Please enable JavaScript.
Coggle requires JavaScript to display documents.
Antenatal foetal surveillance (Stages (Assigning risk Finding normal…
Antenatal foetal
surveillance
Definition
Surveillance of foetus
in the antenatal period
to detect and treat medical
problems as they arise
Stages
Assigning risk
Finding normal babies developing in an abnormal situation
Risk assigned per maternal health and previous pregnancy outcomes
Timing delivery
Preterm babies should be delivered only if they show signs of distress (allows max maturity before birth)
High risk babies should be delivered after 36wk
Epidemiology
1/100 stillborn
1/3 stillbirths are IUGR
Identification of
high risk foetus
Imaging
USS
Measure size (HC, AC, FL) and liquor
Plotted against gestational age for growth
Doppler
Pathophysiology
Normally flow through UA not impeded by end-organ resistance so continues to flow away from the heart during diastole; as the placenta fails there is increased vascular resistance and reduced forward flow in diastole, may even get reversed flow
Types
UA: high resistance/pulsatility indicates placental failure
MCA: low resist/pulsatility indicates head sparing
Ductus venous: surrogate for cardiac function, TTTS
Indication
Assessment of blood circulation in baby, uterus and placenta
in known risk pregnancy e.g. maternal pre-eclampsia
Cardiotogography
Pathophysiology
Baseline FHR is 110-160bpm, varies 5-25bpm
Accelerations: reactive if 2/20min (FHR inc by >15bpm for 15s)
Decelerations should not occur (slowing from baseline)
Abnormal result due to failed autonomic regulation of the heart (occurs end stage, so no use in antenatal screening as foetus wouldnt be able to survive outside the body anyway)
Indication
Acute conditions known to cause foetal compromise
Surveillance of chronic conditions associated with poor outcome
Bedside
Symphysis-fundal height
Observe changes in growth over time e.g. IUGR
Using customised charts can improve prediction
USS if abnormal
Foetal movement
Low +ve predictive value of maternal perception
Ausculation foetal heart
Confirms foetus is alive only
Doppler or Pinard