ARTIFACT OR ARRHYTHMIA? - Fetal monitoring ACCELS NOT RELATED TO A NORMAL NEUROLOGIC SYSTEM FOLLOWING…

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  • 9/30/2011

    1

    SupplementalslidesforAFMUpdate2011

    ARTIFACTORARRHYTHMIA?

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    2

    WHATDOYOUTHINKARTIFACTORARRHYTHMIA???

    ARRHYTHMIAislikely.ITISALSOACONVERSIONPATTERNWITHABSENT VARIABILITY,ANDACCELSNOTRELATEDTOANORMALNEUROLOGICSYSTEMFOLLOWINGHOURSOFSEVEREBRAINCOMPRESSIONANDISCHEMIATHATRESULTEDINADECREASEINBARORECEPTORSENSITIVITYANDASHIFTFROMNORMALVAGALREGULATIONOFTHESANODE.

    Arrhythmia

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    WHAT DO YOU THINK???

    MOMHADBEENGIVENNUBAIN10MGBENIGNSINUSOIDAL

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    ARETHESETHESAME?

    LambdaPatternv.CheckmarkPattern

    LambdaPattern

    CheckmarkPattern

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    LambdaPatternv.CheckmarkPattern

    LambdapatternthoughttoberelatedtofetalBPandHRrateshiftTheyareinnocuous

    CheckmarkPatternThefetusisseizing

    NAME THAT PATTERN

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    BOTHTHECNMANDRNCALLEDTHEMVARIABLESISTHERECORDCOMPRESSION?

    FHRbetween150 155bpm withspont accelabove2ndUCandmildvariabledecels.MHR92102bpm and(uniform)accels withUCs.

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    MHR70to90,doublingx25secondsto140 160.

    USlimitationMHRdoubling

    MHRnear87bpm anddoublingnear174.Thefetuswasdeadonadmission.Fetallifewasnotconfirmedpriortomonitorapplication.

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    FHRnearlongWHATDOYOUTHINKTHISIS?

    ARRHYTHMIATHENARTIFACT

    ThefetalECGwaveformisprintedatthetopoftheFHRchannel.

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    TwinOffset

    Is this rate at 120 bpm the fetus?

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    Is this rate at 120 bpm the fetus?

    No!TheUSwasontopofthemonitorpickingupthefansmovement!!

    WHAT ARE THESE SPIKES?

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    Escapebeat

    Supraventricular Tachycardia

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    Maternal Doubling