FOETAL MONITORING

Nikita Lohia Sayali Petkar

Aditya Bhosale Sreeshanth Pillai
1 September 15, 2008
INTRODUCTION
HISTORY OF FOETAL
MONITORING
Pinards Stethoscope
Advent of
Cardiotocography in 1970
Invention of Novel
Techniques

2 September 15, 2008
DEFINITION
Foetal monitoring is defined as monitoring the foetal
growth, well being & babys heart rate for indicators of
stress, usually during intrauterine phase & labour.
The aim of foetal monitoring is to make it possible to
identify & quantify the risk of foetal injury, & if necessary
to operate in time. The idea is to carry out operative
procedures only when necessary & not merely for safety
sake.
3 September 15, 2008
NEED FOR FOETAL MONITORING!
Foetus is mechanically shielded & hence only
limited information can be obtained directly
To monitor foetal growth
To detect foetal abnormalities
To check foetal conditions like hypoxia,
tachycardia, bradychardia
To monitor foetal heart rate & hear heart sounds
during intrauterine phase & labour.
4 September 15, 2008
HOW LONG SHOULD WE MONITOR
FOR?
28 Weeks Gestation Period
Active Sleep
Quiet Sleep
5 September 15, 2008
FOETAL GROWTH
FIRST TRIMESTER
(0 14 WEEKS)

Most Crucial
Rapid Rate of Growth
Length :- 3.4 inches
Weight :- 43 grams
Development of
Limbs & Vital Organs
6 September 15, 2008
FIRST MONTH SECOND MONTH THIRD MONTH
7 September 15, 2008
SECOND TRIMESTER
(15 28 WEEKS)
Organs like Heart &
Kidney Continue to form
Eyebrows & fingernails
form
Skin Covered with Fine
Hair
Length :- 11 14 inches
Weight :- 2 2.5 pounds
Periods of Active & Quiet
Sleep
8 September 15, 2008
FOURTH MONTH
FIFTH MONTH SIXTH MONTH
9 September 15, 2008
THIRD TRIMESTER
(29 40 WEEKS)
Finishing Touches Added
Building Fat Stores &
Muscle Mass
Growing Hair
Length :- 20 inches
Weight :- 7 pounds
10 September 15, 2008
SEVENTH MONTH EIGHTH MONTH
11 September 15, 2008
NINTH MONTH
Modes of Foetal Monitoring
Modes of Foetal Monitoring
Modes of Foetal Monitoring
Intrauterine During Labour
Ultrasound Embryoscopy
Foetoscopy Foetal Heart Rate Monitoring
Foetal Heart Rate Monitoring

Still Birth
ULTRASONOGRAPHY

14 September 15, 2008
Ultrasonography

What is ultra - sonography?

Why should it be performed?

It has a potential for yielding important
diagnostic information
15 September 15, 2008
Ultrasound Equipment

Most machines utilize phased-
array real-time technology
Higher-frequency transducers
achieve high resolution. Lower-
frequency types are used
when increased penetration is
needed.
Hard copy as a means of
documentation
16 September 15, 2008
Performance of Ultrasound
Examination

First Trimester Evaluation:
Presence of gestational sac, Presence of cardiac activity,
Fetal number, Abnormalities

Second & Third Trimester Evaluation:
-Foetal number ,activity should be documented
-Estimation of amniotic fluid volume
-Umbilical cord must be imaged
-Gestational Age and Weight

17 September 15, 2008
Evaluation of Normal Foetal Anatomy
Normal foetal anatomy seen
on sonograms is an area of
considerable growth.
Significant advancements has
been to choose depth of zone
& select freq.
Volume of tissue is insonated
& 3-d images are produced.
18 September 15, 2008
Superficial Anatomy of Foetus
Superficial anatomy of foetus includes face, hair,
ears & external genitalia






External genitalia can be noted from early 2
nd

trimester onwards.
19 September 15, 2008
Musculoskeletal System

Real-time ultrasonography
provides the most
appropriate format for
imaging foetal bones.
Earliest structures seen are
the mandible, maxilla &
clavicle (1
st
bones of the
body to ossify).
Majority of the bones of the
appendicular skeleton can
be seen in early-middle 2
nd

trimester.

20 September 15, 2008
Many bones of the axial skeleton are also
routinely visualized.
In the skull region one can perceive a no. of
bones individually or as a glomerate.







The ribs, spine & pelvis are easily imaged and
serve as excellent landmarks.
21 September 15, 2008
Little space is devoted
to fetal muscular system
even though many
muscles are seen quite
well.
The individual layers of
the abdominal wall
muscles, the internal &
external oblique &
transverse abdominis
also can be seen.


22 September 15, 2008
Cardiovascular System
Foetal echocardiography is the term used to
describe all views of foetal cardiac
examination.
It may be performed after 16 weeks of
gestation.
Transducer frequency for cardiac imaging
must be 5 - 7.5 MHz.
Ultrasound systems equipped with M - mode,
color wave Doppler, pulse-waved &
continuous-wave Doppler are desirable.
contd.
23 September 15, 2008
Cardiovascular System
To define the cardiac position it is
necessary to note the position of the head
as the superior landmark & spine as
posterior.
Once the foetal heart is located only slight
movements of the probe is needed.
24 September 15, 2008
the superior vena cava, cross-section of the ascending aorta, main pulmonary artery
25 September 15, 2008
Doppler Echocardiography
Pulsed doppler demonstrates
the direction of blood flow &
allows for the analysis of flow
disturbances.
Doppler scanning uses the
change in frequency (Doppler
shift principle) of sound
waves reflected from the
RBCs.
Continuous Doppler is used
to measure high velocities of
flow.
26 September 15, 2008
It helps in evaluation of:
Gestational age
Foetal growth
Suspected foetal death
Suspected multiple gestations
Foetal anomalies
Assessment of foetal cardiac function


27 September 15, 2008
Methods of Monitoring Foetal
Heart Rate
METHODS OF MONITORING
FOETAL HEART RATE (FHR)
Abdominal foetal electrocardiogram
Foetal phonocardiogram
FHR measurements from ultrasound doppler
foetal signals
FHR measurements with direct FECG


29 September 15, 2008
Abdominal foetal electrocardiogram
Standard values for FECG: Maximum amount of FECG is
about 100 300V
Precautions to be taken:
Low electrode skin contact impedance
Is proper electrode material with low depolarization
effects
Placement of electrodes at proper position
Electrode positions: One near the umbilicus and other
above the symphysis.



30 September 15, 2008
Abdominal foetal electrocardiogram
Problems in obtaining FECG:
Sources of noise:
Amplifier input noise
Fluctuations in the electrode polarization potential
Maternal Muscle Noise
Maternal ECG
To overcome problems involved
Significance

September 15, 2008 31
32 September 15, 2008
Foetal phonocardiogram
How to obtain?: By a sensitive microphone
Problems involved: Greatly disturbed by maternal movements &
external noise
Device used: Crystal microphone
Nature of signals received: Two sounds corresponding to
contractions & relaxation of heart muscles
Noise reduction is achieved by using the repetetive properties of
FHR
Significance: Detects the smooth baseline FHR
Limitations : Susceptible to artifacts from ambient noise and
patient movement

33 September 15, 2008
EMBRYOSCOPY
When to perform?
Significance
Techniques
When to use?

34 September 15, 2008
6 weeks
7 weeks
10 weeks
35 September 15, 2008
11 weeks
13 weeks
14 weeks
36 September 15, 2008
Fetoscopy
Fetoscopy is an endoscopic procedure during
pregnancy to allow access to the fetus, the amniotic
cavity, the umbilical cord, and the fetal side of the
placenta.
A small (3-4 mm) incision is made in the abdomen,
and an endoscope is inserted through the abdominal
wall and uterus into the amniotic cavity.
Fetoscopy allows medical interventions such as a
biopsy or a laser occlusion of abnormal blood
vessels.

September 15, 2008 37



FOETAL HEART RATE MONITORING
DURING LABOR

Foetal Heart Rate Monitoring is to monitor
babys heart rate during labor and
delivery, with special equipments.



39 September 15, 2008
Types of Monitoring
Foetal heart rate monitoring
Auscultation Electronic foetal monitoring
External Internal
40 September 15, 2008
Tools used to Monitor Labour

Fetoscope

Doptone

Electronic Foetal Monitor
External Foetal Monitor
Internal Foetal Monitor

Telemetry


41 September 15, 2008
Risks of Monitoring

Baby may have a problem that goes undetected
Risk of infection for mother and baby
Restricts movement of the mother

Non Medical risks:
False readings may cause panic or fear
Discomfort due to restricted positioning
42 September 15, 2008
Still-Birth

A stillbirth, meaning
"quiet birth", occurs
when a foetus which
has died in the uterus
or during labour or
delivery exits a
woman's body.
43 September 15, 2008
Causes of Still-Birth
The causes of a large percentage of human stillbirths
remain unknown.
The term used to describe these is Sudden Antenatal
Death Syndrome (SADS).
In cases where the cause is known, some possibilities of
the cause of death are:
1. bacterial infection
2. consumption of nicotine, alcohol, recreational drugs
3. physical trauma
4. birth defects
5. Radiation poisoning

44 September 15, 2008
Abnormalities
Micromelia Patau syndrome
Down's Syndrome
45 September 15, 2008
RECENT ADVANCES IN
INTRANATAL MONITORING

Radio telemetry
Computerised data analysis: Analysis of the various
parameters including FHR and uterine activity. A
computerised prognostic comment is also developed.
Foetal electroencephalography (EEG).
Continuous foetal tissue pH or PO2 measurement.
Maternal and foetal blood lactate measurement
46 September 15, 2008
48
Questions and Comments
September 15, 2008