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Fetal Surveillance Practice Guideline. Evidence-based Workshop Fetal Surveillance 1-2 December 2005 Assoc.Prof. Pannee Sirivatanapa MFM Unit, Dept. OB-GYN Fac. Med., Chiang Mai University. Existent Fetal Monitor in Various OB-Service. Nothing NST (non-stress test)

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fetal surveillance practice guideline

Fetal SurveillancePractice Guideline

Evidence-based Workshop

Fetal Surveillance

1-2 December 2005

Assoc.Prof. Pannee Sirivatanapa

MFM Unit, Dept. OB-GYN

Fac. Med., Chiang Mai University

existent fetal monitor in various ob service
Existent Fetal Monitor inVarious OB-Service
  • Nothing
  • NST (non-stress test)
  • SP (sound provoke)
  • U/S (ultrasound)
  • NST, SP
  • NST, U/S
  • U/S, SP
  • NST, U/S, SP
fetal surveillance practice guideline1
Fetal Surveillance Practice Guideline

All pregnant women

Risk screening

Low risk

High risk

fetal surveillance practice guideline cont

Fetal movement count (FMC)

start at W28-30

Fetal Surveillance Practice Guideline (cont.)

Routine ANC

Low risk pregnant women

>10 counts in 4 hrs

<10 counts in 4 hrs

More tests as high risk

fetal surveillance practice guideline cont1

FMC c existent fetal monitor

(start at W28-30)

Fetal Surveillance Practice Guideline (cont.)

NST SPU/S NST NST U/S NST

SPU/SSPU/S

SP

High risk pregnant women

sequence of fetal surveillance
Sequence of Fetal Surveillance

Fetal Movement Count

NSTSP Rapid AST

BPP

Modified or Full BPP

+ Doppler

(CST for OB-service having NST only)

sequence of fetal surveillance cont
Sequence of Fetal Surveillance (cont.)

❃NST (non stress test)

- fetal heart beat pattern, fetal movement

❃ AST (acoustic stimulation test)

- NST, sound provoke

❃SP (sound provoke)

- sound stimulation, maternal perception of fetal movement

❃Rapid BPP (rapid biophysical profile)

- sound provoke, ultrasound detection of

fetal movement, amniotic fluid assessment

sequence of fetal surveillance cont1
Sequence of fetal Surveillance (cont.)

✽Modified BPP (modified biophysical profile)

- fetal breathing, body movement, fetal

tone, amniotic fluid assessment

✽Full BPP (full biophysical profile)

- modified BPP, NST

✽ CST (contraction stress test)

- uterine contraction, fetal heart beat pattern

case 1 private clinic
Case 1(Private Clinic)

Age 35 yrs G2P1001 NL-full term 6 yrs

BW 43 kgs Ht 151 cm

Hb 12.0 g%. Hct 36% Bl.gr. B

OFT -ve DCIP -ve

VDRL -ve HIV -ve HBsAg -ve

1st ANC GA 12-13 wks (U/S = 10 wk)

case 1 cont1
Case 1 (cont.)

Risks✵Age 35 yrs

✵BMI = 18.8 (low BMI)

✵Low weight gain

✵IUGR

case 2 community hospital
Case 2(Community Hospital)

Age 23 yrs G2P0101 NL 1,500 gm 5 yrs

BW 83 kgs Ht 159 cm

Hb - Hct 38% Bl.gr 0

OFT -ve DCIP -

VDRL -ve HIV -ve HBsAg -ve

1st ANC GA 25-26 wks

case 2 cont1
Case 2 (cont.)

Risks❃ Hx of low birth weight newborn

❃BMI = 32.8 (obesity)

❃Thalassemic fetus

❃Hypertension

❃Difficult labor

case 3 maharaj
Case 3 (Maharaj)

Age 35 yrs G2P1001 NL–full term 13 yrs

BW 81 kgs Ht 160 cm

Hb 11.5 g% Hct - Bl.gr. AB

OFT +ve HbE -ve

VDRL -ve HIV -ve HBsAg -ve

1st ANC GA 9-10 wks

case 3 cont1
Case 3 (cont.)

Risks❀Age 35 yrs

❀BMI = 31.6 (obesity)

❀Thalassemic fetus

❀Excessive weight gain

❀Difficult labor

case 4 community hospital
Case 4 (community hospital)

Age 16 yrs G1 P 0000

BW 44 kgs Ht 154 cm

Hb - Hct 30 g% Bl.gr AB

OFT -ve HbE -ve

VDRL -ve HIV –ve HBsAg –ve

1st ANC GA 15-16 wks

case 4 cont1
Case 4 (cont.)

Risks♣Age 16 yrs

♣BMI = 18.5 (low BMI)

♣Anemia

♣Low weight gain

♣IUGR

case 5 maharaj
Case 5 (Maharaj)

Age 25 yrs G1 P0000

BW 48 kgs Ht 158 cm

Hb 12.8 g% Hct - Bl.gr. A

OFT -ve Hb E -ve

VDRL -ve HIV -ve HBsAg –ve

1 st ANC GA 12 wks

slide23
Case 5 (cont.)

Risks: no (BMI = 19.2 normal)

case 6 maharaj
Case 6 (Maharaj)

Age 33 yrs G3P1011 NL-full term 8 yrs

BW 50 kgs Ht 152 cm

Hb 12.4 g% Hct - Bl.gr. A

OFT -ve HbE -ve

VDRL -ve HIV -ve HBsAg -ve

1 st ANC GA unknown

case 6 cont1
Case 6 (cont.)

Risks :❃Unknown date

❃BMI = 21.6 (normal)

❃GDM class A2

slide27
ภาวะเสี่ยงต่อการเกิดภาวะแทรกซ้อนในขณะตั้งครรภ์และทารกแรกเกิดภาวะเสี่ยงต่อการเกิดภาวะแทรกซ้อนในขณะตั้งครรภ์และทารกแรกเกิด

☛มีเลือดออกขณะตั้งครรภ์

☛มีประวัติทารกตายคลอด

☛อายุ < 16 ปี หรือ > 40 ปี

☛เคยคลอดลูกน้ำหนัก < 2,500 กรัม หรือ > 4,000 กรัม

☛เคยผ่าตัดที่มดลูก

☛ตั้งครรภ์แฝด

☛มีความดันโลหิตสูง, เบาหวาน, โรคหัวใจ หรือโรคเรื้อรัง

ทางอายุรกรรม

☛ทารกดิ้นน้อยตั้งแต่อายุครรภ์ 30 สัปดาห์

slide28
ภาวะเสี่ยงต่อการมีทารกแรกคลอดน้ำหนักน้อยภาวะเสี่ยงต่อการมีทารกแรกคลอดน้ำหนักน้อย

♣น้ำหนักมารดา < 45 กิโลกรัม

♣ ส่วนสูงมารดา < 145 เซนติเมตร

♣ดัชนีมวลกายมารดา < 18.5

♣ น้ำหนักมารดาเพิ่ม < 10 กิโลกรัม

♣สูบบุหรี่

♣ มีความดันโลหิต

slide29
Case 1 NL ♀ 1,750 g 6 ➙ 10

Case 2 NL ♂ 3,300 g 9 ➙ 10

Case 3 NL ♀ 3,220 g 10 ➙ 10

Case 4 NL ♂ 2,550 g 9 ➙ 10

Case 5 NL ♂ 2,950 g 9 ➙ 10

Case 6 FE ♂ 3,150 g 10 ➙ 10 (Fetal distress)