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Antepartum Fetal Serveillance - Aklil
Antepartum Fetal Serveillance - Aklil
Objective
Introduction
Techniques of evaluation
Early pregnancy:
1.
Biochemical:
a. Maternal serum alpha-fetoprotein (MSAFP):
Oncofetal protein produced by yolk sac &
fetal liver
Fetal & amniotic fluid level is highest at 13
weeks & then after decreases while
maternal serum level peaks at 32 weeks
Level of 2.5 MoMs when adjusted for
maternal weight is taken as cut off point
e.
2.
Clinical
U/S
GA assessment, DX of multiple pregnancy, congenital
malformation, fetal growth pattern
Biochemical methods Estriol, HPL, Amniocentesis
Techniques of evaluation
3.
Biophysical methods
Doppler U/S
Effect of hypoxia
Fetal hypoxemia
(asphyxia)
Celluar dysfunction
Aortic body
Chemoreceptor
Redistr. CO
Increased BF
Decr. BF
- Fetal brain(IVH) -Fetal kidneys(Oligo)
- Adrenal
-Lungs(RDS)
-Heart
- Gut(NEC)
- Placenta
-Liver
&carcass(IUGR)
Methods
Count for 30 - 60 min, 2-3x / day - / each day
- < 3 movement / hr
Count for at least 60 min / each day
< 3 movement / hr, for 2 consecutive days
Cardiff count to ten:10 or more in12hrs
Problem - poor sensitivity
5% of patients report decreased fetal activity
~ 80% of fetal movements are detected by the
mother
Placental location.
Length of fetal movement.
Amniotic fluid volume.
Fetal anomalies.
Medications.
Obesity.
Contd
-Accelerations
-Sinusoidal pattern
NST contd
Advantage
Cheap, simple, risk free
Additional unusual FHR pattern that indicate fetal
jeopardy ( bradycardia, persistent variable
deceleration, sinusoidal pattern..)
Perinatal mortality: 6.2 / 1000
False positive rate - 50%
False negative rate 3.2 %
Principle
the response of the fetus at risk for uteroplacental
insufficiency to uterine contraction
In hypoxic fetus uterine contractions will elicit fetal late
decelaration
Late decelarations correlate with stillbirth, IUGR, and low
APGAR scores
Types -oxytocin(90 min)
nipple stimulation(30 min)
CST contd
CST contd
1.
2.
3.
4.
5.
Interpretation of CST
Negative - no late deceleration and adequate
FHR recording
Positive - late deceleration that are consistent
/ persistent in >50% of contractions
Suspicious - late deceleration are present with
less than half of the contractions
Hyperstimulation - >5 contractions in 10 min or
lasting for 90 seconds
Unsatisfactory - quality of tracing inadequate for
interpretation or no adequate contraction
CST contd
CST contd
Management of CST
Suspicious, hyperstimulation, or unsatisfactoryrepeat after 24 hrs
Negative test repeated weekly
Positive test acted on according to clinical
condition
Advantage- not affected by alcohol or drug
ingestion by the mother, not GA dependent
Disadvantage - expensive , cxns, time
consuming, False +ve ( 50%)
CST contd
Contra indications
PROM
Multiple gestation
Cervical incompetence
Previous classical c / d or ux surgery
Placenta previa
Perinatal mortality 1.2 / 1000
High equivocal rate
False positive rate: 8 57%
False negative rate: 0.4 / 1000
Biophysical profile
BPP...
It comprises of:
BPP...
Acute variables:
NST.
Fetal breathing movement-1 or more
episodes of fetal breathing movement of
30or more within 30.
Fetal movement- 3 or more discrete
body/limb movement within 30.
Fetal tone- 1 or more episodes of
extension of extremity with return to
flexion.
BPP...
Chronic variable:
Amniotic fluid volume- SDP>2cm.
Regardless of the score ,SDP<2cm needs
further evaluation.
BPP...
Interpretation:
10/10 or 8/10(NL AFV)-risk of fetal asphyxia
within one wk if no intervention is1/1000.
8/10(abn AFV)-risk of fetal asphyxia within
one wk if no intervention is 89/1000.
AFV equivocal ,possible fetal
asphyxia.reapet test within 24hrs(preterm).
BPP...
BPP...
Factors
Antenatal
corticosteroids
NST + AFI
FT+ FBM+GBM+AFI
Hyperthyroidism
Cyanotic heart disease
PIH
Decreased fetal movement
oligohydramnios/polyhydramnios.
IUGR.
Post term pregnancy.
Isoimmunization.
Previous fetal demise.
Multiple gestation.
repeated.
When condition that prompt testing
persists, test should be repeated
periodically.
When maternal medical condition is
stable,& CST- ve repeat weekly.
NST,BPP,MBPP wkly(2/wk in certain HRP)
Thank U