Fetal Surveillance & Fetal Distress Flashcards
Causes of stillbirth
Chronic placental insufficiency
Actute placental insufficiency:
Abruptio placenta, placenta previa
Infection
Unexplained
Acute events that occur suddenly may not be identifiable by antepartum testing such as:
Cord accident
Abruptio placenta
Hydrops fetalis
Intrauterine infection
Candidates for testing
Pts with DM
Chronic HTN
Autoimmune disease
Maternal CHD
Maternal hypothyroidism
(All around 32-34 wks)
Post date pregnancy at 42 wks
Conditions that need urgent testing at the time of diagnosis
PET
Suspected IUGR
Discordinate twins
Progressing fetal hypoxia can be detected by changes in :
Fetal heart rate
Amniotic fluid volume
Fetal behavior
Fetal umbilical artery blood velocity
Antepartum fetal surveillance techniques :
FM count
Non stress test (NST)
Contracting stress test (CST)
Biophysical profiles (BPP)
Amniotic fluid index
Doppler velocimetry
Causes if decrease variability in non stress test:
Fetal hypoxia
Drugs (alcohol, opiates, pethidine, diazepam.)
Premature
Fetal sleep (but not longer >30 min)
CNS & Cardiac abnormality
Causes of ++ variability
It is called sinusoidal pattern dt:
Severe fetal anemia (e.g in Rh isoimmunization, bleeding from vasaprevia)
Hypoxia of fetal myocardium
Causes of fetal tachycardia
Idiopathic
Prematuritry
Infection
Maternal pyrexia
Maternal thyrotoxicosis
Drugs (B sympathomemtics)
Causes of fetal bradycardia
Idiopathic
Asphyxia
Fetal cardiac dysarrhythmias and cardiac anomalies
Fetal hge
Drugs (morphine, local anasthesia, digoxin)
Expain CST
It evaluates fetal O2 reserves in the present of uterine contraction
Absolute contraindications to CST:
Classical C/S and other uterine surgery with exception LSCS
Placenta previa
Types of fetal heart deceleration
Early deceleration
Late deceleration
Variable deceleration
Which deceleration associated with UPI:
Late deceleration
Deceleration that is dt head compression
Early deceleration
Deceleration that has no consistent relationship to uterine contractions and it is usually dt **transient compression of the umbilical cord
Variable deceleration
If variable deceleration is prolonged and reccurent, may be associated with
Fetal acidosis
V shaped deceleration:
Early
It occurs during a contraction and is over by the end of contractuon
Early
It begins after the beginning of the contraction, and recovery occurs after the contraction is finished
Late
Often with slow return to base line
Late deceleration is associated with
IUGR, PET, DM, Abruptio placenta, and maternal hypotension
Which deceleration is normal
Early
Biophysical profile items:
Fetal breathing movement
Fetal gross movement
Fetal tone
Amniotic fluid index
Non stress test
In Doppler, blood flow, abesnt, or even reverse flow at the end of diastole are strongly suggestive of
Fetal hypoxia
Monitor fetal well-being in labor by:
Intermittent auscultation by fetostethscope
Continues electronic fetal heart monitoring
Fetal scalp ph
Mothod for performing Continues FHR in labor
External FHR monitoring
Uses doppler device ro detect movement of fetal cardiac valve or movement of blodd in fetal heart and vessels
Internal
By using small electrode applied to fetal scalp (a fetal ECG is obtained)
Causes of acute fetal distress
Abruptio placenta and cord prolapse
Effects of hypoxia on the fetus
• Neurological abnormalities: **cerebral palsy & mental retardation
• Fetal death : can result from severe intrapartum asphyxia
The dx of suspected fetal distress in labor by:
CTG abnormalities
In management of fetal distress
vaginal examination should be performed to exclude:
Cord prolapses or rapid progess to full dilatation (PPT labor)
Main indication for fetal scalp sampling:
Abnormal CTG
Factors that may reduce the threshold to carry out a fetal scalp sampling:
Meconium staining
Post term
Suspected IUGR
