Page 850 - TNFlipTest

OB10 Obstetrics
Antepartum Care
Toronto Notes 2019
Table 5. Classification of Intrapartum EFM Tracings
Reassuring BPP (8/8)
LAMB
Limb extension + flexion AFV2cmx2cm
Movement (3 discrete) Breathing (one episode x 30 s)
Greater than 20 mm of overlap over the internal os in the third trimester of pregnancy is highly predictive of the need for a C/S. Any degree of overlap after 35 wk is an indication for a C/S
Baseline
Variability
Decelerations
Accelerations in Term Fetus
Accelerations in Preterm Fetus (<32 wk)
Action
Normal Tracing (Category 1)
110-160 bpm
6-25 bpm (moderate)
≤5 (absent or minimal) for <40 min
None or occasional variable <30 s
2 accelerations with acme of ≥15 bpm, lasting 15 s over <40 min of testing
>2 accelerations with acme of >10 bpm, lasting 10 s in <40 min
FURTHER ASSESSMENT OPTIONAL, based on total clinical picture
Atypical Tracing* (Category 2)
100-110 bpm or >160 bpm for <30 min
Rising baseline
5 (absent or minimal) for 40-80 min
Variable decelerations 30-60 s duration
2 accelerations with acme of ≥15 bpm, lasting 15 s in 40-80 min
<2 accelerations with acme of >10 bpm, lasting 10 s in 40-80 min
FURTHER ASSESSMENT REQUIRED
Abnormal Tracing* (Category 3)
Bradycardia <100 bpm Tachycardia >160 for >30 min Erratic baseline
≤5 for 80 min Sinusoidal
25 bpm for >10 min
Variable decelerations >60 s Late deceleration(s)
<2 accelerations with acme of ≥15 bpm, lasting 15 s in >80 min
<2 accelerations with acme of >10 bpm, lasting 10 s in >80 min
URGENT ACTION REQUIRED An overall assessment of the situation and further investigation with U/S or BPP is required; some situations will require delivery
Adapted from: SOGC, Fetal Health Surveillance: Antepartum and Intrapartum Consensus Guideline, September 2007
Operating Characteristics
• falsepositiveratedependsonduration;falsenegativerate=0.2-0.3%
Interpretation
• normal:atleast2accelerationsofFHR>15bpmfromthebaselinelasting>15sin20min
• abnormal:<2accelerationsofFHRin40min
• ifnoobservedaccelerationsorfetalmovementinthefirst20min,stimulatefetus(fundalpressure,
acoustic/vibratory stimulation) and continue monitoring for 30 min
BIOPHYSICAL PROFILE Definition
• U/Sassessmentofthefetus±NST
Indications
• post-termpregnancy
• decreasedfetalmovement
• IUGR
• anyothersuggestionoffetaldistressoruteroplacentalinsufficiency
Operating Characteristics
• falsepositiverate≤30%,falsenegativerate=0.1%
Table 6. Scoring of the BPP
Parameter
Tone
Movement
Breathing
Amniotic Fluid Volume (AFV)*
*AFV is a marker of chronic hypoxia, all other parameters indicate acute hypoxia
Interpretation
Reassuring (2 points)
At least one episode of limb extension followed by flexion Three discrete movements
At least one episode of breathing lasting at least 30 s Fluid pocket of 2 cm in 2 axes
• 8:perinatalmortalityrate1:1,000;repeatBPPasclinicallyindicated
• 6:perinatalmortality31:1,000;repeatBPPin24h
• 0-4:perinatalmortalityrate200:1,000;deliverfetusifbenefitsofdeliveryoutweighrisks