My Panel Discussion on Fetal Monitoring

1. Moderator- Dr.Sameer Dikshit

3. Dr.Poonam Loomba

4. Dr.Ratna Kaul

5. Dr.Chander Lulla

6. Dr.Sabuj Sengupta

7. Dr.Madhuri Sengupta

10. How will you proceed?

11. USG done showed:-

12. 28 weeks GA Measurement Weeks BPD 64 mm 26 weeks HC 234 mm 25 week 4 days AC 201 mm 24 weeks 5 days FL 44 mm 24 weeks 3 days

13. Is this information sufficient?

14. 28 weeks GA Measurement Weeks Centile BPD 64 mm 26 weeks <2 nd HC 234 mm 25 week 4 days <2 nd AC 201 mm 24 weeks 5 days <2 nd FL 44 mm 24 weeks 3 days <2 nd

15. Would you call this IUGR?

16. 28 weeks GA Measurement Weeks Centile BPD 64 mm 26 weeks <2 nd HC 234 mm 25 week 4 days <2 nd AC 201 mm 24 weeks 5 days <2 nd FL 44 mm 24 weeks 3 days <2 nd Weight 735 gms 10 th

17. Now, would you call this IUGR? What is more significant? AC or EFW?

19. Umbilical Vein (LUV) Intra hepatic portion of UV Portal Sinus Right Portal vein Ductus Venosus IVC Left Portal vein Left Hepatic vein Right Hepatic vein Superior mesenteric vein & splenic vein Left Liver Lobe Right Liver Lobe

23. Let us assume that both AC and EFW are less

24. 28 weeks GA Measurement Weeks Centile BPD 64 mm 26 weeks <2 nd HC 234 mm 25 week 4 days <2 nd AC 201 mm 24 weeks 5 days <2 nd FL 44 mm 24 weeks 3 days <2 nd Weight 535 gms <2 nd

25. Any other sonography finding you would like to know?

26. 28 weeks GA Measurement Weeks Centile BPD 64 mm 26 weeks <2 nd HC 234 mm 25 week 4 days <2 nd AC 201 mm 24 weeks 5 days <2 nd FL 44 mm 24 weeks 3 days <2 nd Weight 735 gms 10 th AFI 15 cm

27. What investigations would you like to do?

35. Could this be a genetic syndrome?

40. What about Doppler Studies?

41. What vessels will you study?

43. What are cut-off values?

44. http://www.perinatology.com/calculators/umbilicalartery.htm

45. http://www.perinatology.com/calculators/exbiometry.htm

46. At 30 weeks.. 5 th centile 95 th centile Umb Artery PI 1.1 0.88 1.39 MCA PI 2.1 1.51 3.0 CPR 1.9

47. What is the interpretation? When will you repeat the test?

48. At 32 weeks.. 5 th centile 95 th centile Umb Artery PI 1.4 0.7 1.23 MCA PI 1.8 1.5 2.8 CPR 1.28

49. What is the interpretation? How often will you monitor the pregnancy now?

50. At 33 weeks.. 5 th centile 95 th centile Umb Artery PI 1.7 0.6 1.21 MCA PI 1.2 1.4 2.7 CPR 0.7

51. Ductus Venosus doppler shows “A wave reversal. What will you do now?

52. Is there some test before DV abnormalities?

53. Reversal of flow in Aortic Isthmus

57. Doppler Parameter Days to delivery/ demise Abn Umb A PI 3 weeks Abn CPR 2 weeks Absent Umb A EDV 10 days Abn MCA PI 7 days Reversed Umb A EDV 5 days Elevated DV PI 3 days Umb V Pulsation 2 days Reversed DV a Wave 1 day

65. Role of NST….?

66. If NST is non reactive at 37 weeks, which Doppler study would you recommend?

74. Is there any role of Fetal Biophysical Profile?

75. Uterine Artery Doppler showed bilateral diastolic notches. What is the significance?

76. How will you manage the pregnancy during labour?

77. Role of Fetal ST wave analysis?

78. STAN S-31

83. What about Fetal Pulse Oximeters?

86. Where does continuous electronic Fetal Monitoring stack??

92. Which is the better route for cervical length assessment? PA or PV??

94. What is the technique for measuring cervical length?

97. What is the significance of cervical length?

100. What is the significance of past h/o Preterm Delivery in the obstetric outcome

102. Is there a role for routine screening for bacterial vaginosis?

105. Would you offer the patient elective cerclage?

110. Before cerclage

111. Immediately after cerclage

112. 4 weeks post cerclage

121. What is the role of Fetal Fibronectin?

124. Amniotic Fluid Sludge

127. Images of Cervix

128. Dilatation of cervix

129. Funneling of cervix

130. Herniation of membranes

131. What is the significance of funneling?

136. Is this report adequate?

138. It is monochorionic Twin Pregnancy How will you monitor the pregnancy?

139. She comes for First Trimester Screening  What is more significant? NT or Biochemistry or Both?

140. What is the false positive of NT measurement in Monochorionic Twins Pregnancy?

141. Can one predict development of TTS?

143. No development of TTTS

144. TTTS developed later

147. How frequently should one monitor the pregnancy? And what should one monitor?

150. What are the signs of TTTS?

152. The pregnancy progresses to 26 weeks, there is no TTS, how will you monitor the pregnancy?

153. Role of cervical screening

157. What counseling will you offer?

158. What other tests will you do?

159. What is the role of TORCH test?

160. Toxo IgG negative, IgM negative  ?

161. Toxo IgG positive, Toxo IgM positive 

162. Toxo IgG negative, Toxo IgM positive 

164. What are the sonological markers of TORCH infection?

166. When do these markers appear??

167. What is Toxo Avidity Test? How do you interpret it?

169. What test will you perform next?

171. GA @ sero -conversion Risk of congenital infection Development of severe clinical signs Avidity Test Amniotic fluid PCR 1 st Trimester 6% 61% High If negative, then fetal infection is ruled out 2 nd Trimester 40% 25% 3 rd Trimester 72% 9%

173. How will you treat the patient?

175. How will you monitor the fetus?

176. What things will you look for in Ultrasound examination?

178. What are sonological signs of poor glycemic control?

180. How will you monitor the fetal well being?

181. What is the role of Doppler?

185. Can you predict shoulder dystocia?

189. When would you carry out investigations?

190. What investigations would you carry out?

191. Role of NST?

192. Role of Fetal BPP?

193. Role of Doppler?

195. What advise will you give”

196. Is the risk higher? By what percent?

197. Will you go for straight invasive testing?

199. CVS or Amnio?

200. FISH of full Karyotype?

201. What about cell free DNA?

202. Karyotype is Normal….what next?