fetal surveilance
TRANSCRIPT
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ELECTRONIC FETALMONITORING
BY
PROF. DR. FAREESA WAQAR
HOD GYNAE/OBS DEPARTMENTISLAMIC INTERNATIONAL MEDICALCOLLEGE
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LEARNING OBJECTIVES
Identify various modes of fetalsurveillance.
Describe the main characters of CTG &biophysical profile.
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CONTINOUS ELECTRONIC FETAL HEART
RATE MONITORING (CEFHRM)
The fetal cardiac behavior and uterinecontractions are monitored with a
machine called cardiotocogram and thegraphic record obtained is calledcardiotocograph (CTG).
The word cardio stands for cardiacbehavior and toco for uterine activity.
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CTG MACHINE
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INTERPRETATION OF CTG 1. Baseline Fetal Heart Rate
2. Fetal Heart Rate Variability
3. Acceleration
4. Deceleration
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BASELINE FETAL HEART RATE Normal : 110-150 beats per minute
150 Tachycardia
Causes : prolonged labour when causemay be combination of maternal anxiety,exhaustion and dehydration, fetal infection
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FETAL HEART RATE
VARIABILITY Normal variability 5-25 beats per minute
If less than 5 beats per minute it may be due
to fetal hypoxia, sleep cycle of baby,premature fetus, or maternal administrationof narcotic or anesthetic medications
Reduction in FHR variability alone is poor
predictor of fetal hypoxia Combination with decelerations and passage
of meconium, is more ominous
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ACCELERATIONS increases in fetal heart rate from the
baseline by at least 15 beats per
minute, lasting for at least 15 seconds.
They are normally present, indicating aReactive Tracing.
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DECELRATIONS Decreases in fetal heart rate from the
baseline by at least 15 beats per
minute, lasting for at least 15 seconds.They are normally minimal.
There are three types of decelerations,
depending on their relationship withuterine contraction.
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EARLY DECELRATIONS Begin at start of uterine contraction and
end with conclusion of contraction.
A sign of increased vagal tone due tofetal head compression.
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VARIABLE DECELERATIONS Occur at any time irrespective of uterine
contractions.
A sign of umbilical cord compression.
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LATE DECELERATIONS
Begin at the peak of a contraction andends long after it, hence the "late"
when compared to early decelerations.A sign of fetal hypoxia due to uterus or
placental insufficiency - the most
worrisome deceleration.
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INTERPRETATION OF CTG
1. Reactive CTG
2. Suspicious
3. Ominous
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REACTIVE CTG
It has baseline FHR of 110-150 bpm.
FHR Variability of 5-25 bpm, at least 2
accelerations and no decelerations.
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SUSPICIOUS CTG
With no FHR accelerations and there isan additional one abnormal feature
such as reduced baseline variability,deceleration or baseline tachycardia orbradycardia.
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TYPES OF TESTS
1. Non-stress test
2. Stress test
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NON-STRESS TEST
Use of CTG during the third trimester tomonitor fetal wellbeing is called a nonstress
test. A positive (good) result is indicated by a
reactive non-stress test.
Biophysical profile is another test associatedwith CTG. It is often done when the nonstress test is non reactive.
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STRESS TEST
Use of this machine during labor iscalled a stress test.
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FETAL BLOOD SAMPLING
Fetal blood sampling is a procedure toremove a small amount of blood from thefetus during pregnancy.
A fetal blood sample may be taken to:
diagnose genetic or chromosome abnormalities. check for and treat severe fetal anemia or other
blood problems such as Rh disease. check for fetal oxygen levels. check for fetal infection. give certain medications to the fetus.
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PARTOGRAM
A graphic representation of the progress oflabour
Cervicograph
Descent of Head [moulding] Uterine contractions Features that assist progress
[membranes/augmentation/drugs]
Maternal condition [heart rate, BP,urinalysis]
Fetal condition [heart rate, liquor]
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CERVICOGRAPH
It exhibits the pattern of cervicaldilatation.
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UTERINE CONTRACTIONS
ASSESS DURATION OF CONTRACTION
Mild < 20 sec
Moderate 20
40 sec Strong > 40 sec
ASSESS FREQUENCY OF CONTRATIONS
Number of contractions in last 10 min of each hr.
increased frequency from 1:10 to 5:10minutes
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DESCENT OF HEAD
Descent of head in fifths per abdomen
Engagement at 2/5 and less
If 3/5 or more than CPD [absolute or relative]is present
Vaginal assessmentin relation to ischial
spines not useful to define engagement sinceposition of spines dependant on type of pelvis
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THANK YOU