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Samia Mohamad Eid Assist. Prof of Obs & Gyne. Al-Azhar university

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BPP is applying to detect prenatal asphyxia Doppler ultrasound is a modality for detecting fetal hypoxia and acidosis.

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Hypoxia: decrease oxygen concentration in the tissue & blood. Acidosis increase concentration of H+ in tissue & blood. Asphyxia: hypoxia & metabolic acidosis. Ischemia: Drop in blood flow

Slide 4 > carbon dioxide + water + energy Poor blood flow from"> > carbon dioxide + water + energy Poor blood flow from the uterus and placenta causes the fetus to constrict blood vessels in nonvital peripheral areas in order to supply more blood flow to vital organs such as the heart and brain. How hypoxia leads to acidosis"> > carbon dioxide + water + energy Poor blood flow from" title=" The fetus uses oxygen to "burn" molecules and release energy. The reaction: glucose + oxygen >> carbon dioxide + water + energy Poor blood flow from">

The fetus uses oxygen to "burn" molecules and release energy. The reaction: glucose + oxygen >> carbon dioxide + water + energy Poor blood flow from the uterus and placenta causes the fetus to constrict blood vessels in nonvital peripheral areas in order to supply more blood flow to vital organs such as the heart and brain. How hypoxia leads to acidosis

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With a limited supplies of oxygen (hypoxia) the peripheral tissues can only partially break down the sugar and converts it to lactic acid. Significant levels of acid in the blood (acidemia) may suppress the fetal nervous system and eventually lead to cardiovascular collapse. How hypoxia leads to acidosis

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In 1980, Maning and Platt fashioned a method for Fetal surveillance in high risk pregnancy that combine FHR with various US variable

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FHR monitoring Fetal breathing movement Fetal movement Fetal tone Amniotic fluid assessment Biophysical profile

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Fetal movement and fetal tone develop between 7.5 and 9 weeks menstrual age Fetal breathing movements are detectable by, at least 17-18 weeks gestation The non-stress test is most reliable between 32 weeks and term

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So,BPP has a limited role for assessing fetal well being before 32 gestational weeks. Comment

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Timeline for fetal hypoxia

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So, Doppler ultrasound can predict fetal distress sooner than BPP comment

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It involve the ability of the hypothalamus and medulla to maintain a variable, rather than smooth baseline and to increase the heart rate with fetal movement. Hypoxia or acidosis decrease beat-to-beat variability and accelerated FHR with fetal activity. FHR monitoring

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Fetal breathing movements are detectable by, at least 17-18 weeks gestation. After 30ws of gestation, the fetus will spend about 30%of his time making breathing motion. Fetal breathing

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Action generated in the ventral surface of the 4 th ventricle. One episodes of 3oseconds during an observation period of up to 20 minutes. Prolonged hypoxia and/or acidemia blunt this activity. Fetal breathing

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The fetal cortex generate the massage for the fetus to move his/her arms, legs, trunk. At least 3 trunk movements during 20 minutes observation period. Fetal movement Profound hypoxia and Acidemia will stop this for happening

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Depends on intact cortex and subcortex. One episode of extension with a return to flexion during--------. Is the last to go in a sequence of events ending in severe fetal compromise. Actually, fetal tone is the least useful variable since, By the time tone is lost, all of the other categories will have had scores zero (unless ---------------?) Fetal tone

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Amniotic fluid assessment Amniotic fluid relates indirectly to fetal brain Brain sparing concept Except post term pregnancy

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Assessment of AF. AF volume rise linearly to about 33-34ws when the average is about 1000cc. After which it generally drops slowly to about 800cc at 40 ws and to 600cc at 42ws AF volume rise linearly to about 33-34ws when the average is about 1000cc. After which it generally drops slowly to about 800cc at 40 ws and to 600cc at 42ws

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Basically there are 3 methods commonly used to assess the adequacy of AF: 1.Vertical pocket technique. 2.Amniotic fluid index. 3.subjective (eyeball) assessment. Assessment of AF

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Vertical pocket technique 1 cm oligohydramnios 2cm oligohydramnios

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AFI

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As you know, oligohydramnios may be Mild AFI=5-8cm Moderate AFI=2-5cm Sever AFI