1
Q
Another Name of Fetal Evaluation
A
Fetal Survaillence
2
Q
Methods of Fetal Evaluation
A
A) Determination of fetal age.
B) Determination of fetal maturity.
C) Evaluation of fetal wellbeing.
D) Prenatal diagnosis of congenital anomalies.
3
Q
Duration of Normal Pregnancy
A
4
Q
Determination of GA
- Methods
A
- Hx
- Ex
- INVx
5
Q
Determination of GA
- By Hx
A
6
Q
Determination of GA by Hx
- Menstruation-delivery interval (Naegele’s rule)
A
7
Q
Menstruation-delivery interval (Naegele’s rule)
- Method
A
Commonest Method
- EDD date of 1st day of LNMP+7 days +9 months.
8
Q
Menstruation-delivery interval (Naegele’s rule)
- Characters of LMNP
A
a) Should be of normal characters.
b) Should be preceded by 3 consecutive normal cycles.
c) Shouldn’t be preceded by use of hormonal contraception.
9
Q
Menstruation-delivery interval (Naegele’s rule)
- Causes of Falacies
A
a) Maternal forgetting Recent use of COCs.
b) Bleeding in early pregnancy.
c) Irregular menstruation or prepregnancy amenorrhea.
10
Q
Determination of GA by Hx
- Ovulation-delivery interval
A
EDD = date of ovulation day - 7 days + 9 months.
11
Q
Determination of GA by Hx
- Coital-delivery interval (date of single coitus)
A
EDD = date of single coitus (as in rape) 7 days + 9 months.
12
Q
Determination of GA by Hx
- Date of embryo transfer (ET)
A
EDD = date of ET (in ARTs) 7 days + 9 months.
13
Q
Determination of GA by Hx
- Date of quickening
A
18-20 weeks in primigravida & 16-18 weeks in multipara.
14
Q
Determination of GA by Hx
- Date of 1st +ve pregnancy test
A
Most kits allow urine diagnosis of pregnancy at 4th or 5th weeks after LMP.
15
Q
Determination of GA by Ex
A
16
Q
Determination of GA by Ex
- Fundal Level
A
17
Q
Determination of GA by Ex
- Symphysis-fundus height (gravidogram)
A
18
Q
Determination of GA by Ex
- McDonald’s formula
A
19
Q
Determination of GA by Ex
- Fetal weight (Johnson formula)
A
- Fetal weight (in gm) = [fundal height (in cm) - n] x 155.
▪ n = 12 if head isn’t engaged & 11 if head is engaged
20
Q
Determination of GA by Ex
- Measurement of abdominal girth
A
Using certain tables.
21
Q
Determination of GA by Ex
- Ballotment
A
Internal ballottement at 16 weeks & external ballottement at 20 weeks.
22
Q
Determination of GA by Ex
- Auscultation of FHS
A
- By Doptone at 10 weeks
- By Pinard’s stethoscope at 20 weeks.
23
Q
Determination of GA by INVx
A
24
Q
Determination of GA by US
- Intro
A
- Fetal body measurements (fetal biometry) reflect GA & there are curves corresponding to development of each of these measurements throughout pregnancy (fetal growth curves).
25
**Determination of GA** by US
- Common Measurments
26
**Determination of GA** by US
- GS
At 4 weeks by TVS & 6 weeks by TAS
27
**Determination of GA** by US
- CRL
At 5 weeks by TVS & 7 weeks by TAS
28
**Determination of GA** by US
- BPD
- At 13 weeks
- it ↑↑from 2.4 cm at 13 weeks to 9.5 cm at term
is more accurate at 20-30 weeks
29
**Determination of GA** by US
- FL
- At 14 weeks
- it ↑↑ from 1.5 cm at 14 weeks to 7.8 cm at term
- is more accurate than BPD after 30 weeks
30
**Determination of GA** by US
- AC
- More accurate than BPD after 30 weeks
- it is the single most important measurement to
make in late pregnancy
- (it reflects fetal size & weight rather than age)
31
**Determination of GA** by US
- HC
...
32
**Determination of GA** by US
- EFW
- Using > 2 parameters in published formulas.
- True weight is 15-20% above estimated weight.
33
Measurements used in early pregnancy (up to 12-13 w)
GS diameter & CRL
34
Measurements used during 2nd & 3d trimesters
BPD, FL, AC, HC & EFW
35
Accurate GA è uncertain LNMP can be obtained from
a) 1 CRL measurement early in 1st trimester.
b) 2 measurements () 16 & 24 weeks showing linear growth.
36
Accuracy of ultrasound dating of pregnancy is as follows
a) In 1st trimester: CRL is accurate èin 3-5 days from menstrual dating.
b) In 2d trimester: Measurements are èin 2 weeks from menstrual dating.
c) In 3rd trimester: Measurements are èin 3 weeks from menstrual dating.
37
Causes of **Oversized Uterus**
38
Causes of Causes of **Undersized Uterus**
39
**Determination of Fetal Maturity**
- Importance
A) Before elective TOP to determine fetal prognosis.
B) For performing & standardization of all fetal wellbeing tests.
40
**Determination of Fetal Maturity**
- Methods
41
**Determination of Fetal Maturity** by Hx & Ex
For determination of fetal age (see above).
42
**Determination of Fetal Maturity** by INVx
- US
- X-Ray
- Amniotic Fluid
43
**Determination of Fetal Maturity** by INVx
- US
BPD, FL, AC & EFW.
44
**Determination of Fetal Maturity** by INVx
- X-Ray
Appearance of ossific centers.
45
**Determination of Fetal Maturity** by INVx
- AF
46
**Determination of Fetal Maturity** by AF
47
**Determination of Fetal Maturity** by AF
- Fetal Lung Maturity
48
**Determination of Fetal Maturity** by AF
- Fetal Kidney Maturity
AF creatinine level (levels ≥ 2 mg/dl indicate maturity)
49
**Determination of Fetal Maturity** by AF
- Fetal Liver Maturity
AF bilirubin level.
50
**Determination of Fetal Maturity** by AF
- Fetal Skin Maturity
Detection of fat cells after staining by Nile blue sulfate.
51
Types of **Evaluation of Fetal Wellbeing (Fetal Wellbeing Tests)**
- Antepartum
- Intrapartum
52
Def of **Antepartum Evaluation of Fteal Wellbeing**
Assessment of in utero fetal condition during pregnancy.
53
Time of **Antepartum Evaluation of Fteal Wellbeing**
Started usually at 30 weeks.
54
Methods of **Antepartum Evaluation of Fetal Wellbeing**
55
Methods of **Antepartum Evaluation of Fetal Wellbeing**
- ClinicalMethods of **Antepartum Evaluation of Fetal Wellbeing**
- Biophysical
56
Methods of **Antepartum Evaluation of Fetal Wellbeing**
- Biochemical
57
Methods of **Antepartum Evaluation of Fetal Wellbeing**
- Clinical (Detailed)
58
Methods of **Antepartum Evaluation of Fetal Wellbeing**
- Daily fetal movement count (DFMC):
59
Methods of **Antepartum Evaluation of Fetal Wellbeing**
- Antepartum FHR monitoring
By using external Doppler machine applied on mother's abdomen.
60
Features of FHR tracing
- Baseline Rate
- Variability
- Periodic Changes
61
Normal **Baseline rate of FHR**
120-160 bpm
62
Abnormal **Baseline rate of FHR**
63
Abnormal **Baseline rate of FHR**
- tachycardia
64
Abnormal **Baseline rate of FHR**
- Bradycardia
65
Importance of **Variability of FHR**
Most clinically significant indicator of fetal status & it is regulated by fetal autonomic nervous system.
66
Types of **Variability of FHR**
- Short term variability (beat to beat variability)
- Long term variability (baseline variability)
67
Types of **Variability of FHR**
- Short term variability Long term variability (beat to beat variability)
Instantaneous change (of 2-3 beats) in FHR from one beat to next beat
68
Types of **Variability of FHR**
- Long term variability (baseline variability)
Oscillation of baseline tracing è amplitude of 5-25 bpm & frequency of 3-5 oscillations/min
69
Types of **Variability of FHR**
- Causes of decreased or lost variability
70
**Periodic Changes of FHR**
- Acceleration
- Decceleration
71
**Periodic Changes of FHR**
- Def of Acceleration
- Transient episodes of ↑↑ FHR è amplitude of ≥ 15 bpm & duration of ≥ 15 seconds.
72
**Periodic Changes of FHR**
- Causes of Acceleration
Fetal movement, uterine contractions or partial cord compression.
73
**Periodic Changes of FHR**
- Def of Deceleration
- Transient episodes of↓↓ FHR è amplitude of ≥ 15 bpm & duration of ≥ 15 seconds.
74
**Periodic Changes of FHR**
- Types of Deceleration
75
**Types & Causes of Deceleration**
- Early Deceleration
76
**Types & Causes of Deceleration**
- Late Deceleration
77
**Types & Causes of Deceleration**
- variable deceleration
78
**Types & Causes of Deceleration**
- Prolonged Deceleration
79
**Antepartum Fetal Evaluation**
- Doppler US
80
**Antepartum Fetal Evaluation** by Doppler US
- Method
abdominally or transvaginally
81
**Antepartum Fetal Evaluation** by Doppler US
- Importance
- It demonstrates direction & characteristics of blood flow:
▪ So, it helps in assessment of placental blood flow through measuring Doppler indices in umbilical or uterine arteries.
82
**Antepartum Fetal Evaluation** by Doppler US
- Most Important Index
Most important Doppler index is:
▪ S/D ratio (systolic/ diastolic velocity ratio).
83
**Antepartum Fetal Evaluation** by Doppler US
- First Abnormality to appear
Umbilical artery Doppler abnormalities are 1st to appear:
▪ So, it is logic to use Doppler as the main screening tool
84
**Antepartum Fetal Evaluation** by Doppler US
- Results in defective placental flow (as in PIH)
In defective placental flow (as in PIH):
▪ There is ↑↑umbilical artery S/D ratio (normally = 3 at 30 weeks) & in severe cases, there is absent or reversed diastolic flow
85
**Antepartum Fetal Evaluation**
- Amnioscopy
Visualization of amniotic cavity through intact membranes when cervix is sufficiently dilated to diagnose meconium stained liquor.
86
**Antepartum Fetal Evaluation**
- NST & CST
87
Most commonly used test for fetal wellbeing
NST
88
Another name of CST
Named also oxytocin challenge test (OCT)
89
Def of **NST & CST**
90
Principle of **NST & CST**
91
Indications of **NST & CST**
92
Time of **NST & CST**
93
Technique of **NST & CST**
94
Interpretation of **NST & CST**
95
Frequency of **NST & CST**
96
Advantages of **NST & CST**
97
Disadvantages of **NST & CST**
98
Vibroacoustic stimulation test (VAST)
By using about 80 db sound probe as an
alternative to fetal movements in NST (at this
db, it isn't a stress test).
99
CI of **CST**
→ Previous uterine scar (as previous CS).
→ Placenta previa.
→ PROM.
→ Multifetal pregnancy
→ Threatened preterm labor
→ history of preterm labor.
100
**Antepartum fetal Evaluation**
- Biophysical profile (BPP)
101
**Antepartum fetal Evaluation** by BPP
102
**Antepartum fetal Evaluation** by BPP
- Def
- Scoring system for certain fetal biophysical activities that help in assessment of in utero fetal condition.
103
**Antepartum fetal Evaluation** by BPP
- Time
Usually started at 32-34 weeks.
104
**Antepartum fetal Evaluation** by BPP
- Technique
105
**Antepartum fetal Evaluation** by BPP
- Interpretation
106
**Antepartum fetal Evaluation** by BPP
- Advantages
a) Non invasive
b) safe
c) easy to perform.
d) Can be used for assessment of wellbeing of twins.
e) Low false -ve results.
107
**Antepartum fetal Evaluation** by BPP
- Disadvantages
108
**Antepartum fetal Evaluation** by BPP
- Modified Additions
109
**Antepartum fetal Evaluation**
- Biochemical Assessment
110
Def of **Intrapartum Evaluation of Fetal Wellbeing**
Assessment of in utero fetal condition during labor.
111
Time of **Intrapartum Evaluation of Fetal Wellbeing**
Started whenever labor starts.
112
Methods of **Intrapartum Evaluation of Fetal Wellbeing**
- Clinical
- Biophysical
- Biochemical
113
Methods of **Intrapartum Evaluation of Fetal Wellbeing**
- Clinical
1) Partogram.
2) Examination of AF.
114
Methods of **Intrapartum Evaluation of Fetal Wellbeing**
- Biophysical
115
**Intrapartum Evaluation of Fetal Wellbeing** by Biophysical Tests
- Intermittent FHR monitoring
116
**Intrapartum Evaluation of Fetal Wellbeing** by Biophysical Tests
- Continuous electronic FHR monitoring
117
**Intrapartum Evaluation of Fetal Wellbeing**
- Biochemical Tests
FFF
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