Antepartum Fetal Surveillance Willians Ch.15

Antepartum Fetal Surveillance  To test fetal well-being  Fetal physical activities Movement Breathing Amniotic fluid production Heart rate  Goal: to prevent fetal death

Fetal Movements  Passive unstimulated fetal activity: 7 wks  20~30 wks: rest-activity cycles  足月胎兒睡眠時間的百分比 :  足月胎兒一個睡眠週期約 75% 20~75 分鐘

Perception of 10 fetal movements in up to 2 hours is considered normal

Fetal Heart Rate

Non-Stress Test  Fetal heart rate accelerations  Normal nonstress tests 20 分鐘內有兩次, 加速 15 下維持 15 秒

20 分鐘 2次2次 15 下 15 秒

Worse Prognosis  Absent acceleration up to 80 mins  Repetitive decelerations > 3 / 20 mins  Deceleration lasting > 1 min

Contraction Stress Test  Oxytocin challenge test 3 spontaneous contractions of 40 sec present in 10 mins Negative: no late or significant variable decelerations Positive: late decelerations following 50% or more of contractions

Biophysical Profile BPP

Score 2Score 0 Nonstress test 20 分鐘內 2 次 15 下 15 秒 沒有 Fetal breathing >1 episode of rhythmic breathing > 30 sec in 30 mins 沒有 Fetal movement > 3 body or limb movement in 30 mins 沒有 Fetal tone >1 次 ( 四肢伸直再屈曲或 手打開再合起 ) in 30 mins 沒有 Amniotic fluid volume Single vertical pocket > 2 cm 沒有

Score 10 Keep follow up 8, normal fluid 6~8Deliver if > 37 weeks 4Deliver if repeat < 6 0~2Deliver

Fetal Death After Normal BPP  Fetomaternal hemorrhage  Umbilical cord accidents  Placental abruption  Incidence: 1/1000

Amniotic Fluid Volume

Pathophysiology  Decreased uteroplacental perfusion  Diminished fetal renal flow  Decreased urine production  Oligohydramnios

Poor Prognosis  Single vertical pocket < 2 cm  Amniotic fluid index ( 四個象限 vertical pocket) < 5 cm

Umbilical Artery Doppler Velocity

Umbilical Artery Doppler  S/D ratio: most commonly used index  End diastolic flow  prognosis  Perinatal mortality Absent end-diastolic flow: 10% Reversed end-diastolic flow: 33% S D

下圖為三種 40 週胎兒的臍動脈血流速度的波形， 請問下列敘述何者最合適？ (A) 甲波形正常，乙、丙波形異常 (B) 甲、乙波形正常，丙波形異常 (C) 甲、乙、丙波形皆正常 (D) 甲、乙、丙波形皆異常

Pregnancy 31 weeks with preterm labor, SGA was noted in series OBS sono Keep tocolysis and observation

Pregnancy 37 weeks with preeclampsia (BP 146/84, urine protein +) MBD with OPD follow up

Pregnancy 24+6 weeks with SLE, hyperthyroidism, hypertension, and preterm labor C/S on 2009/05/08, BW 635gm, Apgar: 2’-3’

Pregnancy 31+3 weeks with oligohydramnios and preterm labor, with preeclampsia, with HELLP syndrome  C/S on 2009/4/08, BW 1140gm, Apgar: 5’-8’

Antepartum Fetal Surveillance  Telling more about the well-being of the baby  An “ abnormal ” result not always mean that the baby is in trouble. It simply mean that you need special care or test

感恩