This document discusses various methods used to monitor fetal well-being during labor, including fetal heart rate monitoring, fetal blood sampling, fetal pulse oximetry, fetal electrocardiography, and ultrasound. It provides details on interpreting fetal heart rate patterns, the results of fetal blood sampling, and evidence regarding electronic fetal monitoring versus intermittent auscultation. While electronic fetal monitoring has increased cesarean rates compared to intermittent auscultation, studies have not found it reduces rates of hypoxic ischemic encephalopathy or cerebral palsy.
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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.
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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.
Fetus is another patient needs to be given adequate attention and importance to find out whether it is alright or sick. This presentation will give a brief skeleton of tests to be done.
Fetus is another patient needs to be given adequate attention and importance to find out whether it is alright or sick. This presentation will give a brief skeleton of tests to be done.
Meconium-stained amniotic fluid is common complication, seen in 1 out of every 5 pregnancies.Golden rule for management of MSAF is Foetal Heart Monitoring
Undergraduate course lectuers in Obstetrics&Gynecology
Prepared by DR Manal Behery
Assistant Professor in OB&GYNE ,Faculty of medicine,Zagazig University
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
3. Fetal heart rate (FHR) monitoring
Fetal parasympathetic nervous system Matures
by Term.
Sympathetic nervous system development is still
ongoing even after delivery.
Fetus is conditioned to thrive in a mildly hypoxic and
acidic environment.
Change in fetal heart rate, caused by the impact of
hypoxia and acidosis which forms the premise of FHR
it is based on the assumption that fetal heart rate is a
reflection of fetal oxygenation status.
4. Electronic fetal monitoring (EFM)> Doppler> Auscultation.
Electronic fetal monitoring (EFM)-Is a paper record of FHR
pattern plotted simultaneously in relation to uterine activity.
So-
i. Intermittent auscultation alone for low-risk pregnancies
ii. Continuous EFM for pregnancies with higher risk.
5.
6.
7.
8. FHR
surface transducers
on the maternal
abdomen
Not feasible in morbid
obesity.
small electrode into
the skin of the fetal
presenting part
Requires dilatation of the
cervix and rupture of the fetal
membranes
Mild infection at the
electrode site.(4%)
11. Image of CTG monitor and routinely recorded parameters, including fetal heart
rate, maternal heart rate, and strength and frequency of uterine contractions
12. Fetal heart rate is assessed for four features-
i. Baseline rate
ii. Baseline variability
iii. Presence or absence of decelerations
iv. Presence of accelerations
13. Baseline heart rate
Between 110 and 160 bpm
Fetal bradycardia, defined as an FHR <110 bpm.
Fetal tachycardia, defined as an FHR >160 bpm.
Fetal dysrhythmias are typically associated with FHR
>200 bpm.
The base line is judged by looking at the mean heart
rate over 10min.
14. FETAL BRADYCARDIA FETAL TACHYCARDIA
congenital heart block
i. congenital heart
malformation
ii. Maternal systemic lupus
erythematosus
iii. Maternal medications(β-
antagonists—Labetalol)
iv. Fetal acidosis.
i. Maternal fever
ii. Infection
iii. Stimulant medications
(atropine)
iv. Drugs(β2-agonists)
v. Hyperthyroidism
15. Baseline variability
Between 5 to 25 bpm.
Measured from the peak to a trough of a recording during 1
min.
Reduced baseline variability-
1. Depression of the fetal CNS(fetal immaturity, hypoxia)
2. Fetal sleep,
3. Maternal medications such as narcotics, sedatives, β-
blockers, corticosteroids, intravenous magnesium
sulfate.
Marked variability-
1. Thumb sucking.
2. Fetal Hypoxia
16.
17. Persistent absence of variability is considered a pre-
terminal feature and carries with it high probability of
a hypoxic fetus.
Sinusoidal variability is an oscillating pattern of three
to five cycles per minute-
1. fetal anemia.
2. Severe fetal hypoxia.
18.
19. Accelerations
Accelerations of the FHR in response to movements
(To mechanical stimulation of the fetal Scalp/
vibroacoustic stimulation) are reassuring.
>15 beats min for at least 15 sec
22. Early decelerations Late decelerations Variable decelerations
Symmetric in shape
Benign in nature.
Variable in their shape
Mirror uterine
contractions in time of
onset, nadir, duration,
and termination
“late” in relation
to uterine contractions.
No specific relationship
with contractions
Seen in active labor when
the fetal head is
compressed
in the pelvis
Result of uteroplacental
insufficiency
Result from fetal
umbilical cord
compression.
23.
24. Late decelerations
A fall in the heart rate of 15 bpm below baseline (even if still within the
range of 110 to 160 bpm) and lasting for >15 seconds is significant.
As the uteroplacental insufficiency/hypoxia worsens-
(i) baseline variability will be reduced and then lost,
(ii) decelerations will last longer
(iii) they will begin sooner following the onset of a contraction
(iv) they will take longer to return to baseline
(v) the rate to which the fetal heart slows will be lower.
Repetitive late decelerations demand action.
25.
26. Variable decelerations
“Concerning characteristics” include –
i. Deceleration lasting more than 60 seconds
ii. Reduced baseline variability within the deceleration
iii. Failure to return to the baseline
iv. Biphasic (W) shape
v. Absence of shouldering (transient increase in the
heart rate before the start of deceleration).
31. EVIDENCE
A 2009 systematic review of 12 randomized trails
including > 37,000 women(both low and high risk)
comparing continuous electronic FHR monitoring and
intermittent auscultation showed-
i. Intrapartum fetal death rate approximately 0.5/1000
births with either approach
ii. Use of electronic FHR monitoring instead of
intermittent auscultation did not result in a
significant reduction in overall risk of perinatal
death(RR 0.85,95% CI 0.59-1.23)
32. iii. APGAR scores and NICU admission rates were
similar for both modalities
iv. Electronic FHR monitoring instead of intermittent
auscultation did not-reduce the risk of hypoxic
ischemic encephalopathy, long –term neurologic
impairment , or cerebral palsy.
v. Frequency of neonatal seizure was reduced in the
electronically monitored group(RR 0.50, 95% CI
0.31-0.80)
vi. Use of electronic FHR monitoring instead of
intermittent auscultation increased the frequency of
operative delivery (cesarean delivery RR 1.66, 95% CI
1.30-2.13; instrumental vaginal delivery RR 1.16, 95%
CI 1.01-1.32)
33. Fetal blood sampling (FBS)
Done when cesarean section is being planned for fetal
distress.
Rationale- Acidosis or rise in lactate is considered as a
marker of fetal hypoxia.
Falsely reassuring in the presence of chorioamnionitis or
thick meconium
Interpretation of FBS:
i. pH-
Normal: ≥7.25
Borderline: 7.21 to 7.24
Abnormal: ≤7.20
ii. Lactate
Normal: ≤4.1 mmol/L
Borderline: 4.2 to 4.8 mmol/L
Abnormal: 4.9 ≥mmol/L
34. FETAL BLOOD
SAMPLE
Normal
No accelerations
in response to
fetal scalp
stimulation
second fetal
blood sample no
more than 1 hour
later
Borderline
No accelerations
in response to
fetal scalp
stimulation
fetal blood
sample no more
than 30 minutes
later
still abnormal
Assisted
NVD/LSCS
35. Fetal scalp electrode
The fetal heart rate is derived from the R-R interval of
the fetal electrocardiographic (fECG) trace
Carries the risk of infection
May allow more reliable recording of fetal heart rate
36. Fetal pulse oximetry
The literature suggests that fetal saturations 30% are
reassuring(usually associated with PH> 7.13), whereas
<30% should prompt consideration of intervention.
A Cochrane review of fetal pulse oximetry (FPO) to
supplement CTG concluded that its use did not appear
to enhance clinical practice.
37. Fetal electrocardiograpy
Rationale- Hypoxaemia alters characteristics of the f
ECG (P-R interval, T:Q.RS ratio and ST segment).
Automated ST analysis (STAN) software which looks at
the CTG and fECG concurrently. The analysis of the
fECG using STAN requires a scalp electrode to be
placed.
The current NICE guideline does not make a
recommendation on the use of STAN.
38. Ultrasound
Trans abdominal ultrasound scanning for fetal distress
in labour.
Has ability to visualize fetal cardiac activity rapidly.