10 - Obs - Fetal Growth, Compromise and Surveillance - Methods of Surveillance Flashcards
USS Assessment of Fetal Growth
USS used to measure fetal size after ?st trim, esp ? and ?
circumferences.
Changes recorded on ? charts. 3 factors help ID ????fetus:
- ? of growth
- Pattern of ?: fetal ? wall stop growing before ?– result is ? fetus or ? growth restriction.
- Allowance for constitutional ?-? determinants of fetal growth.
Benefits: Serial USS confirms ? growth in high risk and ?
pregs, essential to mgmt
Limitations: ‘One-off’ USS in later preg are of limited benefit in ? risk pregs.
? measurements common, can be harmful.
1 abdo head centile IUGR
Rate smallness abdo head thin asymmetrical non-pathological
consistent
multiple
low
inaccurate
Doppler Umbilical Artery Waveforms
Used to measure ? waveforms in ? aa’s. Evidence of ?resistance circ i.e reduced ?? in fetal diastole vs systole suggests ? dysfunction.
Benefits: Umbilical aa waveforms IDs the ? fetuses that are ????/compromised. Usage improves ? outcome in high risk pregs and reduces ?
in low risk. Also absence of ?
flow usually predates ??? and correlates well w severe
compromise.
Limitations: Doppler not useful in ?-risk pregs – less effective.
velocity umbilical high BF placental
small IUGR perinatal intervention umbilical CTG low
Doppler Waveforms of Fetal Circulation
All major fetal ? seen, but ???
and ductus venosus most commonly measured. W fetal compromise, MCA shows ?resistance vs thoracic ? or ?
vessels – shows head ?
effects. Flow velocity incr in fetal ?
Benefits: Use restricted to ?
risk pregs and specific situations eg ?, and gen contributes to (vs dictates) decisions re intervention.
Limitations: ? use doesn’t reduce perinatal mort/morb.
vessels MCA low aorta renal sparing anaemia
high
anaemia
routine
USS Assessment of Biophysical Profile/Amniotic Fluid Volume
4 variables (? mvmt, tone, ? mvmt, ? vol) scored 0-2 to total /8. ??? also inc and score /10. Takes 30mins, low score = ? compromise. Reduced ? is a non-spec finding more common in ? fetuses.
Benefits: Useful in high risk preg where ??? or ? give equivocal results.
Limitations: ? consuming and little use in low risk preg.
limb breathing liquor CTG severe liquor compromised
CTG
doppler
time
Cardiotocography or Non-Stress Test
Fetal heart recorded elec for up to an ?. ? and variability >?bpm should be present, decelerations ? and rate in range of ?-?.
Benefits: Antenatal abnormalities represent ?stage fetal compromise and ?
indicated. Computerised interpretation of ? benefits buying time in delaying ? of ?compromised premature fetuses.
Limitations: ??? alone no use as ANC ? test. Reliance as test of fetal wellbeing leads to incr perinatal ?. Normal CTG = fetus wont die in next ?hrs. So must be done ?
hour accelerations >5bpm absent 110-160
late delivery variability delivery chronically
CTG screening mortality 24 daily
Interpreting CTG - DR C BRAVADO?
Define Risk - what risk and why Contractions - freq/duration Baseline Rate - tachy/brady? Accelerations - present? VAriability - 5-10 bpm? Decelerations - early/variable/late Overall impression - comment + mgmt
Kick Chart
Mother records number of indiv ? every day.
Benefits: Most compromised fetuses have ? mvmts in days/hrs before ?. RFM indicates more ? testing. Simple and ?.
Limitations: Compromised fetuses stop moving only shortly before ?. Routine counting limited in reducing perinatal ? and may -> unnecessary ? and incr maternal ?. Not used ?.
mvmnts
reduced
demise
sophisticated
cheap
death mort intervention anxiety routinely
