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