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Fetal Monitoring. RC 290. Estriol. By-product of estrogen found in maternal urine Production requires functional placenta and fetal adrenal cortex Levels increase as pregnancy progresses Low or absent levels may indicate fetal demise or anencephaly

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estriol
Estriol
  • By-product of estrogen found in maternal urine
    • Production requires functional placenta and fetal adrenal cortex
  • Levels increase as pregnancy progresses
    • Low or absent levels may indicate fetal demise or anencephaly
  • Levels checked in maternal urine or plasma
amniocentesis
Amniocentesis
  • Amniotic fluid is withdrawn via ultrasound-guided needle aspirations
  • High yield with low occurrence of risk
    • Puncture of fetus, umbilical cord or placenta
    • Infection
    • Spontaneous abortion
amniocentesis findings
Amniocentesis Findings
  • Bilirubin levels – presence of RH disease
  • Creatinine levels – normally increase as gestation progresses
    • Shows maturation of fetal kidney
  • Cellular exam – identify genetic and chromosomal abnormalities
amniocentesis cont
Amniocentesis (cont.)

Presence of meconium

  • Usually seen in term or post-term babies
  • Indicates episode(s) of intrauterine stress, eg, hypoxia or asphyxia
  • Fetus may aspirate which will cause respiratory distress after delivery
amniocentesis cont6
Amniocentesis (cont.)
  • L/S ratio: compares amount of lecithin to sphingomyelin in amniotic fluid
  • Assesses maturity of fetal lungs and surfactant
  • An L/S ratio of 2:1 shows fetal lung and surfactant maturity
    • Normally occurs at 35 weeks gestation
shake test
Shake Test
  • Various mixtures of amniotic fluid, ETOH and saline are shaken so that a bubbly froth forms
  • Test evaluates the ability of lecithin to create a stable foam in the presence of ETOH
    • Is simpler and less costly than L/S ratio
surfactant maturation

Surfactant Maturation

Normally occurs at 35 weeks when L/S ratio hits 2:1

any chronic low grade stress will accelerate surfactant maturation

Any chronic, low grade stress will accelerate surfactant maturation

L/S ratio hits 2:1 before 35 weeks

accelerated surfactant maturation
Smoking

Maternal respiratory problems

Maternal diabetes (usually type I)

Maternal anemia

Maternal hypertension

Maternal infection

Maternal narcotic use

Maternal malnutrition

PROM – Premature Rupture of the Membrane

Also makes infant prone to hypothermia and infection

Placental problems

Placenta Praevia

Placenta Abruptio

Accelerated Surfactant Maturation
delayed surfactant maturation
Delayed Surfactant Maturation

L/S Ratio 2:1 AFTER 35 weeks

  • Type II diabetes
  • Fetal RH disease
  • Chronic glomerulonephritis
  • Acute, severe hypoxia, hypoglycemia, or hypothermia
slide12
DMS
  • Ultrasound used to assess fetal growth and maturity
    • Sometimes determines gender of fetus!
  • Non-invasive so should not harm mother or fetus
fetal heart rate monitoring
Fetal Heart Rate Monitoring
  • FHR monitored during uterine contractions
  • Normal rate is 120-160
    • Fetal response to hypoxia is bradycardia!
early decelerations
Early Decelerations
  • Due to increased ICP causing vagal stimulation
  • Usually benign
late decelerations
Late Decelerations
  • Bad sign! Indicates uteroplacental insufficiency
    • Fetus is becoming hypoxic due to decreased maternal blood flow to IV spaces during contractions
  • Mother is given O2, fluids (if she is hypotensive) and beta-2 stimulants to relax uterine contractions
variable decelerations
Variable Decelerations
  • Most commonly seen
  • Caused by compression of umbilical cord
  • Mother’s position is changed
high risk delivery and fetal rescue if
High Risk Delivery and Fetal Rescue if:
  • Late decelerations
  • Variable decelerations where heart rate drops to 60 or less and stays there for one minute or longer
  • Will require C-section and resuscitation
contraction stress test
Contraction Stress Test
  • Pre-labor test to check for UPI
  • Oxytocin (Pitocin) administered to stimulate contractions
  • Positive test if two episodes of late decelerations are seen within ten minutes
  • Positive test indicates impending fetal asphyxia when labor starts!
fetal scalp ph
Fetal Scalp pH
  • If scalp pH is less than 7.20 on two consecutive samples, then fetus is hypoxic
    • Used in conjunction with FHR
  • Falsely low if mother has low pH
    • May be caused by inadequate fluids or
    • Prolonged labor with muscle fatigue