutritional deficiencies and prevent complications like Wernicke's encephalopathy. Enteral nutrition through nasojejunal feeding tubes is preferable to parent
The document summarizes changes to CDC guidelines for prevention of early-onset group B streptococcal (GBS) disease. Key changes include: expanded laboratory detection options for GBS; revised thresholds for reporting GBS in urine cultures; clarified definitions of adequate antibiotic prophylaxis and high risk for anaphylaxis; and adjustments to neonatal management algorithms to reduce unnecessary evaluations. Guidelines emphasize using cefazolin over clindamycin or vancomycin when possible for penicillin-allergic women.
The document discusses the use of Foley bulbs for cervical ripening and labor induction. It finds that:
1) A Foley bulb induction is as effective as common prostaglandin methods like misoprostol for cervical ripening and inducing labor, with fewer risks of complications.
2) Inflating the Foley bulb to 60-80ml is more effective for cervical dilation and shorter delivery times than only inflating to 30ml.
3) Using a Foley bulb alone without additional prostaglandins or oxytocin is equally effective while avoiding increased need for pain management.
This document provides guidelines for the management and interpretation of intrapartum fetal heart rate tracings. It discusses important factors to consider when interpreting tracings such as gestational age, maternal conditions, and fetal conditions. It describes the physiology underlying different fetal heart rate patterns. It also presents the NICHD nomenclature for standardized description of tracings, including definitions for baseline rate, variability, accelerations, and decelerations. Tracings are categorized as Category I, II, or III based on patterns that reflect fetal acid-base status. Category I tracings are normal while Category III tracings indicate abnormal fetal status and need for prompt evaluation and treatment.
Asymptomatic short cervix and vaginanal, progesteroneBabak Jebelli
1. Vaginal progesterone reduces preterm birth in women with an asymptomatic sonographic short cervix in the midtrimester. The meta-analysis found vaginal progesterone once daily from identification of a short cervix <25mm until 37 weeks decreases preterm birth <33 weeks by 45% and decreases neonatal morbidity and mortality.
2. Treatment with vaginal progesterone was associated with significant reductions in preterm birth before 28 weeks, 33 weeks, and 35 weeks as well as composite neonatal morbidity and mortality.
3. There were no significant differences in adverse maternal events or congenital anomalies between the vaginal progesterone and placebo groups.
The document discusses pertussis (whooping cough) prevention, treatment, and epidemiology. It provides guidelines for vaccinating pregnant women and new mothers with Tdap to prevent transmission to infants. It describes the symptoms and phases of pertussis, recommends antibiotic treatment and prophylaxis, and defines close contacts for evaluation and post-exposure prophylaxis. Pertussis cases are increasing significantly in California and infants are most at risk for severe disease.
The document discusses evidence that magnesium sulfate administered to mothers at risk of preterm birth reduces the risk of cerebral palsy in infants. Several large randomized controlled trials and meta-analyses involving over 15,000 women found magnesium sulfate decreased the risk of cerebral palsy without increasing mortality. The number needed to treat to prevent one case of cerebral palsy is estimated at 63 women. The document also describes a modified magnesium sulfate neuroprotection protocol used at Riverside Hospital for imminent preterm deliveries between 23 and 33 weeks.
A Visual Guide to 1 Samuel | A Tale of Two HeartsSteve Thomason
These slides walk through the story of 1 Samuel. Samuel is the last judge of Israel. The people reject God and want a king. Saul is anointed as the first king, but he is not a good king. David, the shepherd boy is anointed and Saul is envious of him. David shows honor while Saul continues to self destruct.
Philippine Edukasyong Pantahanan at Pangkabuhayan (EPP) CurriculumMJDuyan
(𝐓𝐋𝐄 𝟏𝟎𝟎) (𝐋𝐞𝐬𝐬𝐨𝐧 𝟏)-𝐏𝐫𝐞𝐥𝐢𝐦𝐬
𝐃𝐢𝐬𝐜𝐮𝐬𝐬 𝐭𝐡𝐞 𝐄𝐏𝐏 𝐂𝐮𝐫𝐫𝐢𝐜𝐮𝐥𝐮𝐦 𝐢𝐧 𝐭𝐡𝐞 𝐏𝐡𝐢𝐥𝐢𝐩𝐩𝐢𝐧𝐞𝐬:
- Understand the goals and objectives of the Edukasyong Pantahanan at Pangkabuhayan (EPP) curriculum, recognizing its importance in fostering practical life skills and values among students. Students will also be able to identify the key components and subjects covered, such as agriculture, home economics, industrial arts, and information and communication technology.
𝐄𝐱𝐩𝐥𝐚𝐢𝐧 𝐭𝐡𝐞 𝐍𝐚𝐭𝐮𝐫𝐞 𝐚𝐧𝐝 𝐒𝐜𝐨𝐩𝐞 𝐨𝐟 𝐚𝐧 𝐄𝐧𝐭𝐫𝐞𝐩𝐫𝐞𝐧𝐞𝐮𝐫:
-Define entrepreneurship, distinguishing it from general business activities by emphasizing its focus on innovation, risk-taking, and value creation. Students will describe the characteristics and traits of successful entrepreneurs, including their roles and responsibilities, and discuss the broader economic and social impacts of entrepreneurial activities on both local and global scales.
How to Setup Default Value for a Field in Odoo 17Celine George
In Odoo, we can set a default value for a field during the creation of a record for a model. We have many methods in odoo for setting a default value to the field.
Gender and Mental Health - Counselling and Family Therapy Applications and In...PsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Andreas Schleicher presents PISA 2022 Volume III - Creative Thinking - 18 Jun...EduSkills OECD
Andreas Schleicher, Director of Education and Skills at the OECD presents at the launch of PISA 2022 Volume III - Creative Minds, Creative Schools on 18 June 2024.
How to Manage Reception Report in Odoo 17Celine George
A business may deal with both sales and purchases occasionally. They buy things from vendors and then sell them to their customers. Such dealings can be confusing at times. Because multiple clients may inquire about the same product at the same time, after purchasing those products, customers must be assigned to them. Odoo has a tool called Reception Report that can be used to complete this assignment. By enabling this, a reception report comes automatically after confirming a receipt, from which we can assign products to orders.
CapTechTalks Webinar Slides June 2024 Donovan Wright.pptxCapitolTechU
Slides from a Capitol Technology University webinar held June 20, 2024. The webinar featured Dr. Donovan Wright, presenting on the Department of Defense Digital Transformation.
This document provides an overview of wound healing, its functions, stages, mechanisms, factors affecting it, and complications.
A wound is a break in the integrity of the skin or tissues, which may be associated with disruption of the structure and function.
Healing is the body’s response to injury in an attempt to restore normal structure and functions.
Healing can occur in two ways: Regeneration and Repair
There are 4 phases of wound healing: hemostasis, inflammation, proliferation, and remodeling. This document also describes the mechanism of wound healing. Factors that affect healing include infection, uncontrolled diabetes, poor nutrition, age, anemia, the presence of foreign bodies, etc.
Complications of wound healing like infection, hyperpigmentation of scar, contractures, and keloid formation.
2. DO NOT INTERPRET FHR in ISOLATION
• TIMING IS IMPORTANT ie MULTIP MOVING QUICKLY vs NULLIP
with unfavorable cervix OR IN EARLY LABOR or INDUCTION
• PELVIS & BABY SIZE & OB HISTORY & OB Complications
• CLINICAL FACTORS
– Gestational age ( Postdates / < 32 weeks )
– Maternal Medical Complications ( ?Exacerbation?)
– Previous Fetal Status (Change from admission?)
– Fetal Complications
(IUGR, Oligohydramnios, Anomalies, Abruption, Postdates)
– Medications ( Narcotics, B sympatho, Ephedrine, B blockers,)
MISCELLANEOUS FACTORS
– Fever, Meconium, Magnesium Sulfate, Epidural, Vaginal
bleeding, VABC, Recent AROM, Smoking , illicit drugs
3. Physiologic Control of FHR
• Normal FHR patterns rely on sympathetic
and parasympathetic activity AND ability
of the heart to respond appropriately to
the input from the nervous system
• Parasympathetic and Sympathetic nervous
system are dependent on intact functioning
CNS with no preceding damage or
significant anatomical anomaly or insult
• Normal function of CNS & Myocardium both
depend on adequate oxygenation
7. Physiologic Control of FHR
• Sinoatrial node (fastest rate)
• Atrial node (next fastest)
• Ventricular rate (slowest 60 bpm or less)
• Sympathetic nervous system (increases
heart rate)
• Parasympathetic nervous system
(decreases heart rate)
8. PHYSILOGY EARLY Decelerations
• Early decelerations caused by
– Vagal stimulation commonly associated with
Head compression / Prolonged vaginal exam
– Results in a normal physiologic decrease in
fetal heart rate not associated with fetal
hypoxemia or acidosis
12. PHYSIOLOGY LATE Decelerations
• Late deceleration
– Reflex
• Decrease in blood flow delivered to the baby ( maternal
hypotension/maternal venous compression/cord
compression/occlusion/uterine hyperstimulation) resulting in
the inability to deliver enough O2 to the baby
• OR deoxygenated blood delivered to the baby (
abruption/maternal seizure/ ss crisis/pneumonia/PE/asthma)
resulting in low PaO2 sensed by chemoreceptors which
results in vagal discharge resulting in slowing of heart rate
– Non-reflex
• Deoxygenated blood insufficient to support normal
myocardial contarctions resulting in direct myocardial
depression
14. NICHD NOMENCLATURE
STANADARDIZED NOMENCLATURE
should lead to comparable research & improved
communication
• Revised and Presented in 2008 by NICHD
• NICHD nomenclature endorsed by
– American College of Obstetricians and Gynecologists
– American Women’s Health, Obstetric, and Neonatal
Nursing
15. NICHD NOMENCLATURE
• Baseline
• Periodic
– Associated with uterine contractions
– Distinguished on basis of onset of waveform
• Abrupt
• Gradual
• Episodic
– Not associated with uterine contractions
16. NICHD NOMENCLATURE
• No distinction made between short-term
variability and long-term variability
• Variability defined visually based on
amplitude of FHR complexes
18. NICHD NOMENCLATURE
• Full description of FHR tracing requires:
– Contraction pattern
– Fetal heart rate
– Variability
– Accelerations
– Periodic or Episodic Decelerations
– Changes or trends of FHR patterns over time
19. Uterine Contractions
• Number of contractions in 10-minute
window, averaged over 30 minutes
Tachysystole
> 5 contractions in 10 minutes
20. Uterine Contraction Descriptions
• Tachysystole qualified as to
presence/absence of decelerations
• Tachysystole applies to spontaneous or
stimulated labor
• Terms hyperstimulation and
hypercontractility are not defined and
should be abandoned
21. CATEGORY II OR III
TACHYSYSTOLE
GOAL REDUCE UTERINE ACTIVITY
• Discontinue oxytocin or cervical ripening
agents
• Administer tocolytic medication
( Brethine 0.25 mg SQ only if necessary )
• DO NOT USE BRETHINE FOR TACHYSYSTOLE
ASSOCIATED ABRUPTION
23. NICHD NOMENCLATURE
BASELINE FETAL HEART RATE
The mean FHR rounded to increments of 5 beats per minute during a
MINIMUM OF 2 MINUTES AND < 1O MINUTES EXCLUDING :
—Periodic or episodic changes
— Periods of marked FHR variability
— Segments of baseline that differ by more than 25 beats per minute
•The baseline must be for a minimum of 2 minutes in any 10-
minute segment, or the baseline for that time period is indeterminate. In
this case, one may refer to the prior 10-minute window for determination of
baseline.
• Normal FHR baseline: 110–160 beats per minute
• Tachycardia: FHR baseline is greater than 160 beats per minute
• Bradycardia: FHR baseline is less than 110 beats per minute
24. NICHD NOMENCLATURE
BASELINE VARIABILITY
Fluctuations in the baseline FHR that are irregular in
amplitude and frequency. Variability is visually
quantitated as the amplitude of peak-to-trough in beats
per minute.
• Absent — amplitude range undetectable
• Minimal —amplitude range detectable but 5 beats per
minute or fewer
• Moderate (normal)—amplitude range 6–25 beats per
minute
• Marked —amplitude range greater than 25 beats per
minute
25. Variability
Amplitude range Descriptive term
Undetectable Absent
< 5 bpm Minimal
6-25 bpm Moderate
> 25 bpm Marked
27. NICHD NOMENCLATURE
ACCELERATION
• A visually apparent abrupt increase (onset to peak in less than 30 seconds)
in the FHR above the baseline
• At 32 weeks of gestation and beyond, an acceleration has a peak of 15
beats per minute or more above baseline, with a duration of 15 seconds
or more but less than 2 minutes from onset to return.
• Before 32 weeks of gestation, an acceleration has a peak of 10 beats per
minute or more above baseline, with a duration of 10 seconds or more but
less than 2 minutes from onset to return.
• Prolonged ACCELERATION
> 2 minutes < 10 minutes in duration
BASELINE CHANGE
If an acceleration lasts >/= to 10 minutes
it is a baseline change
28. LATE DECELERATIONS
• Late deceleration
– Visually apparent gradual (defined as onset of
deceleration to nadir ≥30 seconds) decrease and
return to baseline FHR associated with uterine
contraction
– The decrease calculated from most recent portion of
baseline
– The deceleration is delayed in timing, with the nadir
of the deceleration occurring after the peak of the
contraction.
• In most cases the onset, nadir, and recovery of
the deceleration occur after the
beginning, peak, and ending of the
contraction, respectively
30. EARLY DECELERATIONS
• Early deceleration
– Visually apparent gradual decrease (defined as onset
of deceleration to nadir ≥30 seconds) and return to
baseline FHR associated with uterine contraction
– Calculated from most recent portion of baseline
– Coincident in timing, with nadir of deceleration
occurring at same time as the peak of contraction
• In most cases onset, nadir, and recovery of
deceleration are coincident with the
beginning, peak, and ending of the
contraction, respectively
31. VARIABLE DECELERATIONS
• Variable deceleration
– Visually apparent abrupt decrease (defined as onset
of deceleration to beginning of nadir <30 seconds) in
FHR below the baseline
– The decrease is calculated from most recent portion
of baseline
– The decrease in FHR below baseline is ≥15
beats/min, lasting ≥15 seconds, and <2 minutes from
onset to return to baseline.
• When variable decelerations are associated with
uterine contractions, their onset, depth, and
duration commonly vary with successive uterine
contractions
32. PROLONGED DECELERATION
>/= 2 & < 10 minutes
– Decrease in FHR below baseline calculated
from most recent10 minute stable baseline
– Decrease from baseline is ≥15
beats/min, lasting ≥2 minutes, but <10
minutes from onset to return to baseline.
• IF 15 BPM DECELERATION LAST
≥ 10 minutes it is a
FETAL HEART RATE BASELINE CHANGE
33. QUANTIFICATION OF
DELERATIONS & ACCELERATIONS
• Decelerations are quantitated by the depth of the nadir in
BPM below baseline
• The duration is quantitated in minutes and seconds from
beginning to end of deceleration
• Accelerations are quantitated similarly
• Decelerations may be defined as recurrent if they occur
with ≥50% of uterine contractions in any 20-minute
segment
• Bradycardia and tachycardia are quantitated by actual
FHR in BPM.
34. Interpretation of FHR patterns
• New three-tier system
• FHR tracing patterns reflect current fetal
acid-base status
• FHR tracing patterns cannot RELIABLY
OR CONSISTENTLY predict development
of cerebral palsy
35. Category I
Category I FHR tracings include all of the following:
• Baseline rate:110–160 beats per minute
• Baseline FHR variability: MODERATE
• Late or Variable Decelerations
ABSENT
• Early decelerations: May be present
• Accelerations: Present or ABSENT
36. Category I FHR tracing
• Includes ALL of the following:
– Baseline rate NORMAL : 110-160 BPM
– Baseline Variability: MODERATE
– Late or Variable Decelerations: ABSENT
– Early Decelerations: PRESENT OR ABSENT
– Accelerations: PRESENT OR ABSENT
• Category I FHR tracings are normal
– Strongly predictive of normal fetal acid-base status at
time of observation
- Requires no change in management
37. Category II FHR tracing
Includes ANY of the following
RATE
1) Bradycardia not accompanied by absent baseline
variability
2) Tachycardia
Baseline FHR variability
1) Minimal baseline variability
2) Absent baseline variability with no recurrent
decelerations
3) Marked baseline variability
38. Category II FHR tracing
ACCELERATIONS
– Absence of induced accelerations after fetal
stimulation
–NO FETAL HEART RATE
ACCELERATIONS WITH FAS
OR SCALP STIMULATION
39. Category II FHR tracing
PERIODIC OR EPISODIC DECELERATIONS
• Recurrent variable decelerations accompanied by
minimal or moderate baseline variability
• Prolonged deceleration more than 2 minutes but
less than10 minutes
• Recurrent late decelerations with moderate baseline
variability
• Variable decelerations with other characteristics
such as slow return to baseline, overshoots, or
“shoulders
40. Category II FHR tracing
• Category II FHR tracings are INDETERMINATE
• NOT predictive of abnormal fetal acid-base
status
• Requires continued surveillance and
interpretation in light of entire clinical
information
41. CATEGORY II MANAGEMENT
• Both responses are highly predictive of normal
fetal acid–base status and, thus, may help guide
clinical management
1) Moderate FHR Variability
2) The presence of FHR accelerations
-spontaneous
-digital scalp stimulation
-vibroacoustic stimulation
42. CATEGORY II MANAGEMENT
Recurrent Variable decelerations
Prolonged Decelerations
Bradycardia
GOAL
Alleviate umbilical cord compression
Amnioinfusion
?PROLAPSED CORD?
DOES NOT HELP WITH LATE DECELERATIONS
43. Category III FHR tracing
ABSENT FHR VARIABILITY
AND
• Recurrent late decelerations
• Recurrent variable decelerations
• Bradycardia
OR
SINUSOIDAL PATTERN
44. Category III FHR tracing
• Category III FHR tracings are abnormal
• Predictive of abnormal fetal acid-base status at time
of observation
• Require prompt evaluation
• Depending on situation, efforts may include:
– Maternal oxygen( 10 liter per mask)
– Maternal position change
– Discontinuation of labor stimulation
– Treatment of maternal hypotension
– AFTER CORRECTIVE ATTEMPT make an effort to TO
DEMONSTARTE FETAL HEART RATE ACCELERATION BY
FETAL DIGITAL SCALP STIMULATION OR FAS
STIMULATION TO DOWN GRADE BACK TO CATEGORY II
45. Promote Oxygenation
and
Improve blood flow
• Minimal or Absent FHR variability
• Recurrent late decelerations
• Prolonged decelerations
• Bradycardia
INITIATE
• Lateral positioning (either left or right)
• Oxygen administration
• IV fluid bolus
• Reduce uterine contraction frequency
46.
47.
48. NICHD Expert Panel
Agreement about definition of NORMAL FHR tracing that confers an
extremely high predictability of a NORMALLY oxygenated fetus when it is
obtained
• Normal baseline rate
• Moderate FHR variability
• Presence of accelerations
• Absence of decelerations
Agreement that patterns predictive of current or impending fetal asphyxia
PLACING the fetus is at risk for NEUROLOGIC DAMAGE OR DEATH
ABSENT FHR VARIABILITY
AND
RECURRENT LATES
RECURRENT VARIABLES
49. Goals of EFM
• Delivery of newborn
– In the absence of a significant acidosis
• Umbilical artery pH < 7.1, base excess < -12
• And/or 5 minute Apgar < 7
– In the presence of neonatal vigor
• Quickly categorize FHR patterns based on their
relationship (or lack thereof) to the above goals
• Clearly communicate FHR patterns to members
of the OB team
50. Communication
• SBAR
– Situation (patient characteristics)
– Background (evolution of tracing)
– Assessment (description of current tracing)
– Recommendation (action plan)
51. Communication
• Description of FHR pattern
– VARIABILLITY (absent, minimal, moderate, marked)
– Descriptions of PERIODIC/EPISODIC changes
• Type or shape
• Recurrent or intermittent
• Severity (nadir)
• Relationship to uterine activity
– BASELINE FHR
– Presence/absence of ACCELERATIONS
– Has the FHR tracing changed or evolved over time
since admission. Is the change transient with an
obvious cause (
meds, hypotension, meconium, AROM, fever, bleedin
g, maternal position)
– Potential influence of Maternal condition &/OR Fetal
condition in relation to FHR patterns
52. DESCRIPTION FOR SBAR
– RATE
(Tachycardia or increase in baseline >/ = to 15 bpm from
admission)
– VARIABILITY
(loss of variability with change in fetal maternal condition)
– ACCELERATIONS (spontaneous or stimulated & 15 bpm or
less )
– PERIODIC/EPISODIC DECELERATIONS
– Changes of FHR OR PATTERN OR MATERNAL CONDITION
COMPARED TO ADMISSION OR SIGNIFICANT TIME FRAME
62. Prematurity results in CP
• CP develops in as many as 15-20 % of surviving premature infants
• The earlier the gestational age at delivery; The greater is the risk
of developing CP.
• CP risk % >>> 30 weeks >> 32-34 weeks with a plateau > 34
weeks unless chorioamnionitis or intrapartum hypoxia occurs.
• CP as a result of prematurity is associated with the presence of
Periventricular Leukomalacia (PVL is an anatomic lesion.)
• In addition to perinatal inflammation, cerebral ischemia contributes
to PVL and may result in CP in preterm infants.
• Other conditions that primarily affect preterm infants and may lead
to CP include severe intraventricular hemorrhage (IVH) and
periventricular hemorrhagic infarction which may result in
posthemorrhagic hydrocephalus which frequently leads to CP
63. Chorioamnionitis SYNERGISTICALLY
Increases the risk of CP with Prematurity
• There are significant associations between clinical chorioamnionitis or
histological chorioamnionitis and cerebral palsy, for clinical
chorioamnionitis a pooled odds ratio of 2.42 (95% CI 1.52–3.84), and for
histological chorioamnionitis a pooled odds ratio of 1.83 (95%
confidence interval, 1.17–2.89).
• This data is associated with an increased risks of 140% and 80% for
neonates exposed to clinical chorioamnionitis or histological
chorioamnionitis, to develop CP respectively.
• PVL occurs more frequently in premature infants born to mothers with
chorioamnionitis, premature or prolonged rupture of the membranes. In
a meta-analysis, chorioamnionitis was associated with cystic PVL
(relative risk 3.0) and cerebral palsy (relative risk 1.9) . Funisitis or
neonatal sepsis also increases the risk of PVL
Obstet Gynecol 2010;116:387–92 Clin Obstet Gynecol 1998 Dec;41(4):827-31
.
Paediatr Perinat Epidemiol 1998 Jan;12(1):72-83
64. < 5 % of CP results from
Intrapartum Hypoxia
Obstet Gynecol. 2006 Jun;107(6):1357-65.
• Data were available for analysis in 213 cases of CP. Major antenatal or
pediatric cerebral palsy-related pathologies were identified in 98.1% of all
these cases. An isolated acute intrapartum hypoxic event was defined as
likely in only 2 of the 46 neonates born at term and none born preterm.
• CONCLUSION: Cerebral palsy was seldom preceded by acute intrapartum
hypoxia but antenatal cerebral palsy-related pathologies are often
detectable. The objective American College of Obstetricians and
Gynecologists/American Academy of Pediatrics criteria are useful to audit
cerebral palsy causation and exclude primary intrapartum hypoxia