INTRA PARTUM FETAL MONITORING INTRA PARTUM FETAL MONITORING

Diagnosis:Diagnosis:

It consists of continuous FHR uterine contraction with intermittent complementary & supplementary fetal micro blood sampling F2 PH and respiratory gases to clarify clinical situation.

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:How to Record:

There are 2 methods of recordingThere are 2 methods of recording FHRFHR

A → ExternalB → Internal

FHR Pattern FHR Pattern

Periodic Change = Duration at least 10 minutes

Acceleration → Repetitive ↑ in rate

Deceleration Early → ↓ with contraction Late → ↓ without contraction Variable →

FHR Pattern FHR Pattern Baseline :1. Normal = 120 – 160 beats/min2. Tachycardia – Moderate 160 – 180 beats/min3. Severe > 180 beats/min

4. Bradycardia – Moderate 100 – 120 beats/min Severe < 100 beats/min

Variability:Normal > 5 beats/minReduced 3 – 5 beats/minAbsent < 3 beats/min

PostPost Term 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 → anoxia2. Fetus become large → dystocia

Post Term Post Term

Diagnosis: During pregnancy

1. Last M.P 2. ↑ abdominal girth 3. U / S - bi – partial diameter - placental

After birth :1. Long more than 45 cm. & weight more than 4.3 2. Well ossified skull with small fontanels 3. Fingernails are unduly long

Management :

Termination of pregnancy is advisable (if there is placental insufficiencyeither by:)

1. Induction of labor2. Cesarean section in primi & any other obstetrical complications.

Intra Uterine Fetal Death (IUFD)Intra Uterine Fetal Death (IUFD)

Etiology1. Hypertensive - PET - Eclampsia - Essential Nephritis - Chronic Nephritis2. Diabetic Mellitus 3. Erythroblastosis → due to destructive effect, maternal antibodies on fetal red blood cells4. Syphilis → due to endarteritis obliterans of the vessels & the villi5. Placental insufficiency - Accidental He - Multiple infarction - Small Placenta

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)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)Intra Uterine Fetal Death (IUFD)Investigations:

1. Pregnancy test negative 2. No fetal heart3. X-ray - Spalding sign - Hyperflexia of the spine - Collapse of the thorax

Complications:1. Intra uterine infection2. Hypofibrinogenmia3. Amnionitic fluid embolism

Intra Uterine Fetal Death (IUFD) 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