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FETAL MOVEMENT COUNT NONSTRESS TEST CONTRACTION STRESS TEST BIOPHYSICAL PROFILE MODIFIED BIOPHYSICAL PROFILE DOPPLER VELOCIMETRY
Returned to fetus via umbilical vein with partial pressure 4.7kpa or 35-40mmHG and 8090% saturation
Between 50-60% of this placental venous blood bypasses hepatic circulation via ductus venosus to enter IVC
AT THE JUNCTION OF IVC AND RIGHT ATRIUM IS A TISSUE FLAP KNOWN AS EUSTACHIAN VALVE
This valve tends to direct more highly oxygenated blood streaming along IVC, FORAMEN VALVE in to left atrium Oxygen saturation in the left atrium s 65%
Reduce the incidence of fetal death Minimize morbidity by optimizing the timing of delivery Identify more clearly those fetuses genuinely at risk of chronic hypoxia and avoiding unnecessary interventions Identifying those fetuses at risk of acute hypoxia in labour
MATERNAL
HYPERTENSIVE DISORDERS DIABETES CHRONIC RENAL DISEASE ANTIPHOSPHOLIPID ANTIBODY SYNDROME AND OTHER AUTOIMMUNE DISEASES CYANOTIC HEART DISEASE INADEQUATE NUTRITION SMOKING
IUGR RECURRENT ABRUPTION PREECLAMPSIA ABNORMAL AMNIOTIC FLUID VOLUME REDUCED FETAL MOVEMENTS ABDOMINAL PAIN WITH OUT A CLEAR CAUSE POSTDATES PREGNANCY PREVIOUS STILLBIRTH PREVIOUS IUGR
Gestation at which these tests should be initiated depends largely on the prognosis for fetal survival should intervention be required owing to an abnormal test result PRACTICAL FETAL VIABILITY
IDEALLY AT 32 34 WEEKS GESTATION - 26-28 WEEKS OF GESTATION IN HIGH RISK CASES
Between 20 and 34 weeks height of uterine fundus measured in cm correlates with gestational age in weeks
the rule of thumb is lag of growth greater than four cm.
Fundal height should be measured as the distance over the abdominal wall from the top of symphysis pubis to the top of the fundus
Bladder must be emptied before the measurement Dextorotation should not be corrected Abnormalities of fundal height should lead to further investigation Accuracy very poor
minutes
NORMAL
FETAL TONE
9WEEKS
- 20-21 WEEKS
STATE 1F - quiescent state quiet sleep with a narrow oscillatory bandwidth of fetal heart rate
STATE 2F frequent gross body movements , continuous eye movements, wider oscillation of fetal heart rate REM OR ACTIVE SLEEP in the neonate STATE 3F continuous eye movements in the absence of body movements and no heart rate accelerations STATE 4F VIGOROUS BODY MOVEMENTS with continuous eye movements and heart rate accelerations
1ST sign of reduced blood supply by which fetuses conserves its energy
It is the simplest and least costly method Most studies initiate fetal movements after 28-32 weeks of gestation Women perceived 16 movements
80 % of actual fetal
Fetal movements perceived best when lying down Maternal exercise does not alter fetal activity
Most studies did not show increased movements after food or glucose
Cardiff count method too conservative will not allow early detection of fetal hypoxia
MOORE AND PIACQUADIO
NELDAM Women are instructed to count fetal movements for 1 hour a day and the count is accepted as reassuring if it equals or exceeds a previously established baseline count
ACOG
- PERCEPTION OF TEN DISTINCT MOVEMENTS IN UP TO 2 HRS CONSIDERED REASSURING - COUNTING CAN BE DISCONTINUED FOR THAT DAY AFTER TEN MOVEMENTS
All high risk women with reduced fetal movements Fetal movements < 10 in 2 hrs
NST
REACTIVE
NONREACTIVE
Regulation of FHR due to balance between sympathetic and parasympathetic nervous system
Place the patient in semifowlers or left lateral tilt position Apply external monitor to the maternal abdomen and observe FHR RECORDING
recording continued for 20 minutes
REACTIVE when there are two or more accelerations of FHR of 15 beats per minute for atleast 15 seconds duration over a 2o minute recording after 32 weeks
IN PRETERM FETUSES an acceleration of FHR of 10 beats/ minute or more above the base line lasting 10 seconds or longer In extreme preterm fetuses with immature CNS . NST has no role
NON REACTIVE
LACK OF ACCELERATIONS FOR A PERIOD OF 40 MINUTES Most common cause of non reactive fetus fetal inactivity prematurity
If the pattern is nonreactive after 20 minutes of observation then vibroacoustic stimulation (VAS), using an artificial larynx, may be performed.
The acoustic stimulator should be positioned on the maternal abdomen and a stimulus of 3 sec or less applied near the fetal head. If the NST remains nonreactive, the stimulus is repeated at 1-minute intervals up to three times.
Uteroplacental blood flow decreases during uterine contractions Healthy fetus tolerate the stress with out difficulty for 2-3 minutes
Test requires 3 contractions lasting 40- 60 seconds with in 10 minute period If uterine activity absent stimulate with oxytocin 0.5 miu/minute
Double the rate every 15 20 minutes
Classical caesarean section Extensive uterine surgery Placentaprevia Preterm labour Preterm rupture of membranes Multiple gestation
It is rarely performed due to longer duration of the test Requirement for continuous supervision by trained personnel and existence of risks and contraindications associated with its performance False negative rate is 0.4 per 1000
Introduced in 1980 by MANNING Assigns a maximum of two points to each of five variables 1. fetal breathing 2. fetal movement 3. fetal tone 4. qualitative amniotic fluid 5. NST Recorded for 30 minutes
Component
Definition
Two or more fetal heart rate accelerations peak (but do not necessarily remain) at least 15 beats per minute above the baseline and last 15 seconds from baseline to baseline within a 20-minute period with or without fetal movement discernible by the woman. A single 2 cm x 2 cm pocket is considered adequate or AFI greater than 5.0 cm . One or more episodes of rhythmic fetal breathing movements of 30 seconds or more within 30 minutes. Hiccups are considered breathing activity. At least three discrete body or limb movements. Episodes of continuous movement are considered as a single movement. One or more episodes of extension of a fetal extremity or trunk with return to flexion, or opening or closing of a hand
Non-stress test
Fetal movements
Fetal tone
Normal BPS SCORE OF 8 OR 10 with normal amniotic fluid indicative of healthy fetus
Even a good score with low AFI carries high risk to the fetus
Score of 8 due to reduced amniotic fluid high risk for chronic compensated hypoxia either delivered or repeat the BPS not less than twice a week
A BPS of 6 EQUIVOCAL INDIVIDUALIZED A BPS of 4 or less immediate delivery
Score 8- 10 6
4 2
0
Abnormal Abnormal
Abnormal
26.3 94.0
285.7
*The perinatal mortality is 0.8/1000 for structurally normal fetuses with a normal test within 7 days.
FETOMATERNAL HAEMORRHAGE
UMBILICAL CORD ACCIDENTS ABRUPTION
False positivity rate is 30% False negative rate is 0.7 per 1000 Positive predictive value better than of NST
Excellent test for primary fetal surveillance An index of acute fetal hypoxia and chronic fetal problems
Combines NON STRESS TEST AND AMNIOTIC FLUID INDEX.
Performed in an average of twenty minutes It has excellent negative and positive predictive values
EASILY INTERPRETED
Decreased uteroplacental perfusion Diminished fetal renal flow Decreased urine production Oligohydramnios
Amniotic Fluid Index (AFI) The amniotic fluid index is measured by dividing the uterus into four quadrants
The linea nigra is used to divide the uterus into right and left halves.
The umbilicus serves as the dividing point for the upper and lower halves. The transducer is kept parallel to patients longitudinal axis and perpendicular to the floor. POCKETS consisting primary of umbilical cord are disregarded
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