Transcript INTRA PARTUM FETAL MONITORING

INTRA PARTUM FETAL MONITORING
Diagnosis:
It consists of continuous FHR uterine
contraction with intermittent complementary &
supplementary fetal micro blood sampling F PH
and respiratory gases to clarify clinical situation.
2
Aim:
To detect hypoxia and so prevent
asphyxia which may cause either death
or permanent neurological damage as
cerebral palsy, mental deficiency or
both.
How to Record:
There are 2 methods of recording FHR
A → External
B → Internal
FHR Pattern
Periodic Change = Duration at least 10 minutes
Acceleration → Repetitive ↑ in rate
Deceleration
Early → ↓ with contraction
Late → ↓ without contraction
Variable →
FHR Pattern
Baseline :
1. Normal = 120 – 160 beats/min
2. Tachycardia – Moderate 160 – 180 beats/min
3. Severe > 180 beats/min
4.
Bradycardia –
Moderate 100 – 120 beats/min
Severe < 100 beats/min
Variability:
Normal
> 5 beats/min
Reduced
3 – 5 beats/min
Absent
< 3 beats/min
Post Term
It is prolongation of pregnancy 14 days or more after full
term ,incidence 3 – 7 ½ common in primi.
Etiology → unknown maybe
a. hereditary
b. hormonal factor
Complication:
1. Placental insufficiency → anoxia
2. Fetus become large → dystocia
Post Term
Diagnosis:
During pregnancy
1.
2.
3.
Last M.P
↑ abdominal girth
U/S
- bi – partial diameter
- placental
After birth
1.
2.
3.
:
Long more than 45 cm. & weight more than 4.3
Well ossified skull with small fontanels
Fingernails are unduly long
Management :
Termination of pregnancy is advisable (if there is placental insufficiency
either by:)
1.
2.
Induction of labor
Cesarean section in primi & any other obstetrical complications.
Intra Uterine Fetal Death (IUFD)
Etiology
Hypertensive
- PET
- Eclampsia
- Essential Nephritis
- Chronic Nephritis
2. Diabetic Mellitus
3. Erythroblastosis → due to destructive effect, maternal
antibodies on fetal red blood cells
4. Syphilis → due to endarteritis obliterans of the vessels &
the villi
5. Placental insufficiency
- Accidental He
- Multiple infarction
- Small Placenta
1.
6. Congenital anomalies of the fetus
7. Knots of the cord
8. Acute infectious diseases of the mother
9. Chemical poisoning
10. Idiopathic
- Severe anemia
- Malnutrition
Intra Uterine Fetal Death (IUFD)
Pathology Changes:
1.
Pealing of the skin starts 12 hours after death.
2.
The brain undergoes softening and CST is absored so the
cranial bones override.
This is shown in x-ray → Spalding sign.
Diagnosis:
A.Symptoms
1. Cessation of fetal movements
2. Regression of breast changes
B. Signs
1. The uterus is smaller than date
2. The fetus feels like homogenous mass
3. No fetal heart
Intra Uterine Fetal Death (IUFD)
Investigations:
1. Pregnancy test negative
2. No fetal heart
3. X-ray
- Spalding sign
- Hyperflexia of the spine
- Collapse of the thorax
Complications:
1.
2.
3.
Intra uterine infection
Hypofibrinogenmia
Amnionitic fluid embolism
Intra Uterine Fetal Death (IUFD)
Management:
1.
Await spontaneous evacuation of the uterus in 4 weeks.
2.
If the dead fetus is retained more than 4 weeks or :
- the mother is very anxious
- if the hypofibrinogenmia is detected
- sign of intra uterine infection developed
a) Give pitocin drip
b) Prostaglandin
c) Cytotec or Nalidor