Fetal monitoring during pregnancy and labor

Antenatalna skrb je u današnjem obliku prisutna zadnjih nekoliko desetljeća, a uključuje nadzor majke i djeteta s ciljem poboljšanja prenatalnog ishoda. Osim probira fetalnih anomalija, glavna svrha prenatalnog nadzora je procjena uhranjenosti i poremećene oksigenacije. Iako je njihova detekcija danas najčešće korištenim metodama nadzora (CTG, dopler, biofizikalni profil) nesigurna, osnovni cilj je prepoznati ugroženost fetusa i dovršiti trudnoću prije nastanka nepovratnih oštećenja. U prvom tromjesečju potrebno je što ranije ultrazvukom procijeniti trajanje trudnoće te učiniti biometrijska mjerenja kako bi se kasnije u trudnoći moglo lakše primijetiti zaostajanje u rastu ili druga eventualna patologija. Ako se radi o trudnoći u kojoj postoji povećan rizik za fetalne anomalije, uputno je napraviti laboratorijski probir za Downov sindrom i anomalije zatvaranja neuralne cijevi. Za potvrdu pozitivnih laboratorijskih pretraga, provode se invazivne metode prenatalne dijagnostike. U slučaju sumnje na hipoksiju, tri su najčešće korištene metode nadzora. Biofizikalnim profilom, koji uključuje četiri ultrazvučno mjerene komponente i non-stress test, može se procijeniti trenutno stanje fetusa, a preko podatka o količini plodove vode dobiti uvid o kvaliteti oksigenacije tijekom dužeg perioda. Dopler umbilikalne arterije pokazao se kao dobar prediktor krajnjeg ishoda trudnoće, a u visokorizičnim trudnoćama u kombinaciji s non-stress testom dokazano dovodi do boljeg ishoda. Zlatni standard nadzora fetusa tijekom porođaja jest kardiotokografija. Iako postoje dvojbe oko nužnosti CTG-a u niskorizičnih trudnica, zasigurno je od važnosti u situacijama kada postoji sumnja na fetalnu hipoksiju. Dodatni načini procjene hipoksije tijekom poroda su fetalna pH-metrija i fetalna pulsna oksimetrija.Antenatal care in the form we know it today exists for last few decades and it includes mother and child supervision with the aim of improving the prenatal outcome. In addition to screening for fetal anomalies, the main purpose of prenatal surveillance is nutritional and impaired oxygenation estimation. Although their detection with most commonly used surveillance methods (CTG, Doppler, biophysical profile) is not entirely reliable, the primary goal is to identify fetal endurance and to complete pregnancy before irreversible damage occurs. In the first trimester, it is necessary to evaluate the duration of pregnancy by ultrasound and make biometric measurements so that growth restriction or other pathology can be more easily observed during pregnancy. If there is a higher risk for fetal anomalies, it is advisable to make a laboratory screening for Down's syndrome and the anomalous closure of the neural tube. In the case of positive laboratory tests, invasive methods of prenatal diagnosis are being carried out to confirm that findings. In case we doubt of hypoxia, there are three most commonly used methods of surveillance. The biophysical profile, which includes four ultrasound-measured components, can be used to estimate the current fetal state and to gain insight into the quality of oxygenation during a longer period of time. The umbilical artery Doppler has proven to be a good predictor of the ultimate outcome of pregnancy, and in high-risk pregnancies when combined with a non-stress test, it leads to a better outcome. The gold standard for fetal control during childbirth is cardiotocography. Although there is some doubt about the necessity of CTG in low-risk pregnant women, it is certainly of great importance in situations where there is suspicion of fetal hypoxia. Additional methods of hypoxia estimation during labor are fetal blood sampling and fetal pulse oximetry