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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