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    Intrapartum Assessment: Jonelle Baloloy, MD MCMC Ob Gyne

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    Jonelle baloloy
    The document provides an overview of intrapartum fetal heart rate monitoring and assessment. It defines key terms used to describe the fetal heart rate pattern including baseline, variability, accelerations, decelerations. It describes categories of fetal heart rate tracings from Category I (normal) to Category III (abnormal) and management guidelines for nonreassuring patterns. It then presents four case studies demonstrating application of the guidelines and interpretation of fetal heart rate tracings during labor.

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    Intrapartum Assessment: Jonelle Baloloy, MD MCMC Ob Gyne

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    Jonelle baloloy
    75 views39 pages
    The document provides an overview of intrapartum fetal heart rate monitoring and assessment. It defines key terms used to describe the fetal heart rate pattern including baseline, variability, accelerations, decelerations. It describes categories of fetal heart rate tracings from Category I (normal) to Category III (abnormal) and management guidelines for nonreassuring patterns. It then presents four case studies demonstrating application of the guidelines and interpretation of fetal heart rate tracings during labor.

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    Williams 27th edition

    Original Title

    Intrapartum assesment

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    The document provides an overview of intrapartum fetal heart rate monitoring and assessment. It defines key terms used to describe the fetal heart rate pattern including baseline, variability, accelerations, decelerations. It describes categories of fetal heart rate tracings from Category I (normal) to Category III (abnormal) and management guidelines for nonreassuring patterns. It then presents four case studies demonstrating application of the guidelines and interpretation of fetal heart rate tracings during labor.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    75 views39 pages

    Intrapartum Assessment: Jonelle Baloloy, MD MCMC Ob Gyne

    Uploaded by

    Jonelle baloloy
    The document provides an overview of intrapartum fetal heart rate monitoring and assessment. It defines key terms used to describe the fetal heart rate pattern including baseline, variability, accelerations, decelerations. It describes categories of fetal heart rate tracings from Category I (normal) to Category III (abnormal) and management guidelines for nonreassuring patterns. It then presents four case studies demonstrating application of the guidelines and interpretation of fetal heart rate tracings during labor.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 39

    INTRAPARTUM

    ASSESSMENT
    Jonelle Baloloy, MD
    MCMC OB Gyne
    INTRAPARTUM ASSESSMENT
    • INTERNAL/DIRECT ELECTRONIC
    MONITORING
    • Bipolar electrode placed directly to the fetus (scalp
    electrode)
    • More precise
    • EXTERNAL/ INDIRECT ELECTRONIC
    MONITORING
    • FHR detected through maternal abdominal wall
    using ultrasound doppler principle
    DEFINITION OF TERMS
    BASELINE VARIABILITY
    • FHR rounded to • Fluctuations in FHT that
    increments of 5bpm in a are irregular in amplitude
    10-min segment and frequency
    • Minimum of 2min in any • ABSENT: range
    10-min segment undetectable
    • NORMAL FHR- 110- • MINIMAL: < or = 5bpm
    160bpm
    ACCELERATION
    • ABRUPT increase in FHR <30seconds
    • Before 32 weeks AOG- acceleration peak of 15 bpm
    • PROLONGED ACCELERATION- >2mins but <10 mins
    • Causes:
    • fetal movement,
    • Contractions,
    • Umbilical cord occlusion,
    • Fetal stimulation
    • ALWAYS REASSURING
    EARLY DECELETATION LATE DECELERATION
    • Deceleration symmetrical, • Gradual decrease and return to
    gradual decrease and return of FHR
    FHR • After the contraction
    • Mirror image of contraction • Reflects uterine perfusion or
    • Physiological response placental function =
    • Not associated with fetal COMPROMISED
    hypoxia, acidemia or low UTEROPLACENTAL
    APGAR scores PERFUSION 
    uteroplacental-induced
    • Causes:
    hypoxia
    VARIABLE •Decrease in FHR
    DECELERATION below baseline
    •Abrupt decrease less >15bpm and less
    than 30 secs than 2 mins and
    •FHR decreased 15 return to baseline
    bpm or greater FHR
    lasting >15 seconds •Causes:
    and less than 2 mins •Uterine
    Interpretation of Tracing
    CATEGORY I- Normal

    Include all of the following:


    • Baseline rate: 11—160 bpm
    • Baseline FHR variability: Moderate
    • Late or variable decelerations: Absent
    • Early decelerations: Present or Absent
    • Accelerations: Present or Absent
    CATEGORY II- Indeterminate
    • All FHR tracings not categorized Accelerations
    as Category I or III. • Absence of induced accelerations
    Baseline rate: after fetal stimulation
    • Bradycardia not accompanied by Periodic or episodic decelerations
    absent baseline variability • Recurrent variable decelerations
    • Tachycardia accompanied by minimal or
    Baseline FHR variability: moderate baseline variability
    • Minimal baseline variability • Prolonged deceleration > 2min but
    <10 min
    • Absent baseline variability not
    CATEGORY III- Abnormal
    Include either:
    • Absent baseline FHR variability and any of the following
    • Recurrent late decelerations
    • Recurrent variable decelerations
    • Recurrent variable decelerations
    • Bradycardia
    • Sinusoidal pattern
    • IV hydration- 500-1000mL lactated ringer solution given over 20 mins
    • Lateral decubitus positioning
    • Administration of oxygen at 10 L/min using a nonrebreathing mask
    MANAGEMENT
    • Terbutaline sulfate- to inhibit uterine contractions and improve
    fetal oxygenation
    • Amnioinfusion- for variable or prolonged decelerations attributable
    to cord entrapment
    • Variable or prolonged decelerations
    • Oligohyrdambios as with prolonged PROM
    • Dilute or wash out thick meconium
    CASE SERIES
    CASE #1
    P.C; 42 y/o
    • Stable VS
    • FHR: 139bpm
    • FH: 30cm
    • IE: Cx 1cm dil. 50% eff., cephalic st -3, (+) leaking bow
    thinly stained AF.
    •Diagnosis: G1P0 PU 41 2/7wks AOG, Cephalic
    in beginning labor; PROM x 15hrs.
    • BFHR- 120-124bpm
    • Moderate variability
    • (+) Accelerations
    • (-) Decelerations
    • (+) Mild contractions
    every 8-10 mins
    • Impression: Category
    1
    Final Diagnosis

    Gravida 1 Para 1 (1001) pregnancy uterine


    term cephalic delivered live baby boy AS 9,9
    BW 3000gms, AGA, by NSD
    CASE #2
    B,C; 26 y/o
    • Stable VS
    • FH: 29cm
    • IE: cx 1cm dilated, beg eff cephalic st -3; (-) bow. Thickly
    MSAF.
    •Diagnosis: G1P0 PU 41 4/7wks AOG CIBL;
    PROM x 3hrs. t/c IUGR; GDM.
    • BFHR- 160-165 bpm
    • Moderate variability
    • (+) Accelerations
    • (-) Decelerations
    • (+) Mild contractions
    • Impression: Category
    2 for fetal tachycardia
    • BFHR- 140—145 bpm
    • Reduced variability
    • (+) Acceleration (1 in a
    10 min trace)
    • (+) 3 spontaneous
    decelerations dipping to
    30 beats below baseline
    • (-) Contractions
    • Impression: Category 3
    for recurrent variable
    decelerations with
    reduced variability
    FINAL DIAGNOSIS

    • G2P2 (2002) PU term cephalic delivered


    live baby boy AS 9,9 BW 2800gms, AGA
    by LTCS for NRFS (Category III); GDM-
    diet controlled
    CASE # 3
    R,P; 31 y/o
    • Stable VS
    • FH: 25cm
    • IE: Cervix 3cm dilated, 50% effaced; cephalic, st -3; (+)
    bow.
    •Diagnosis: G2P1 (1001) PU 33 6/7 weeks AOG,
    Cephalic in preterm labor, Preeclampsia severe
    • BFHR- 135-140bpm
    • Moderate variability
    • (+) Accelerations
    • (-) Deccelerations
    • No contractions
    • Impression: Reactive
    • FHT- 120-125bpm
    • Marked variability
    • (-) Accelerations
    • (-) Decelerations
    • No contractions
    • Impression: Category
    2 for absence of
    accelerations and
    marked variability
    • FHT- 115-120bpm
    • Marked variability
    • (-) Accelerations
    • (-) Decelerations
    • No contractions
    • Impression: Category
    2 for absence of
    accelerations and
    marked variability
    • BFR- 130-135bpm
    • Moderate variability
    • (+) accelerations
    • (-) decelerations
    • (+) mild contractions
    every 3-5mins
    • Interpretation:
    category 1
    • BFR- 105-110bpm
    • Moderate variability
    • (+) accelerations
    • (-) Decelerations
    • (+) Mild Irregular
    Contractions
    • Interpretation:
    category 3 for
    baseline change (fetal
    bradycardia)
    Final Diagnosis

    Gravida 2 Para 2 (1102) Pregnancy Uterine


    Preterm Cephalic Delivered Live baby boy AS
    5,7 BW 2100g, BS 33 weeks, AGA by Low
    Transverse Cesarean Section for Non Reassuring
    Fetal Status (Category III) under Spinal
    Anesthesia; Preeclampsia Severe-controlled
    CASE #4
    B,R; 26 y/o
    • Stable VS
    • FH: 30cm
    • IE: Cervix 1cm dilated, beginning effacement; cephalic, st -3;
    Leaking BOW.
    •Diagnosis: G1P0 PU 38 6/7 weeks AOG, CBIL,
    PROM x 3hrs; CAP-MR; COVID Suspect
    • BFR- 130-135 bpm
    • Moderate variability
    • (+) accelerations
    • (-) Decelerations
    • (+) Moderate
    irregular
    contractions
    • Interpretation:
    category 1
    • BFR- 130-135 bpm
    • Reduced variability
    • (+) 1 episode of
    acceleration in a 10 min
    trace
    • (-) Decelerations
    • (+) Moderate
    contractions every 3-5
    mins
    • Interpretation: category
    2 for reduced variability
    • BFR- 130-135 bpm
    • Moderate variability
    • (-) Acceleration
    • (+) Spontaneous
    deceleration dipping as
    low as 70 beats below the
    baseline lasting for 4 mins
    • (+) Moderate contractions
    every 2-5 mins
    • Interpretation: category 2
    for prolonged deceleration
    • BFR- 130-135 bpm
    • Moderate variability
    • (-) Acceleration
    • (+) Spontaneous
    deceleration dipping as
    low as 70 beats below the
    baseline lasting for 4 mins
    • (+) Moderate contractions
    every 2-5 mins
    • Interpretation: category 2
    for prolonged deceleration
    Final Diagnosis

    G1P0 Pregnancy uterine term cephalic


    delivered live baby boy AS 9,9 BW 3000gms
    by LTCS for NRFS (Category III, prolonged
    deceleration) under spinal anesthesia; CAP-
    MR-resolved; COVID suspect
    Thank you.

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