Gawat Darurat Ibu dan Anak

(GDIA) Pusdiklat Sari Mulia

Fetal Cardiotocography
Zayed Norwanto
Banjarmasin, 4 Oktober 2015

Electronic fetal heart monitoring {EFM}:

developed in the 1960s.
is achieved by either :
* internal or direct monitoring ,
by applying a bipolar electrode to the skin of
the
fetal scalp ,the cervix has to be dilated and
membranes ruptured.

* external or indirect monitoring.

by using ultrasound ,usually by ;
External toco dynamo metry with a pressure
transducer placed on the uterus.

Indications for EFM

* low risk women with;
normal RHR on auscultation , no meconium
staining liquor and normal progress of labor
are extremely unlikely to deliver an
asphyxiated infants.

is

Admission test :
initial 20 minutes EFM screen in early labor

enough to predict the likelihood of

subsequent
fetal hypoxia.

* high risk women;

Maternal disorders:
hypertensive diseases.
diabetes mellitus.
renal diseases.
cardiac diseases.
APH.
RH isoimmunization.

Labor complications :
dysfunctional labor ( slow progress).
oxytocin augmentation or induction .
preterm labor.
VBAC.
Fetal complications :
IUGR.
previous SB.
meconium staining.
Post term pregnancy.
abnormal FHR on auscultation.
twins.

; A: Fetal heartbeat
B: Indicator showing movements felt by mother (caused by
; pressing a button)
; C: Fetal movement
D: Uterine contractions

DoCtor BRaVADO
Low or High:
Define Risk
Frequency, Length:
Contractions
Bradycardia, Normal, Tachycardia:
Baseline Rate
5-10bpm/min:
Variability
Present or Absent:
Accelerations
Present or Absent, Type:
Decelerations
Normal, Suspicious. Pathological. Outcome:
Management Plan

Contraction

Base Line
Baseline FHR:
* It is the rate recorded in between uterine
contractions.
* Normally 110 150 bpm.
* usually assessed over 15 minute interval
during labor.

Baseline tachycardia
* It is a FHR above 150 - 160 bpm.
* causes :
Fetal hypoxia.
Maternal or Fetal infection.
Drugs as ritodrine and atropine.
Maternal hyperthyrodism.
maternal dehydration.
Fetal anemia .
Fetal cardiac arhythmias.

Baseline tachycardia

Baseline bradycardia
* It is a FHR less than 90 -110 bpm.
* It may be mild ( 90 -110 bpm. ) or
severe ( < 90 bpm. ).
* persistent mild fetal bradycardia is usually
benign. While severe bradycardia caused
by
fetal congenital heart block.

Baseline bradycardia

Variability
* baseline or beat - to -beat variability is
controlled by the balance between the
sympathetic and parasympathetic nervous
control of the heart.
* normal variability is 5 25 bpm.
* it is reduced < 5 bpm. in :
fetal hypoxia.
physiological during fetal sleep cycles.
drugs as ;dethadine ,barbiturates and
atropine.

normal beat to beat variability

Reduced beat to beat variability

Poor or absent variability

Accelaration
Periodic FHR
periodic changes in the FHR may be either :
A. Accelerations :
* is associated with ;
fetal movements.
uterine contractions.
* are considered benign and its presence
indicates a well oxygenated fetus.

normal FHR accelerations associated with fetal

movements ( reactive NST )

normal FHR accelerations with uterine

contractions

Deccelaration

Decelerations :
classically 3 well defined decelerations
are described ; early ,variable and late.
1. Early deceleration :
this deceleration have a uniform shape
( bell),
starts early in the contraction and mirrors it.
the magnitude of the deceleration is
<40bpm.
cause : head compression
mediated by vagal reflex.
it occurs during the active phase , they are
benign .

early deceleration

2.Variable deceleration :
it is the most common deceleration pattern.
it appears as abrupt fall and return in FHR,
preceded and followed by small
accelerations ( shoulders).
they are variable in shape V ,U or W shape ,
duration and timing.
the magnitude is usually 50-80 bpm.
cause : cord compression.
if it persists fetal hypoxia occurs.
mild variable deceleration ( last < 30 sec.) is
benign.
moderate (last 30 -60 sec.) and severe (last > 60
sec.)
indicates fetal hypoxia.

Variable deceleration.

3. Late deceleration:
it have a similar shape and magnitude
as
early deceleration but their timing is
different.
it start as the contraction peaks and
does
not return to the baseline FHR until after
the end of the contraction.
cause : fetal hypoxia.

Late decelerations

Prolonged deceleration

(up) Sinusoidal pattern, (down) Pseudo-sinusoidal

Outcome

Reassuring ( normal ) FHR pattern.

KATAGORI I : Pola DJJ Normal

Frekuensi dasar DJJ : 110 160 dpm . 1

Variabilitas DJJ : moderat (5 25 dpm) . 2

Tidak ada deselerasi lambat dan variabel . 3
Tidak ada atau ada deselerasi dini. 4

Ada atau tidak ada akselerasi. 5

KATAGORI II : Pola DJJ Ekuivokal

Frekuensi dasar DJJ : Bradikardia (<110 dpm) yang tidak disertai . 1
hilangnya variabilitas (absent variability)
Takhikardia ( DJJ >160 dpm). 2

Variabilitas minimal (1 5 dpm) . 3

Tidak ada variabilitas, tanpa disertai deselerasi berulang . 4

Variabilitas > 25 dpm (marked variability) . 5

KATAGORI III : Pola DJJ abnormal

Deselerasi lambat berulang. 1
Deselerasi variabel berulang . 2
Bradikardia. 3

Pola sinusoid (sinusoidal pattern). 4

Management

A. Reversible cause:
* stop oxytocin .
* treat hypotension.
* maternal repositioning
in left lateral position.
* relieve pain & fear.
* give oxygen to mother.
* treat maternal fever.
* pelvic exam:
to exclude cord prolapse.
cx. fully dilated carry out
assisted vaginal delivery.

Irreversible cause :
cx. is not fully dilated with
persistent nonreassuring FHR patterns.

B.

* immediate delivery and

extra- uterine
resuscitation.
* fetal scalp blood pH
determination :
if pH >7.25 observe.
if pH 7.2 7.25 repeat.
if pH <7.2
CS.

Thank you