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Antepartum Fetal Surveillance

Antepartum Fetal Surveillance. Willians Ch.15. Antepartum Fetal Surveillance. To test fetal well-being Fetal physical activities Movement Breathing Amniotic fluid production Heart rate Goal: to prevent fetal death. Fetal Movements. Passive unstimulated fetal activity: 7 wks

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Antepartum Fetal Surveillance

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  1. Antepartum Fetal Surveillance Willians Ch.15

  2. Antepartum Fetal Surveillance • To test fetal well-being • Fetal physical activities • Movement • Breathing • Amniotic fluid production • Heart rate • Goal: to prevent fetal death

  3. Fetal Movements • Passive unstimulated fetal activity: 7 wks • 20~30 wks: rest-activity cycles • 足月胎兒睡眠時間的百分比: • 足月胎兒一個睡眠週期約 75% 20~75 分鐘

  4. Perception of 10 fetal movements in up to 2 hours is considered normal

  5. Fetal Heart Rate

  6. Non-Stress Test • Fetal heart rate accelerations • Normal nonstress tests • 20分鐘內有兩次, 加速15下維持15秒

  7. 2次 15下 15秒 20分鐘

  8. Worse Prognosis • Absent acceleration up to 80 mins • Repetitive decelerations > 3 / 20 mins • Deceleration lasting > 1 min

  9. Contraction Stress Test • Oxytocin challenge test • 3 spontaneous contractions of 40 sec present in 10 mins Negative: no late or significant variable decelerations Positive: late decelerations following 50% or more of contractions

  10. Biophysical Profile BPP

  11. Fetal Death After Normal BPP • Fetomaternal hemorrhage • Umbilical cord accidents • Placental abruption • Incidence: 1/1000

  12. Amniotic Fluid Volume

  13. Pathophysiology • Decreased uteroplacental perfusion • Diminished fetal renal flow • Decreased urine production • Oligohydramnios

  14. Poor Prognosis • Single vertical pocket < 2 cm • Amniotic fluid index (四個象限 vertical pocket) < 5 cm

  15. Umbilical Artery Doppler Velocity

  16. Umbilical Artery Doppler • S/D ratio: most commonly used index • End diastolic flow  prognosis • Perinatal mortality • Absent end-diastolic flow: 10% • Reversed end-diastolic flow: 33% S D

  17. 下圖為三種40週胎兒的臍動脈血流速度的波形，請問下列敘述何者最合適？ • (A)甲波形正常，乙、丙波形異常 • (B)甲、乙波形正常，丙波形異常 • (C)甲、乙、丙波形皆正常 • (D)甲、乙、丙波形皆異常

  18. Pregnancy 31 weeks with preterm labor, SGA was noted in series OBS sono Keep tocolysis and observation

  19. Pregnancy 37 weeks with preeclampsia (BP 146/84, urine protein +) MBD with OPD follow up

  20. Pregnancy 24+6 weeks with SLE, hyperthyroidism, hypertension, and preterm labor C/S on 2009/05/08, BW 635gm, Apgar: 2’-3’

  21. Pregnancy 31+3 weeks with oligohydramnios and preterm labor, with preeclampsia, with HELLP syndrome  C/S on 2009/4/08, BW 1140gm, Apgar: 5’-8’

  22. Antepartum Fetal Surveillance • Telling more about the well-being of the baby • An “abnormal” result not always mean that the baby is in trouble. It simply mean that you need special care or test

  23. 感恩

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