Use of Fetal Monitoring, Pregnancy Assessment

Use of Fetal Monitoring, Pregnancy Assessment 1)CTG (Cardiotocography) 1. Definition of Cardiotocography Cardiotocography (CTG) is an electronic toolwhich is used to detect related disturbances with fetal hypoxia, how far the disorder is, and determine the follow-up action from the results of the examination through assessment of fetal heart rate patterns in relation to there are contractions or fetal activity. 2. Use of CTG Fetal monitoring can be done internally/invasively namely, the monitoring device is inserted into the uterine cavity through the vagina such as transvaginal ultrasound, and noninvasive/external methods, namely tools monitors installed on the mother's abdominal wall such as CTG, ultrasound, etc Doppler. In a CTG tool, there are 2 types of transducers/probes that are required installed. One type of probe is a tool for detecting uterine contractions. And other probes as a DJJ detection tool. One CTG unit has a probe 2 DJJ detectors for certain brands to guard against it turns out the pregnancy contains two fetuses. Then there is a detection button fetal movements. All probes should be given jelly for recording The results obtained from fetal activity are correct, because this tool relies on the power of sound reflection to detect the fetus in the womb. BesidesTherefore, the probe has been placed in the appropriate location should be fixed properly using the ropes provided integrated into the CTG device. Give the mother the fetal movement/kick detection button pregnant woman to squeeze when the mother feels the fetus moving. Advise mother lie down normally and breathe normally and maintain relaxation During the CTG graph recording process, it lasts ± 20 minutes forever. Then massage the zero button when the full his graph appears and the DJJ graph is intact as a marker for the correct location of the probe. Then massage print button so that the CTG graph is drawn on the paper. a. DJJ characteristics The average DJJ frequency is around 140 beats per minute (bpm) with normal variation of 20 bpm above or below the average value. So, value Normal DJJ is between 120-160 bpm. In a CTG examination, there are 2 types of normal DJJ, namely: 1) basal FHR (basal fetal heart rate),namely the basic frequency (baseline rate)and variability (variability)DJJ when the uterus is in position rest (relaxation). a) basic frequency (baseline rate) - Under normal circumstances, the DJJ frequency ranges between 120-160 bpm. - CalledTachycardiaif the basic frequency is > 160 bpm. Tachycardia can occur if: o Fetal hypoxia  Preterm pregnancy (<30 weeks)  Maternal and fetal infections  The mother is febrile or restless  Hyperthyroid mother  Fetal tachyarrhythmia  Medicines (eg: atropine, betamimetics)  Tachycardia accompanied by FHR variabilitywhich is still normal, usually the fetus is internal good condition.  CalledBradycardiaif the basic frequency is <120 bpm. Bradycardia occurs when:  Jaundice hypoxia (severe/acute)  Fetal hypothermia  Fetal bradyarrhythmia  Medicines (eg: propranolol, anesthetic drugs local)  Fetus with congenital heart defects  Bradycardia 100-120 bpm accompanied  Variability is still normal, usually indicates mild fetal hypoxia can still be compensated by the fetus.  But if the bradycardia decreases < 100 bpm, usually the variability becomes clearer becomes abnormally low. 2. NST (NONSTRESSEST) 1. Understanding The method for examining the fetus is using cardiotocography at gestational age > 32 weeks. This examination is carried out with the aim of seeing the relationship between changes in heart rate and fetal movement. This examination can be carried out both during pregnancy and childbirth. 2. Function a. The NST examination is carried out to assess the appearance of the Fetal Heart Rate (DJJ) in relation to fetal movement/activity. The NST assessment is carried out on the basic frequency of FHR (baseline), variability and the onset of acceleration in accordance with fetal movement/fetal activity (Fetal Activity Determination/FAD). b. This is done to assess whether the baby is responding to stimuli normally and whether the baby is receiving enough oxygen. Generally done at a minimum gestational age of 26 28 weeks or whenever according to the baby's condition. c. What is assessed is the image of FHR in relation to fetal movement or activity. In healthy fetuses that move actively, you can see an increase in the frequency of FHR, whereas if the fetus is not doing well, fetal movements are not followed by an increase in the frequency of FHR. If the increase in frequency occurs quickly (< 1-2 minutes) and increases at least 15 bpm from the basic frequency within 15 seconds it is calledacceleration (acceleration) If the decrease in frequency occurs quickly (< 1-2 minutes) it is called deceleration (deceleration). b) FHR variability (variability) Variability is a picture of irregular oscillations, this is normal and is considered a graphic indication that the brain is still working to maintain brain oxygenation.