Ob1 Lec - Intrapart Asses

  • November 2019
  • PDF

This document was uploaded by user and they confirmed that they have the permission to share it. If you are author or own the copyright of this book, please report to us by using this DMCA report form. Report DMCA


Overview

Download & View Ob1 Lec - Intrapart Asses as PDF for free.

More details

  • Words: 590
  • Pages: 2
OBSTETRICS I – Intrapartum Assessment (Lecture by Dra Coloma) USTMED ’07 Sec C - AsM CONDUCT OF LABOR AND DELIVERY Monitoring • Maternal o Vital signs, uterine contractions, general condition • Fetal o FHR • Progress of labor o dilatation and descent Monitoring the fetus • Clinical o Auscultation of fetal heart tones o Character of the amniotic fluid • Electronic FHR monitoring = cardiotocograph ( CTG)



o Parasympathetic Chemo- and baro-receptors

ADVANCING GESTATION, • Parasympathetic dominance (vagus nerve) • Decreasing rate • Increasing variability BASELINE RATE • Approximate mean rate rounded to increments of 5 bpm during a 10-minute segment, minimum interpretable duration of 2 min • Normal: 110-150 bpm

• •

Bradycardia : < 110 bpm, for at least 3 min. o moderate 80-100 o severe less than 80 Tachycardia: > 160 bpm o mild 161-180 bpm o severe > 180 bpm

!!!LOOK OUT FOR FETAL DISTRESS!!! AMNIOTIC FLUID Fetal hypoxia

Pituitary release of arginine vasopressin Increased intestinal peristalsis Passage of meconium

Auscultation • Stethoscope or Doppler devices • The maternal pulse must be counted as the FHR is counted.



The fetal heart must be auscultated IMMEDIATELY AFTER A CONTRACTION.

** Changes in the fetal heart rate that are most likely to be ominous almost always are detectable immediately after a uterine contraction. Suspect compromise if: • FHT repeatedly below 110 bpm, even though there is recovery to 110-160 bpm • Further labor if allowed should be should be monitored electronically Recommendations In the absence of any abnormalities • First stage – every 30 min • Second stage – every 15 minutes High-risk pregnancies • First stage – every 15 minutes • Second stage – every 5 minutes Electronic FHR monitoring ADMISSION TEST (baseline trace) • Normal: o intermittent auscultation, o trace every 2 hrs • Abnormal trace or high-risk case: o continuous trace Reading EFM trace • Baseline heart rate • Baseline variability • Accelerations • Decelerations FHR regulation • Central nervous system • Autonomic nervous system o Sympathetic

BASELINE VARIABILITY • Oscillations at the baseline (jiggliness) • Figure 14-10. Edwards text Grades of baseline variability • Absent variability • Minimal (poor) +/< 5 bpm • Moderate = NORMAL 6-25 bpm • Marked > 25 bpm Periodic patterns • ACCELERATION o Visually abrupt increase above baseline o Intact neurohormonal cardiovascular control mechanisms o Favorable sign of fetal well-being •

DECELERATION

o o o

Early – head compression Late – placental insufficiency Variable – cord compression

INTERPRETATION FIGO classification • Normal • Suspicious • Abnormal NICHD • Reassuring = FIGO normal • Non-reassuring = FIGO suspicious • Ominous = FIGO abnormal NORMAL TRACE or REASSURING PATTERN • Baseline rate 110-160 bpm • Baseline variability 6-25 bpm • Accelerations present • Decelerations absent SUSPICIOUS • Absence of accelerations and any one of the following: 1. abnormal baseline rate < 110bpm or > 150 bpm 2. reduced baseline variability < 10bpm for >40mins 3. variable decelerations without ominous features Abnormal

• •

• • • •

Baseline < 100bpm or >170bpm Baseline variability <5 bpm for >40 mins Severe variable decelerations Severe repetitive early decelerations Prolonged decelerations Late decelerations

• Sinusoid pattern SEVERELY ABNORMAL CTG PATTERNS • Poor to absent variability • Persistent late or variable decelerations • Prolonged bradycardia

Management approach to non-reassuring FHR pattern Intrauterine Resuscitation • Administer oxygen to mother • Reposition patient • Discontinue uterine stimulamnts • Hydrate patient • Vaginal examination • Alert anesthesia, nursing and neonatal care staff • Possible abdominal delivery Intrapartum Assessment • Electronic monitor trace • Clinical context [email protected]

Related Documents

Ob1 Lec - Intrapart Asses
November 2019 7
Ob1 Lec - Ultrasound
November 2019 8
Ob1 Lec - Noninvasiv
November 2019 11
Ob1 Lec - Analgesia
November 2019 20
Ob1
November 2019 7