antepartum fetal surveillance willians ch.15. antepartum fetal surveillance to test fetal...
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Antepartum Fetal SurveillanceWillians Ch.15
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Antepartum Fetal SurveillanceTo test fetal well-beingFetal physical activitiesMovementBreathingAmniotic fluid productionHeart rateGoal: to prevent fetal death
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Fetal MovementsPassive unstimulated fetal activity: 7 wks20~30 wks: rest-activity cycles: 75%20~75
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Perception of 10 fetal movements in up to 2 hours is considered normal
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Fetal Heart Rate
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Non-Stress TestFetal heart rate accelerationsNormal nonstress tests20, 1515
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2021515
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Worse PrognosisAbsent acceleration up to 80 minsRepetitive decelerations > 3 / 20 minsDeceleration lasting > 1 min
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Contraction Stress TestOxytocin challenge test3 spontaneous contractions of 40 sec present in 10 minsNegative: no late or significant variable decelerationsPositive: late decelerations following 50% or more of contractions
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Biophysical ProfileBPP
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Score 2Score 0Nonstress test2021515 Fetal breathing>1 episode of rhythmic breathing > 30 sec in 30 minsFetal movement> 3 body or limb movement in 30 minsFetal tone>1 () in 30 minsAmniotic fluid volumeSingle vertical pocket > 2 cm
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Score10Keep follow up8,normal fluid6~8Deliver if > 37 weeks4Deliver if repeat < 6 0~2Deliver
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Fetal Death After Normal BPPFetomaternal hemorrhageUmbilical cord accidentsPlacental abruption
Incidence: 1/1000
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Amniotic Fluid Volume
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PathophysiologyDecreased uteroplacental perfusionDiminished fetal renal flowDecreased urine productionOligohydramnios
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Poor PrognosisSingle vertical pocket < 2 cmAmniotic fluid index ( vertical pocket) < 5 cm
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Umbilical Artery Doppler Velocity
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Umbilical Artery DopplerS/D ratio: most commonly used indexEnd diastolic flow prognosisPerinatal mortalityAbsent end-diastolic flow: 10%Reversed end-diastolic flow: 33%
SD
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40 (A) (B) (C) (D)
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Pregnancy 31 weeks with preterm labor, SGA was noted in series OBS sonoKeep tocolysis and observation
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Pregnancy 37 weeks with preeclampsia (BP 146/84, urine protein +)MBD with OPD follow up
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Pregnancy 24+6 weeks with SLE, hyperthyroidism, hypertension, and preterm laborC/S on 2009/05/08, BW 635gm, Apgar: 2-3
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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
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Antepartum Fetal SurveillanceTelling more about the well-being of the babyAn abnormal result not always mean that the baby is in trouble. It simply mean that you need special care or test