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

Levels checked in maternal urine or plasma

Amniocentesis
Amniotic fluid is withdrawn via ultrasoundguided needle aspirations High yield with low occurrence of risk
Puncture of fetus, umbilical cord or placenta Infection Spontaneous abortion

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

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

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

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

FHR monitored during uterine contractions Normal rate is 120-160
Fetal response to hypoxia is bradycardia!

External (Doppler) FHR Monitoring

Internal FHR Monitoring

Early Decelerations

Due to increased ICP causing vagal stimulation Usually benign

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 beta2 stimulants to relax uterine contractions

Variable Decelerations

Most commonly seen Caused by compression of umbilical cord Mothers position is changed

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

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
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

Time to earn your money!