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Manual on Antepartum Fetal Surveillance: Fetus—Our Second Patient
Narendra Malhotra, Jaideep Malhotra, Neharika Malhotra Bora, Rishabh Bora
CHAPTER 1:
Introduction to Antepartum Fetal Surveillance
ANTEPARTUM FETAL SURVEILLANCE INVOLVES USE OF VARIOUS TECHNIQUES
INDICATIONS FOR ANTENATAL FETAL ASSESSMENT
Indications
FETAL BODY MOVEMENT MONITORING
Monitoring Techniques
DIURNAL VARIATION
DECREASED FETAL ACTIVITY
EXCESS FETAL ACTIVITY
ASSOCIATION OF FHR and FM
ASSOCIATION OF FM/FHR/ACOUSTIC STIMULATION
Labor
Effect of Medication
CLINICAL APPLICATION
Stillbirth
Hypertension
Congenital Malformations
Twins
Diabetes
Fetal Growth Retardation
Postdate Pregnancies
Rh Isoimmunization
BIOCHEMICAL ASSESSMENT OF FETAL WELLBEING
IMPORTANT BIOCHEMICAL MARKERS FOR ANTENATAL FETAL SURVEILLANCE
Estrogen-Estriol
Tests
False Values
Human Placental Lactogen
CHAPTER 2:
Nonstress Test
DECELERATIONS
Baseline Variability
Causes of Decreased Base Line Variability
Baseline Tachycardia
Baseline Bradycardia
Decelerations
Early Decelerations
Late Decelerations
Variable Decelerations
NST SCHEME
CHAPTER 3:
Contraction Stress Test
PATHOPHYSIOLOGY
Procedure
INTERPRETATION
When to do the test?
CTG in Breech
BIOPHYSICAL PROFILE
Manning and SIPOS
Vintzileos
Score
Pathophysiology
Acute Markers
Chronic Markers
Advantages
Disadvantages
MBBP
Abnormal
Indications
Contraindications
When to Begin Testing?
When to Start Testing in a Diabetic Patient?
When to Start Testing in Chronic Hypertensives?
Procedure
Interpretation
Reversible Causes of an Abnormal CST
ADMISSION TEST (AT)
Planning Management
How Long Should a CTG Last?
Intrapartum Cardiotocography (Fetal Surveillance During Labor)
Fetal Metabolic Acidosis—Prevalence and Significance (Causes of Asphyxial Brain Damage)
Internal (Direct) Uterine Activity Monitoring
EXTERNAL (INDIRECT) ACTIVITY MONITORING
ELECTRONIC FETAL HEART MONITORING
Defining the Intrapartum CTG
CHAPTER 4:
FAST (Fetal Acoustic Stimulation Test) and VAST (Vibroacoustic Stimulation Test)
FETAL ACOUSTIC STIMULATION TEST (FAST)
VIBROACOUSTIC STIMULATION TEST (VAST)
CLINICAL ASPECTS OF VAST
VAST IN FETAL ADMISSION TEST
HABITUATION
SAFETY
CHAPTER 5:
Biophysical Profile
INTRODUCTION
Historical Events
BIOPHYSICAL PROFILE
VARIABLES
TWO SCORING SYSTEMS
While Performing BPP test
MODIFIED BIOPHYSICAL PROFILE
CAMPBELL'S BPP SCORING CRITERIA
Nonstress Test
Fetal Movements
Fetal Breathing Movements
Fetal Tone
Amniotic Fluid Volume
Placental Grading
BASIC PHYSIOLOGY and PATHOPHYSIoLoGY OF BPP COMPONENT
Observation by Vintzileos et al
RELATIONSHIP BETWEEN BIOPHYSICAL ACTIVITY and UMBILICAL VENOUS pH IN FETUS BEFORE LABOR
MANAGEMENT PROTOCOL
ADVANTAGES OF BPP
PITFALLS OF BPP
CHAPTER 6:
Amniotic Fluid Assessment
AMNIOTIC FLUID VOLUME ACCORDING TO GESTATIONAL AGE
AMNIOTIC FLUID VOLUME
ESTIMATION OF AMNiOTIC FLUID VOLUME
METHODS OF ASSESsMENT WITH the USE OF USG
Subjective Method
Maximum Vertical Pocket
According to Manning and Associates
Amniotic fluid index (AFI)
Diagnostic Categories of AFI
AFI AND MVP
AMNIOTIC FLUID INDEX MEASUReMENT TECHNIQUE (FIG. 6.4)
INDICATIONS OF AFI TESTING
Routine USG Examination at 16 Weeks
During the Antepartum Testing
MONITORING OF PATIENTS WITH PRETERM PROM
FREQUENCY OF AMNIOTIC FLUID VOLUME ASSESSMENT
DRAWBACK OF AFI ESTIMATION
OLIGOHYDRAMNIOS
CONDITIONS ASSOCIATED WITH OLIGOHYDRAMNiOS
POLYHYDRAMNIOS
Meconium Staining of Amniotic Fluid
Passage of Meconium
Adult
Involuntary Defecation
CHAPTER 7:
Ultrasound Markers of Chromosomal Anomalies in First Trimester
NUCHAL TRANSLUCENCY (NT)
ABSENT NASAL BONE
Examination of Nasal Bone (FMF Guidelines)
Other Ultrasound markers
Structural Anomalies
Doppler Studies
CHAPTER 8:
Second Trimester Scan
HEAD
How to Examine
FACE AND NECK
How to examine?
SPINE
THORACIC CAVITY
HEART
Parameters to Note
ABDOMEN
GENITOURINARY SYSTEM
Common Abnormalities
EXTREMITIES
Fingers
Feet
UMBILICAL CORD
PLACENTA
AMNIOTIC FLUID
CERVIX
How to Optimize the Result
CHAPTER 9:
Role of Color Doppler in the Management of High-Risk Pregnancy
DEFINITION
ETIOLOGY
PATHOPHYSIOLOGY
FETAL GROWTH RATES
Diagnosis of Fetal Growth Restriction
DIAGNOSIS OF FETAL COMPROMISE OR JEOPARDY
Test for Fetal Wellbeing
Indications of Fetal Wellbeing Studies
Sequential Changes in Tests for Fetal Wellbeing (Fig. 9.13)
Detection of Fetal Growth Restriction (FGR) and Intrauterine Growth Restriction (IUGR) (Fig. 9.14)
Fetal Oxygenation
Hypoxemia
Hypoxia
Asphyxia or Acidosis
CONCLUSION
CHAPTER 10:
3D and 4D US for Fetal Well-being
INTRODUCTION
First Trimester (Fig. 10.1)
Nuchal Translucency Scan (Fig. 10.2)
Nasal Bone (Fig. 10.3)
Facial Abnormalities (Figs 10.4 to 10.7)
Micrognathia
Ear Abnormalities (Fig. 10.8)
Cranial Abnormalities
Central Nervous System
Spinal Abnormalities
Chest
Abdomen
Limb Abnormalities
Placenta
3D–4D US for Fetal Echocardiography
Limitations of 3D–4D US
CHAPTER 11:
Biochemical Markers
SECOND TRIMESTER (15–20 WEEKS)
Alpha-Fetoprotein (AFP)
Human Chorionic Gonadotropin (hCG)
Estriol
Inhibin-A
FIRST TRIMESTER (9–14 WEEKS)
Free Beta hCG
Pregnancy-associated Plasma Protein-A (PAPP-A)
CHAPTER 12:
Fetal Maturity Testing
CONCLUSION
CHAPTER 13:
Invasive Diagnostic Tests for Prenatal Diagnosis
METHODS OF PRENATAL SCREENING AND DIAGNOSIS
AMNIOCENTESIS (FIG. 13.1)
CHORIONIC VILLUS SAMPLING (CVS) (FIG. 13.2)
MATERNAL BLOOD SAMPLING FOR FETAL BLOOD CELLS (FIG. 13.3)
CHAPTER 14:
Fetal MRI
INDICATIONS
Brain and Spine
Skull, Face and Neck
Thorax
Abdominal, Retroperitoneal and Pelvic
RISKS OF FETAL MRI
BENEFITS OF FETAL MRI
CHAPTER 15:
Future in Antepartum Fetal Surveillance
NEW MONITORS WHICH ARE BEING MADE AVAILABLE IN UK AND USA
Passive Fetal Heart Monitoring System
Maternal-Fetal Monitoring System
CHAPTER 16:
Normal Values and Charts in Pregnancy
Bibliography
INDEX
TOC
Index
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