Biophysical
Biophysical
pregnancy
pregnancy
monitoring
monitoring
Biophysical
Biophysical
pregnancy
pregnancy
monitoring
monitoring
Biophysical pregnancy
Biophysical pregnancy
monitoring
monitoring
Assessment of fetal heart rate
Assessment of fetal heart rate
Ultrasonography
Ultrasonography
Assessment of fetal heart
Assessment of fetal heart
rate
rate
Auscultation (Pinard stethoscope)
Auscultation (Pinard stethoscope)
Electronic monitoring
Electronic monitoring
(cardiotocography-
(cardiotocography-
CTG)
CTG)
Assessment of fetal heart
Assessment of fetal heart
rate
rate
The Pinard stethoscope has been used in
The Pinard stethoscope has been used in
obstetrics for about 200 years. The
obstetrics for about 200 years. The
examination consists in assessing the
examination consists in assessing the
number of beats of the fetal heart per
number of beats of the fetal heart per
one minute, taking into consideration
one minute, taking into consideration
fetal movements and uterine
fetal movements and uterine
contractions.
contractions.
During labour we auscultate in between
During labour we auscultate in between
contractions for about 30 to 60 seconds.
contractions for about 30 to 60 seconds.
Assessment of fetal heart
Assessment of fetal heart
rate
rate
110-160 bpm
110-160 bpm
physiological fetal
physiological fetal
heart rate
heart rate
< 110 bpm bradycardia
< 110 bpm bradycardia
> 160 bpm tachycardia
> 160 bpm tachycardia
Reasons for bradycardia
Reasons for bradycardia
Acute fetal hypoxemia (umbilical
Acute fetal hypoxemia (umbilical
cord
cord
or head
or head
compression
compression
)
)
Inborn
Inborn
fetal heart disease
fetal heart disease
Medications
Medications
(i.e. benzodiazepine)
(i.e. benzodiazepine)
Reasons for tachycardia
Reasons for tachycardia
Fetal
Fetal
hyperactivity
hyperactivity
Fear and
Fear and
stress of the woman in labour
stress of the woman in labour
( her body releases catecholamines and
( her body releases catecholamines and
stimulates the
stimulates the
sympathetic nervous
sympathetic nervous
system)
system)
Pregnancy
Pregnancy
of below 32 weeks ( the
of below 32 weeks ( the
vagus is not developed
vagus is not developed
)
)
Maternal
Maternal
temperature
temperature
F
F
etal infections
etal infections
Chronic fetal hypoxia
Chronic fetal hypoxia
M
M
edications
edications
(i.e.
(i.e.
fenoterol, atropine
fenoterol, atropine
)
)
Cardiotocography
Cardiotocography
C
C
ardiotocography
ardiotocography
CTG -
CTG -
is a
is a
technical means of recording
technical means of recording
and
and
graphically presenting
graphically presenting
the
the
fetal
fetal
heartbeat, uterine contractions and
heartbeat, uterine contractions and
fetal movements during pregnancy
fetal movements during pregnancy
and labor.
and labor.
CTG examination is performed from
CTG examination is performed from
28th weeks.
28th weeks.
Cardiotocography
Cardiotocography
The basic fetal h
The basic fetal h
e
e
art activity is the average
art activity is the average
number of fetal heart beats per ten minutes.
number of fetal heart beats per ten minutes.
Oscillating fetal heart activity – the
Oscillating fetal heart activity – the
difference in heart beats between the
difference in heart beats between the
lowest and the highest value
lowest and the highest value
(fluctuations in
(fluctuations in
the FHR)
the FHR)
Oscillations
Oscillations
(variability)
(variability)
result from
result from
interactivity between the sympathetic and
interactivity between the sympathetic and
the parasympathetic nervous systems.
the parasympathetic nervous systems.
The types of baseline
The types of baseline
variability
variability
Reassuring
Reassuring
the difference between the highest and the lowest
the difference between the highest and the lowest
value does not exceed 10-25 beats per minute
value does not exceed 10-25 beats per minute
physiological
physiological
Saltatory
Saltatory
t
t
he difference between the highest and lowest
he difference between the highest and lowest
value exceeds
value exceeds
25 beats per minute
25 beats per minute
caused by the stimulation of the sympathetic
caused by the stimulation of the sympathetic
nervous system, a response to acute fetal hypoxia
nervous system, a response to acute fetal hypoxia
The types of baseline
The types of baseline
variability
variability
Narrow
Narrow
the difference between the highest and the
the difference between the highest and the
lowest value does not exceed 10 beats per
lowest value does not exceed 10 beats per
minute
minute
Fetal sleep (cannot last longer than 40 min),
Fetal sleep (cannot last longer than 40 min),
medications given to the mother
medications given to the mother
(
(
e.g.
e.g.
tranquilizers
tranquilizers
)
)
, severe fetal hypoxia
, severe fetal hypoxia
Absent
Absent
the difference between the highest and the
the difference between the highest and the
lowest value does not exceed 5 beats per minute
lowest value does not exceed 5 beats per minute
;
;
the graph is a flat line
the graph is a flat line
Reassuring (C) and
Reassuring (C) and
saltatory (D) variability
saltatory (D) variability
Absent (A) and zawężona
Absent (A) and zawężona
(B) varability
(B) varability
Accelerations
Accelerations
Acceleration
Acceleration
of the heart beat of up
of the heart beat of up
to 15 beats per minute or more
to 15 beats per minute or more
lasting
lasting
15 seconds or longer
15 seconds or longer
Fetal heart rate accelerates in
Fetal heart rate accelerates in
response to uterine contractions and
response to uterine contractions and
fetal movements
fetal movements
Decelerations
Decelerations
D
D
ecelerations of fetal heart rate of at
ecelerations of fetal heart rate of at
least 15 beats per minute
least 15 beats per minute
lasting at
lasting at
least 10 seconds
least 10 seconds
The types of
The types of
decelerations
decelerations
Early
Early
Late
Late
Variable
Variable
Early Decelerations
Early Decelerations
The
The
onset of deceleration occurs at the
onset of deceleration occurs at the
beginning of a uterine contraction
beginning of a uterine contraction
The
The
lowest value occurs and the contraction
lowest value occurs and the contraction
peak
peak
R
R
eturn to the original value occurs at the end
eturn to the original value occurs at the end
of the uterine contraction
of the uterine contraction
Can
Can
be caused by the fetal head being
be caused by the fetal head being
compressed in the birth canal
compressed in the birth canal
,
,
a result of the
a result of the
vagus being stimulated (Gauss syndrome)
vagus being stimulated (Gauss syndrome)
Early Decelerations
Early Decelerations
Late Decelerations
Late Decelerations
S
S
tart 10 to 30 seconds after the
tart 10 to 30 seconds after the
beginning of a uterine contraction
beginning of a uterine contraction
Very
Very
dangerous
dangerous
:
:
Placenta mulfunction
Placenta mulfunction
reasons can be: diabetes, pregnancy
reasons can be: diabetes, pregnancy
induced
induced
hypertension, kidney diseases
hypertension, kidney diseases
Late Decelerations
Late Decelerations
Variable Deceleration
Variable Deceleration
s
s
S
S
tart in different phases of uterine
tart in different phases of uterine
contractions
contractions
Irregular
Irregular
in shape
in shape
Caused by
Caused by
umbilical cord
umbilical cord
compression
compression
Variable Deceleration
Variable Deceleration
s
s
CTG tests
CTG tests
Nonstress test
Nonstress test
NST
NST
O
O
xytocin challenge test
xytocin challenge test
OCT
OCT
NST
NST
A
A
30-minute CTG record and record of fetal
30-minute CTG record and record of fetal
movements
movements
Reactive
Reactive
two or more accelerations related to the fetal movement
two or more accelerations related to the fetal movement
informs us of the fetus well-being in the
informs us of the fetus well-being in the
next
next
seven days
seven days
Nonreactive:
Nonreactive:
no accelerations
no accelerations
we then perform the OCT
we then perform the OCT
decelerations, tachycardia or bradycardia
decelerations, tachycardia or bradycardia
Caesarean section
Caesarean section
OCT
OCT
Consists
Consists
of
of
administering an adequate dose
administering an adequate dose
of oxytocin in order to induce uterine
of oxytocin in order to induce uterine
contractions
contractions
5 units of oxytocin in 250ml
5 units of oxytocin in 250ml
0.9% NaCl.
0.9% NaCl.
The oxytocin test allows us to assess the
The oxytocin test allows us to assess the
reaction of the fetal heart rate to uterine
reaction of the fetal heart rate to uterine
contractions
contractions
It is a very good prediction tool
It is a very good prediction tool
that
that
helps
helps
diagnose threats to the fetus
diagnose threats to the fetus
OCT
OCT
Negative
Negative
no decelerations during uterine contractions
no decelerations during uterine contractions
present accelerations
present accelerations
present fetal movement
present fetal movement
tells us about the well-being of the fetus
tells us about the well-being of the fetus
Positive
Positive
current late decelerations in more than 50% of
current late decelerations in more than 50% of
contractions
contractions
fetus life threatening situation
fetus life threatening situation
(
(
fetal hypoxia
fetal hypoxia
)
)
immediate Caesarean section
immediate Caesarean section
OCT
OCT
Doubtful
Doubtful
Decelerations in less
Decelerations in less
than 50% of
than 50% of
contractions
contractions
Unsuccessful
Unsuccessful
No uterine contractions
No uterine contractions
Maning test
Maning test
A
A
30-minute ultrasound monitoring
30-minute ultrasound monitoring
of:
of:
fetal movement
fetal movement
breathing movement
breathing movement
muscle tension
muscle tension
amniotic fluid
amniotic fluid