Monitoring
Objectives of Evaluation
• Location • Morphology
• Viability • Biophysical profile
• Number • Adaptation to stress
• Biometry(size, • Lung Maturity
growth) • Prediction of hypoxic-
acidotic insults
• Placental exam
• Amniotic fluid
volume assessment
Tools of Evaluation
1. History.
2. Physical Exam.
3. Pregnancy test.
4. Ultrasound.
5. Doppler: Auscultation; Blood flow studies.
6. Biochemical screening tests.
Tools of Evaluation
• Amenorrhea
• Pain & bleeding in first trimester
• Pregnancy symptoms
• Significant past obstetrical and general history
• Fetal movement first felt at 16-20 weeks “Quickening”.
– Fetal sleep cycle.
• Pain, bleeding, leaking in 2nd and 3rd trimester.
Physical exam
5 weeks 6 weeks
Interauterine Sac HCG > 1200 HCG > 5000
IU/L IU/L
Normal Flow
A. Contraction stress test (CST)
B. Non-Stress Test
Contraction stress test (CST)
CN S
S y m p a t h e t ic P a r a s y m p a t h e t ic
F H R A lt e r a t io n s
Methods of Intrapartum Monitoring
Oxygen Saturation Scalp pH or Lactic Umbilical Blood
Acid Gases
H y p o x ia
Biophysical C N S
Vibroacoustic
Profile S y m p a t h e t ic P a r a s y m p a t h e t ic
Stimulation
F H R A lt e r a t io n s
Fetal ECG
Monitoring of FHR &
Monitoring
Uterine Contractions
(Cardiotocography)
Intermittent
Auscultation Amnioinfusion
Monitoring of FHR & Uterine Contractions
(Cardio-toco-graphy)
Patterns of The FHR
• Normal Pattern
• Baseline Tachycardia/Bradycardia
• Reduced Variability
• Early Decelerations
• Late Decelerations
• Variable Decelerations
• Other Patterns e.g Sinusoidal
FHR Accelerations
compression.
unnecessary interventions.
determination.
7. Search for the cause
– Late decelerations: excessive uterine contractions,
maternal hypotension, or maternal hypoxemia.