Pengenalan CTG obstetri Zayed

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    Gawat Darurat Ibu dan AnakGawat Darurat Ibu dan Anak(GDIA) Pusdiklat Sari Mulia(GDIA) Pusdiklat Sari Mulia

    Fetal CardiotocographyFetal Cardiotoco

    graphy

    ayed !orwantoayed !orwanto

    "an#ar$asin% & 'ktober *+"an#ar$asin% & 'ktober *+

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    ,lectronic -etal heart $onitoring.,FM/0

    de1eloped in the *23s4

    is achie1ed by either 0 5 internal or direct $onitoring%

    by applying a bipolar electrode to the skin o-the

    -etal scalp %the cer1i6 has to be dilated and$e$branes ruptured4

    5 e6ternal or indirect $onitoring4

    by using ultrasound %usually by 7

    ,6ternal toco dyna$o $etry with a pressure

    transducer placed on the uterus4

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    Indications -or ,FM

    5low risk wo$en with7

    nor$al 898 on auscultation % no $econiu$staining li:uor and nor$al progress o- labor

    are e6tre$ely unlikely to deli1er an

    asphy6iated in-ants4

    Ad$ission test 0

    initial $inutes ,FM screen in early laboris

    enough to predict the likelihood o-subse:uent

    -etal hypo6ia4

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    5 high risk wo$en7 Maternal disorders0

    ; hypertensi1e diseases4

    ; diabetes $ellitus4

    ; renal diseases4

    ; cardiac diseases4

    ; AP94

    ; 89 isoi$$uni

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    =abor co$plications 0

    ; dys-unctional labor ( slow progress)4

    ; o6ytocin aug$entation or induction 4 ; preter$ labor4

    ; >"AC4

    Fetal co$plications 0

    ; I?G84

    ; pre1ious S"4

    ; $econiu$ staining4

    ; Post ter$ pregnancy4

    ; abnor$al F98 on auscultation4

    ; twins4

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    ;A: Fetal heartbeatA: Fetal heartbeat;;;B: Indicator showing movements felt by mother (caused byB: Indicator showing movements felt by mother (caused by

    pressing a button)pressing a button);;

    ;C: Fetal movementC: Fetal movement;;

    ;D: terine contractionsD: terine contractions

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    DoCtor BRaVADODoCtor BRaVADO

    ;DDe@ne 8iske@ne 8isk00=ow or 9igh=ow or 9igh

    ;CContractionsontractions00Fre:uency% =engthFre:uency% =ength

    ;BBaselineaseline RaRatete00"radycardia% !or$al% achycardia"radycardia% !or$al% achycardia

    ;VVariabilityariability00+B*bp$$in+B*bp$$in;AAccelerationsccelerations00Present or AbsentPresent or Absent

    ;DDecelerationsecelerations00Present or Absent% ypePresent or Absent% ype

    ;OOutco$e0utco$e0!or$al% Suspicious4 Pathological4!or$al% Suspicious4 Pathological4Manage$ent PlanManage$ent Plan

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    ContractionContraction

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    "aseline F980

    5It is the rate recorded in between uterine

    contractions4

    5!or$ally ** *+ bp$4

    5usually assessed o1er *+ $inute inter1al

    during labor4

    "ase =ine"ase =ine

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    "aseline tachycardia

    5It is a F98 abo1e *+ B *3 bp$4 5causes 0

    ; Fetal hypo6ia4

    ; Maternal or Fetal in-ection4 ; Drugs as ritodrine and atropine4

    ; Maternal hyperthyrodis$4

    ; $aternal dehydration4

    ; Fetal ane$ia 4 ; Fetal cardiac arhyth$ias4

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    "aseline tachycardia

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    "aseline bradycardia

    5It is a F98 less than 2 B** bp$4 5It $ay be $ild ( 2 B** bp$4 ) or

    se1ere ( E 2 bp$4 )4

    5persistent $ild -etal bradycardia is usually

    benign4 hile se1ere bradycardia causedby

    -etal congenital heart block4

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    "aseline bradycardia

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    >ariability

    5baseline or beat B to Bbeat 1ariability is

    controlled by the balance between the

    sy$pathetic and parasy$pathetic ner1ous

    control o- the heart4

    5nor$al 1ariability is + + bp$4

    5it is reduced E + bp$4 in 0

    ; -etal hypo6ia4

    ; physiological during -etal sleep cycles4

    ; drugs as 7dethadine %barbiturates and

    atropine4

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    nor$al beat to beat 1ariability

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    8educed beat to beat 1ariability

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    Poor or absent 1ariability

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    Periodic F98

    periodic changes in the F98 $ay be either 0

    A4 Accelerations 0

    5 is associated with 7

    ; -etal $o1e$ents4

    ; uterine contractions4

    5 are considered benign and its presence

    indicates a well o6ygenated -etus4

    AccelarationAccelaration

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    nor$al F98 accelerations associated with -etal

    $o1e$ents ( reacti1e !S )

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    nor$al F98 accelerations with uterine

    contractions

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    DeccelarationDeccelaration

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    Decelerations 0classically well de@ned decelerations

    are described 7 early %1ariable and late4

    *4 ,arly deceleration 0

    ; this deceleration ha1e a uni-or$ shape

    ( bell)% starts early in the contraction and $irrors it4 ; the $agnitude o- the deceleration is

    E&bp$4 ; cause 0 head co$pression $ediated by 1agal reHe64 ; it occurs during the acti1e phase % they are benign 4

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    early deceleration

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    4>ariable deceleration 0

    ; it is the $ost co$$on deceleration pattern4

    ; it appears as abrupt -all and return in F98% preceded and -ollowed by s$all accelerations ( shoulders)4 ; they are 1ariable in shape > %? or shape % duration and ti$ing4 ; the $agnitude is usually +B bp$4 ; cause 0 cord co$pression4 i- it persists -etal hypo6ia occurs4 ; $ild 1ariable deceleration ( last E sec4) is

    benign4 $oderate (last B3 sec4) and se1ere (last J 3sec4)

    indicates -etal hypo6ia4

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    >ariable deceleration4

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    4 =ate deceleration0

    ; it ha1e a si$ilar shape and $agnitudeas

    early deceleration but their ti$ing is

    diKerent4

    ; it start as the contraction peaks anddoes

    not return to the baseline F98 until a-ter

    the end o- the contraction4

    ; cause 0 -etal hypo6ia4

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    =ate decelerations

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    Prolonged deceleration

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    (up) Sinusoidal pattern% (down) PseudoBsinusoidal

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    'utco$e'utco$e

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    8eassuring ( nor$al ) F98 pattern4

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    LAAG'8I I 0 Pola D !or$alLAAG'8I I 0 Pola D !or$al

    ;11..Frekuensi dasar D 0 ** *3 dp$Frekuensi dasar D 0 ** *3 dp$

    ;22..>ariabilitas D 0 $oderat (+ + dp$)>ariabilitas D 0 $oderat (+ + dp$)

    ;33..idak ada deselerasi la$bat dan 1ariabelidak ada deselerasi la$bat dan 1ariabel

    ;44..idak ada atau ada deselerasi diniidak ada atau ada deselerasi dini;55..Ada atau tidak ada akselerasiAda atau tidak ada akselerasi

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    LAAG'8I II 0 Pola D ,kui1okalLAAG'8I II 0 Pola D ,kui1okal

    ;11..Frekuensi dasar D 0 "radikardia (E** dp$) yang tidak disertaiFrekuensi dasar D 0 "radikardia (E** dp$) yang tidak disertaihilangnya 1ariabilitas (absent 1ariability)hilangnya 1ariabilitas (absent 1ariability)

    ;22..akhikardia ( D J*3 dp$)akhikardia ( D J*3 dp$)

    ;33..>ariabilitas $ini$al (* + dp$)>ariabilitas $ini$al (* + dp$)

    ;44..idak ada 1ariabilitas% tanpa disertai deselerasi berulangidak ada 1ariabilitas% tanpa disertai deselerasi berulang;55..>ariabilitas J + dp$ ($arked 1ariability)>ariabilitas J + dp$ ($arked 1ariability)

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    LLAAG'8I III 0 Pola D abnor$alAAG'8I III 0 Pola D abnor$al

    ;11..Deselerasi la$bat berulangDeselerasi la$bat berulang

    ;22..Deselerasi 1ariabel berulangDeselerasi 1ariabel berulang

    ;33..

    "radikardia"radikardia;44..Pola sinusoid (sinusoidal pattern)Pola sinusoid (sinusoidal pattern)

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    Manage$ent

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    A. Reversible cause:

    5 stop o6ytocin 4

    5 treat hypotension4 5 $aternal repositioning

    in le-t lateral position4

    5 relie1e pain N -ear4 5 gi1e o6ygen to $other4

    5 treat $aternal -e1er4 5 pel1ic e6a$0 ; to e6clude cord prolapse4

    ; c64 -ully dilated carry out assisted 1aginal deli1ery4

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    B. Irreversible cause :

    c64 is not -ully dilated with persistent nonB reassuring F98 patterns4

    5 i$$ediate deli1ery and e6traB uterine

    resuscitation4

    5 -etal scalp blood p9deter$ination 0

    ; i- p9 JO4+ obser1e4; i- p9 O4 O4+ repeat4

    ; i- p9 EO4 CS4

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    hank you