Fetal Well-Being
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ScribdTranslationsFetal Well-Being
Uploaded by
ScribdTranslationsFetal well-being assessment
Fetus that is receiving adequate
Fetal Well-being supply of oxygen and nutrients
necessary for proper growth and
development.
WELL-BEING ASSESSMENT
FETAL
Set of procedures and techniques,
both clinical and biochemical,
bioelectronic, ultrasound, and environmental
internal, which are used to evaluate the
fetal health during pregnancy and childbirth.
Objectives
• Early diagnosis of patients with
greater risk of fetal death.
• Reduce the morbidity and mortality rate
perinatal.
• Reduce the risk of injuries and sequelae in
the RN.
• Guide the most appropriate behavior for the
obstetric problem solving, avoiding
unnecessary interventions:
• Limit iatrogenic prematurity
• Predicting the childbirth prognosis
risky
Instructions • Ideally, it should be done in all pregnancies.
Uteroplacental insufficiency Fetal disorders
• Threat or history of childbirth • Transfusion between twins
preterm • Rh Isoimmunization
• Prolonged pregnancy • Fetal anomaly
• Chronic or preexisting hypertension • RPM
• Pregnancy-induced hypertension • Oligohydramnios
• Diabetes Mellitus • Polyhydramnios
• RCIU • Decrease in fetal movements
• DPP • Alterations of the FCF by auscultation
• Placenta previa • Congenital infection
• Hemorrhage in the third trimester • Induction or stimulation of labor
Biophysical Tests
• CLINICAL FETAL MONITORING: It is based on the
elaboration of a complete medical history, it
identify risk factors and thus predict
maternal-fetal complications.
PARAMETERS:
• Fetal movements (FM)
• Uterine growth and maternal weight gain
• Fetal heart activity: Baseline fetal heart rate
(FCF) and the transient changes of the FCF.
Fetal movements
• The pregnant women are just starting to
perceive them around 18 weeks
(multigestations) and 22 weeks
(primiparas).
• The daily frequency of MF
increases with gestational age.
• Maximum: 28-34 weeks.
• Decreases progressively.
They indicate the integrity of
anatomical substrate and
Self-monitoring of fetal movements capacity to
produce functions
complex.
• Indications: For its effectiveness, simplicity, and no cost,
should constitute the first evidence to take into account. In
all pregnancies from 28 weeks onward.
• Contraindications: None.
• Technique:
Pregnant woman in left lateral decubitus, hand on the
maternal abdomen.
2. Instruction to the pregnant woman to note the number of
MF in 60 minutes at least two times a day and after
food intake (morning - afternoon).
3. If there are <3MF in an hour, go to emergency
Heart rate
fetal
• It can be determined clinically.
through a Pinard stethoscope and
also by means of Doppler or
ultrasound.
• 120-160 beats per minute
• Variability:minutebyminuteforthe
less than 10 heartbeats.
• Accelerations: Transitory increases of the FCF over the
baseline values during spontaneous fetal movements
or induced, and with the uterine contractions.
Transient Changes Of • Decelerations
The FCF
• These are the modifications that
experience the FCF in relation
with uterine contractions.
• It allows for the evaluation of fetal well-being
and to detect cases early
of placental insufficiency and
fetal suffering.
• ELECTRONIC FETAL MONITORING: The objective of electronic fetal monitoring (EFM),
also known as fetal cardiotocography (CTG), is the identification of those high-risk data
suffer intrauterine damage or death, detecting fetal hypoxia and preventing neonatal asphyxia.
STRESS-FREE TEST STRESSFUL TEST
• Of evaluation of the • In response to the
response from the FCF to the oxytocin, or tolerance
fetal movements. to contractions.
• Evaluate the sufficiency
placental.
Both tests are performed with the help of the cardiotocograph (an electronic device that allows for recording)
simultaneously the FHR, fetal movements (FM) and uterine contractions).
Non-stressful test
• It consists of the electronic monitoring of heart rate.
fetal studying the characteristics, as well as the
modifications that occur with fetal movements and
spontaneous irregular uterine contractions.
• It is the most commonly used, non-invasive, low-cost test and without
contraindications.
Instructions:
According to the WHO, this test should be performed at least twice during
the whole pregnancy; the first at the beginning of the third trimester and the second one
week before the estimated due date.
• Pregnancies over 28 weeks.
• Risk of deficiency in uteroplacental oxygenation and/or blood flow.
• Antecedents of fetal death.
• In every pregnancy with associated pathology.
• Suspicion of cord dystocia.
• Alteration of amniotic fluid.
Interpretation: • Non-stress test Reactive: Active fetus: Indicative of
preserved neurological function and fetal motor activity.
• Non-stress test Non-reactive: Fetus non-reactive, absence
of fetal motor activity, probably due to the influence of
intrinsic and extrinsic factors.
• Non-stress pathology test: Hypoactive fetus. Absence of
fetal motor activity with deterioration in the fetus.
Stressful test
• It is a test to assess fetal well-being that evaluates
the fetal-placental unit through the study of the
fetal heart rate in relation to contractions
uterine.
• Carry out if the gestational age > 36 weeks, if there is
conditions for vaginal delivery.
• BASIC CONDITIONS:
• Fasting time not greater than two hours, prior to
procedure.
• Maternal activity: rest for 20 minutes prior.
• Discard the use of sedatives or depressant drugs.
central nervous system.
COMPLICATIONS
Hypertension, uterine hyperstimulation, acute pulmonary edema and
convulsions.
Instructions: Contraindications:
• Prolonged pregnancy or in the process of
ABSOLUTES
prolongation (> 40 weeks).
• Previous Césarada two or more times or short PIN (less than two)
• Diabetes mellitus.
years).
• Chronic hypertension.
• Multiple pregnancy.
• Pregnancy-induced hypertension.
• Severe polyhydramnios.
• RCIU.
• Third Trimester Hemorrhages.
• Severe maternal anemia.
• Threat of preterm labor without any complications in the
• Maternal heart disease.
pregnancy.
• Background of fetal births
• Presentation dystocia.
dead.
• Severe oligohydramnios.
• Rh immunization ISO.
• Non-pathological stress test.
• Maternal thyroid pathology.
• Non-stressful non-reactive test no more than twice.
• Maternal collagenopathy.
• Stressful test unsatisfactory more than two times.
• Mild to moderate oligohydramnios.
RELATIVES
• RPM from 34 weeks for
• Previous cesarean more than 2 years ago.
know the tolerance to vaginal delivery and dosage
• Pregnancy with gestational age less than 36 weeks.
of oxytocin sensitization, if it
• Fetal macromia.
wants to induce labor.
Interpretation:
• Positive test: Presence of late decelerations and/or severe variables in 50% or more
of recorded uterine contractions.
• Negative test: Absence of late decelerations and significant variables.
• Suspicious: Late intermittent decelerations (in less than 50% of contractions)
or significant variable slowdowns.
• Unsatisfactory: When the pattern of uterine contractions is not achieved (less than
three contractions every 10 minutes) using the maximum allowed oxytocin (30 mU) or
a trace is obtained that cannot be interpreted.
• FETAL BIOPHYSICAL PROFILE: It is a method to determine risk
of fetal intrauterine asphyxia, based on the joint assessment of a
series of fetal biophysical variables. Combines the results of the ultrasound
with the external electronic monitoring.
TEST OF
MANNING
• SCORE: 8-10 (Negative test: normal fetus with low risk of chronic asphyxia), 6-4 (Suspicion of
chronic asphyxia) and 0-2 (Positive test: strong suspicion of chronic asphyxia, fetal danger)
TESTS
BIOMOLECULAR
Estriol: Placental Lactogen:
Reflects the operation • It is synthesized and
of the fetal unit kept in the
placentary. syncytiotrophoblast.
Low levels of estriol are
associates with an increase
• Levels below
of the risk: fetal death and 4μg/ml after the
neurological sequelae. sem 30 denote
fetal commitment.
