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INTRA PARTUM FETAL MONITORING

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Title: INTRA PARTUM FETAL MONITORING Author: AL MEHAF Created Date: 1/22/2009 11:17:07 AM Document presentation format: On-screen Show (4:3) Other titles – PowerPoint PPT presentation

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Title: INTRA PARTUM FETAL MONITORING


1
INTRA PARTUM FETAL MONITORING
2
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.
3
  • Aim
  • To detect hypoxia and so prevent
    asphyxia which may cause either death or
    permanent neurological damage as cerebral palsy,
    mental deficiency or both.

4
How to Record There are 2 methods of recording
FHR
  • A ? External
  • B ? Internal

5
FHR Pattern
  • Periodic Change Duration at least 10 minutes
  • Acceleration ? Repetitive ? in rate
  • Deceleration Early ? ? with contraction
  • Late ? ? without
    contraction
  • Variable ?

6
FHR Pattern
  • Baseline
  • 1. Normal 120 160 beats/min
  • 2. Tachycardia Moderate 160 180 beats/min
  • 3. Severe gt 180 beats/min
  • 4. Bradycardia Moderate 100 120 beats/min
  • Severe lt 100
    beats/min
  • Variability
  • Normal gt 5 beats/min
  • Reduced 3 5 beats/min
  • Absent lt 3 beats/min

7
Post 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 ? anoxia
  • 2. Fetus become large ? dystocia

8
Post Term
  • Diagnosis
  • During pregnancy
  • Last M.P
  • ? abdominal girth
  • U / S
  • - bi partial diameter
  • - placental

9
  • After birth
  • Long more than 45 cm. weight more than 4.3
  • Well ossified skull with small fontanels
  • Fingernails are unduly long
  • Management
  • Termination of pregnancy is advisable (if there
    is placental insufficiency
  • either by)
  • Induction of labor
  • Cesarean section in primi any other obstetrical
    complications.

10
Intra Uterine Fetal Death (IUFD)
  • Etiology
  • Hypertensive
  • - PET
  • - Eclampsia
  • - Essential Nephritis
  • - Chronic Nephritis
  • 2. Diabetic Mellitus
  • 3. Erythroblastosis ? due to destructive effect,
    maternal
  • antibodies on fetal red blood cells
  • 4. Syphilis ? due to endarteritis obliterans of
    the vessels
  • the villi
  • 5. Placental insufficiency
  • - Accidental He
  • - Multiple infarction
  • - Small Placenta

11
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
12
Intra Uterine Fetal Death (IUFD)
  • Pathology Changes
  • Pealing of the skin starts 12 hours after death.
  • 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

13
Intra Uterine Fetal Death (IUFD)
  • Investigations
  • Pregnancy test negative
  • No fetal heart
  • X-ray
  • - Spalding sign
  • - Hyperflexia of the spine
  • - Collapse of the thorax
  • Complications
  • Intra uterine infection
  • Hypofibrinogenmia
  • Amnionitic fluid embolism

14
Intra Uterine Fetal Death (IUFD)
  • Management
  • Await spontaneous evacuation of the uterus in 4
    weeks.
  • 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
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