Fetal Surveilance

8/12/2019 Fetal Surveilance

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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

Fetal Surveilance

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