INTRAPARTUM

ASSESSMENT
Jonelle Baloloy, MD
MCMC OB Gyne
 INTRAPARTUM ASSESSMENT
• INTERNAL/DIRECT ELECTRONIC
MONITORING
• Bipolar electrode placed directly to the fetus (scalp
electrode)
• More precise
• EXTERNAL/ INDIRECT ELECTRONIC
MONITORING
• FHR detected through maternal abdominal wall
using ultrasound doppler principle
DEFINITION OF TERMS
BASELINE VARIABILITY
• FHR rounded to • Fluctuations in FHT that
increments of 5bpm in a are irregular in amplitude
10-min segment and frequency
• Minimum of 2min in any • ABSENT: range
10-min segment undetectable
• NORMAL FHR- 110- • MINIMAL: < or = 5bpm
160bpm
ACCELERATION
• ABRUPT increase in FHR <30seconds
• Before 32 weeks AOG- acceleration peak of 15 bpm
• PROLONGED ACCELERATION- >2mins but <10 mins
• Causes:
• fetal movement,
• Contractions,
• Umbilical cord occlusion,
• Fetal stimulation
• ALWAYS REASSURING
EARLY DECELETATION
• Deceleration symmetrical,
gradual decrease and return of FHR
FHR
• Mirror image of contraction
• Physiological response
• Not associated with fetal
hypoxia, acidemia or low
APGAR scores
• Causes:
LATE DECELERATION
• Gradual decrease and return to
• After the contraction
• Reflects uterine perfusion or
placental function =
COMPROMISED
UTEROPLACENTAL
PERFUSION 
uteroplacental-induced
hypoxia
VARIABLE •Decrease in FHR
DECELERATION below baseline
•Abrupt decrease less >15bpm and less
than 30 secs than 2 mins and
•FHR decreased 15 return to baseline
bpm or greater FHR
lasting >15 seconds •Causes:
and less than 2 mins •Uterine
Interpretation of Tracing
CATEGORY I- Normal

Include all of the following:

• Baseline rate: 11—160 bpm
• Baseline FHR variability: Moderate
• Late or variable decelerations: Absent
• Early decelerations: Present or Absent
• Accelerations: Present or Absent
 CATEGORY II- Indeterminate
• All FHR tracings not categorized
as Category I or III.
Baseline rate:
• Bradycardia not accompanied by
absent baseline variability
• Tachycardia
Baseline FHR variability:
• Minimal baseline variability
• Absent baseline variability not
Accelerations
• Absence of induced accelerations
after fetal stimulation
Periodic or episodic decelerations
• Recurrent variable decelerations
accompanied by minimal or
moderate baseline variability
• Prolonged deceleration > 2min but
<10 min
CATEGORY III- Abnormal
Include either:
• Absent baseline FHR variability and any of the following
• Recurrent late decelerations
• Recurrent variable decelerations
• Recurrent variable decelerations
• Bradycardia
• Sinusoidal pattern
• IV hydration- 500-1000mL lactated ringer solution given over 20 mins
• Lateral decubitus positioning
• Administration of oxygen at 10 L/min using a nonrebreathing mask
MANAGEMENT
• Terbutaline sulfate- to inhibit uterine contractions and improve
fetal oxygenation
• Amnioinfusion- for variable or prolonged decelerations attributable
to cord entrapment
• Variable or prolonged decelerations
• Oligohyrdambios as with prolonged PROM
• Dilute or wash out thick meconium
CASE SERIES
CASE #1
P.C; 42 y/o
• Stable VS
• FHR: 139bpm
• FH: 30cm
• IE: Cx 1cm dil. 50% eff., cephalic st -3, (+) leaking bow
thinly stained AF.
•Diagnosis: G1P0 PU 41 2/7wks AOG, Cephalic
in beginning labor; PROM x 15hrs.
• BFHR- 120-124bpm
• Moderate variability
• (+) Accelerations
• (-) Decelerations
• (+) Mild contractions
every 8-10 mins
• Impression: Category
1
Final Diagnosis

Gravida 1 Para 1 (1001) pregnancy uterine

term cephalic delivered live baby boy AS 9,9
BW 3000gms, AGA, by NSD
CASE #2
B,C; 26 y/o
• Stable VS
• FH: 29cm
• IE: cx 1cm dilated, beg eff cephalic st -3; (-) bow. Thickly
MSAF.
•Diagnosis: G1P0 PU 41 4/7wks AOG CIBL;
PROM x 3hrs. t/c IUGR; GDM.
• BFHR- 160-165 bpm
• Moderate variability
• (+) Accelerations
• (-) Decelerations
• (+) Mild contractions
• Impression: Category
2 for fetal tachycardia
• BFHR- 140—145 bpm
• Reduced variability
• (+) Acceleration (1 in a
10 min trace)
• (+) 3 spontaneous
decelerations dipping to
30 beats below baseline
• (-) Contractions
• Impression: Category 3
for recurrent variable
decelerations with
reduced variability
FINAL DIAGNOSIS

• G2P2 (2002) PU term cephalic delivered

live baby boy AS 9,9 BW 2800gms, AGA
by LTCS for NRFS (Category III); GDM-
diet controlled
CASE # 3
R,P; 31 y/o
• Stable VS
• FH: 25cm
• IE: Cervix 3cm dilated, 50% effaced; cephalic, st -3; (+)
bow.
•Diagnosis: G2P1 (1001) PU 33 6/7 weeks AOG,
Cephalic in preterm labor, Preeclampsia severe
• BFHR- 135-140bpm
• Moderate variability
• (+) Accelerations
• (-) Deccelerations
• No contractions
• Impression: Reactive
• FHT- 120-125bpm
• Marked variability
• (-) Accelerations
• (-) Decelerations
• No contractions
• Impression: Category
2 for absence of
accelerations and
marked variability
• FHT- 115-120bpm
• Marked variability
• (-) Accelerations
• (-) Decelerations
• No contractions
• Impression: Category
2 for absence of
accelerations and
marked variability
• BFR- 130-135bpm
• Moderate variability
• (+) accelerations
• (-) decelerations
• (+) mild contractions
every 3-5mins
• Interpretation:
category 1
• BFR- 105-110bpm
• Moderate variability
• (+) accelerations
• (-) Decelerations
• (+) Mild Irregular
Contractions
• Interpretation:
category 3 for
baseline change (fetal
bradycardia)
Final Diagnosis

Gravida 2 Para 2 (1102) Pregnancy Uterine

Preterm Cephalic Delivered Live baby boy AS
5,7 BW 2100g, BS 33 weeks, AGA by Low
Transverse Cesarean Section for Non Reassuring
Fetal Status (Category III) under Spinal
Anesthesia; Preeclampsia Severe-controlled
CASE #4
B,R; 26 y/o
• Stable VS
• FH: 30cm
• IE: Cervix 1cm dilated, beginning effacement; cephalic, st -3;
Leaking BOW.
•Diagnosis: G1P0 PU 38 6/7 weeks AOG, CBIL,
PROM x 3hrs; CAP-MR; COVID Suspect
• BFR- 130-135 bpm
• Moderate variability
• (+) accelerations
• (-) Decelerations
• (+) Moderate
irregular
contractions
• Interpretation:
category 1
• BFR- 130-135 bpm
• Reduced variability
• (+) 1 episode of
acceleration in a 10 min
trace
• (-) Decelerations
• (+) Moderate
contractions every 3-5
mins
• Interpretation: category
2 for reduced variability
• BFR- 130-135 bpm
• Moderate variability
• (-) Acceleration
• (+) Spontaneous
deceleration dipping as
low as 70 beats below the
baseline lasting for 4 mins
• (+) Moderate contractions
every 2-5 mins
• Interpretation: category 2
for prolonged deceleration
• BFR- 130-135 bpm
• Moderate variability
• (-) Acceleration
• (+) Spontaneous
deceleration dipping as
low as 70 beats below the
baseline lasting for 4 mins
• (+) Moderate contractions
every 2-5 mins
• Interpretation: category 2
for prolonged deceleration
Final Diagnosis

G1P0 Pregnancy uterine term cephalic

delivered live baby boy AS 9,9 BW 3000gms
by LTCS for NRFS (Category III, prolonged
deceleration) under spinal anesthesia; CAP-
MR-resolved; COVID suspect
Thank you.