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胎兒監視器判讀及處置

台大醫院婦產部

李建南 醫師

大綱

•胎心音監測基本項目 • Baseline, variability, contractions

•胎心音監測分級

• Nonstress test

• Contraction Stress Test

• Acoustic Stimulation Test

• Biophysical Profile

• Cases presentation

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胎心音監測基本項目

• Baseline (基準線) • 110-160 bpm

• >160 bpm: tachycardia • Maternal infection, fetal

compromise, cardiac arrhythmias

• <110 bpm: bradycardia • Congenital heart block and serious

fetal compromise

•和週數相關 • Decreased 1beat/min per week

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23 weeks

35 weeks

Baseline decreased while gestational age increased

• Variability (變異性) • >25 bpm: marked

• 6-25: moderate

• <5 bpm: minimum

• Sinusoidal pattern • Fetal intracranial hemorrhage

• Severe fetal asphyxia

• Severe fetal anemia from Rh alloimmunization • Fetomaternal hemorrhage

• TTTS

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Decreased variability serious compromised, fetal acidemia

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Sinusoid pattern !!!

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• Uterine contraction (子宮收縮) • 正常: 1次/3分鐘

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Caused by: CPD, abruption, uterotonics Fetal compromise Risk of uterine rupture

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Acceleration 胎心音加速

•胎心音自基準線突然加速

•定義: 開始加速到尖峰<30秒，通常持續<2分鐘

• > 32週: > 15bpm, >15 sec

• < 32週: > 10bpm, >10 sec

# Prolonged acceleration: >2 min, < 10min

# Baseline change: >10 min

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Deceleration 胎心音減速

• Early deceleration 早發型減速

• Late deceleration 晚發型減速

• Variable deceleration 變異型減速

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Early deceleration 早發型減速

•和子宮收縮同時相對應

•代表 Fetal head compression

•預後佳

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Late deceleration 晚發型減速

•發生於子宮收縮的最高峰之後

•代表 uteroplacental insufficiency

•胎心音變異性差

•預後差!!

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Prolonged deceleration

• >15bpm, about 2-10 min

• Related to • Uterine hyperactivity

• Cord entanglement • Maternal supine

hypotension

• Maternal hypoperfusion or hypoxia

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Variable deceleration 變異型減速

•不定時間的減速

•胎心音變異性佳

•不定形狀

•代表 cord compression

•預後不定

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Variable deceleration, U-shape, shoulder sign

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Variable deceleration, W-shape

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Atypical variable deceleration

• No shoulder sign

• Slow return

• Overshoot

• Loss of variability

• Biphasic deceleration

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Slow return

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胎心音監測分級

Nonstress test

• The most common cardiotocographic method of antepartum fetal assessment.

• It is noninvasive and can be performed in any setting with an electronic fetal monitor.

• There is no direct risk of maternal or fetal injury associated with nonstress testing.

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Nonstress test

• Reactive tests • The NST test is reactive from 33 weeks

to term

• 2 or more fetal heart rate accelerations reaching a peak

• at least 15 beats per minute (bpm) above the baseline rate

• lasting at least 15 seconds from onset to return to baseline

• in a 20 minute period

Nonstress Test

• Nonreactive tests • The fetal heart rate should be monitored for at least 40 minutes but no more

than 120 minutes before interpreting the test as nonreactive. • Nonreactivity may be a sign of fetal hypoxemia or acidosis.

• Nonreactive tests • Repeat the test in 30 minutes • Perform vibroacoustic stimulation to elicit accelerations • Perform a BPP to evaluate other parameters of fetal well-being • If possible, modify factors potentially causing nonreactive results (eg, smoking

proximate to the test)

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Contraction Stress Testing

Contraction Stress Testing

oxytocin or nipple stimulation fewer than three in 10 minutes

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Contraction Stress Testing

Acoustic Stimulation Test

• a stimulus of 1 to 2 seconds

• may be repeated up to three times for up to 3 seconds

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Biophysical Profile

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Biophysical Profile

Cases

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Pregnancy for 33 weeks preterm uterine contractions polyhydramnios rule out congenital viral infection

Birth weight: 2000 gm Apgar score: 2 to 5 to 7 Umbilical cord entangled with the limbs of the baby rigid extremities placenta 794gm

Pregnancy for 29 weeks Severe preeclampsia Umbilical flow AEDV

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After painless anesthesia

Fetal tachycardia and poor variability

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Fetal tachycardia and poor variability

• A live immature female baby was delivered by breech extraction at 09:48 on 6/5 (1) Birth weight: 2196 gm, (2) Apgar score: 3 to 7.

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Post cesarean section A live premature male baby was delivered by vertex extraction at 10:18 (1) Birth weight: 1838 gm (2) Apgar score: 5 to 8 (3) Cord around neck

Thank you!