ELECTRONIC FETAL MONITORING

BY

PROF. DR. FAREESA WAQAR

HOD GYNAE/OBS DEPARTMENT ISLAMIC INTERNATIONAL MEDICALCOLLEGE

LEARNING OBJECTIVES

Identify various modes of fetal surveillance.

Describe the main characters of CTG & biophysical profile.

CONTINOUS ELECTRONIC FETAL HEART RATE MONITORING (CEFHRM)

The fetal cardiac behavior and uterine contractions are monitored with a machine called cardiotocogram and the graphic record obtained is called cardiotocograph (CTG). The word cardio stands for cardiac behavior and toco for uterine activity.

CTG MACHINE

INTERPRETATION OF CTG

1. 2. 3. 4.

Baseline Fetal Heart Rate Fetal Heart Rate Variability Acceleration Deceleration

BASELINE FETAL HEART RATE

Normal : 110-150 beats per minute <110 Bradycardia

Causes : hypoxia

>150 Tachycardia

Causes : prolonged labour when cause may be combination of maternal anxiety, exhaustion and dehydration, fetal infection

FETAL HEART RATE VARIABILITY

Normal variability 5-25 beats per minute If less than 5 beats per minute it may be due to fetal hypoxia, sleep cycle of baby, premature fetus, or maternal administration of narcotic or anesthetic medications Reduction in FHR variability alone is poor predictor of fetal hypoxia Combination with decelerations and passage of meconium, is more ominous

ACCELERATIONS

increases in fetal heart rate from the baseline by at least 15 beats per minute, lasting for at least 15 seconds. They are normally present, indicating a Reactive Tracing.

DECELRATIONS

Decreases in fetal heart rate from the baseline by at least 15 beats per minute, lasting for at least 15 seconds. They are normally minimal. There are three types of decelerations, depending on their relationship with uterine contraction.

EARLY DECELRATIONS

Begin at start of uterine contraction and end with conclusion of contraction. A sign of increased vagal tone due to fetal head compression.

VARIABLE DECELERATIONS

Occur at any time irrespective of uterine contractions. A sign of umbilical cord compression.

LATE DECELERATIONS

Begin at the peak of a contraction and ends long after it, hence the "late" when compared to early decelerations. A sign of fetal hypoxia due to uterus or placental insufficiency - the most worrisome deceleration.

INTERPRETATION OF CTG

1. Reactive CTG 2. Suspicious 3. Ominous

REACTIVE CTG

It has baseline FHR of 110-150 bpm. FHR Variability of 5-25 bpm, at least 2 accelerations and no decelerations.

SUSPICIOUS CTG

With no FHR accelerations and there is an additional one abnormal feature such as reduced baseline variability, deceleration or baseline tachycardia or bradycardia.

OMINOUS CTG

When there is more than one abnormal feature or repeated variable or late decelerations.

TYPES OF TESTS

1. Non-stress test 2. Stress test

NON-STRESS TEST

Use of CTG during the third trimester to monitor fetal wellbeing is called a nonstress test. A positive (good) result is indicated by a reactive non-stress test. Biophysical profile is another test associated with CTG. It is often done when the non stress test is non reactive.

STRESS TEST

Use of this machine during labor is called a stress test.

FETAL BLOOD SAMPLING

Fetal blood sampling is a procedure to remove a small amount of blood from the fetus during pregnancy. A fetal blood sample may be taken to:

diagnose genetic or chromosome abnormalities. check for and treat severe fetal anemia or other blood problems such as Rh disease. check for fetal oxygen levels. check for fetal infection. give certain medications to the fetus.

PARTOGRAM

A graphic representation of the progress of labour Cervicograph Descent of Head [moulding] Uterine contractions Features that assist progress [membranes/augmentation/drugs] Maternal condition [heart rate, BP, urinalysis] Fetal condition [heart rate, liquor]

CERVICOGRAPH

It exhibits the pattern of cervical dilatation.

UTERINE CONTRACTIONS
ASSESS DURATION OF CONTRACTION

Mild < 20 sec Moderate 20 40 sec Strong > 40 sec Number of contractions in last 10 min of each hr. increased frequency from 1:10 to 5:10 minutes

ASSESS FREQUENCY OF CONTRATIONS

DESCENT OF HEAD

Descent of head in fifths per abdomen Engagement at 2/5 and less If 3/5 or more than CPD [absolute or relative] is present Vaginal assessment in relation to ischial spines not useful to define engagement since position of spines dependant on type of pelvis

THANK YOU