She is 25 yrs primi EDD 25May 2016 c/o decrease foetal movements.Her BP and other reports are normal.U/s shows single loop of cord around neck.Colour Doppler study is normal.CTG done at different times ranges between 106/min to 160/min.Kindly suggest further plan of tt.

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it is variable decelaration mostly due to cord compression.here on loop of cord around neck is their.vaginal delivery possible under strict FHS MONITORING.button here pt.is primi discussion is must with pt about risk of fetal distress during trial if she not allow go for LSCS.

monitoring the BPP
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As she is a primi with reduced fetal movements, cord round the neck, variable decelerations, it is better to do LSCS. we usually find babies with multiple loops of cord round the neck, noticed after delivery. induction of labour with close monitoring of FHR and vacuum delivery also can be done after explaining the patient.

THE LOW HR MAY BE CORD ROUND THE NECK, ITS SIGNIFICANT IF ASSPCIATED WTH MOMENT OF FETUS.EVERY THING IS NORMAL TILL NOW, WAIT FOR NOMAL LABOUR PAINS TO START.WAIT &REVIEW SCAN ON DAY OF EDD , IF AFI IS GOOD NST NORMAL WAIT FOR ONE MORE WK, THEN ADMIT FOR INDUCTION IF CX IS FAVOURABLE .THE STATION OF PRESENTATION IT IS STILL UNENGAGED NEGATVE FACTOR .SHORT & TIGHT CORD LOOP LIKR 8ROUND YHE NECK ARE PROBLEMS

I WONT FOLLOW THIS PROPERLY. IT WAS GIVEN AS DICREASED FETALMOVEMENTS BUT NST SHOWS INCREASED FMS.PERCEPTION FMS BY MOTHER IS MORE SIGNIFICANT WITH VARIATIONS IN NST. If mother is not in active labour continous monitoring for 24 hrs observe the decelarations &FMS IF PERSISTING BRADY WITH DECREASED PERCEPTION BETTER GO FOR ELCTIVE SECTION.FMS INDICATES THE CONSISTENCY FETAL ANS.FETAL HYPOXIA INITIALLY TACHYCARDIA , IF PERSISTS LEADS BRADY.INTRPRETATION OF NST IS MORE IMP, OBSERVER VARIABLES ARE THERE. IN MY EXPERIENCE BEFORE THE ONSET OF FETAL DEMISE THERE WILL FLUTTER LIKE , FAST, MOVEMENTS FOLLWED BY DECREASED FMS. ITS VERY DIFFICULT TO ASSES THE TIME BETWEEN FETAL DISTRESS TO FETAL DEATH, WE CAN DIAGNOSE FETAL DISTRESS ONLY.SO BETTER TO ALERT IF MATERNAL PERCEPTION IS STILL THE SAME EVEN AFTER 24HRS OBSERVSTION IN THIS CASE. FOR ALL ANC PT BETTER GIVE KICK COUNT CHART AFTER COMPLETION OF 34WKS

THE LOW HR MAY BE CORD ROUND THE NECK, ITS SIGNIFICANT IF ASSPCIATED WTH MOMENT OF FETUS.EVERY THING IS NORMAL TILL NOW, WAIT FOR NOMAL LABOUR PAINS TO START.WAIT &REVIEW SCAN ON DAY OF EDD , IF AFI IS GOOD NST NORMAL WAIT FOR ONE MORE WK, THEN ADMIT FOR INDUCTION IF CX IS FAVOURABLE .THE STATION OF PRESENTATION IT IS STILL UNENGAGED NEGATVE FACTOR .SHORT & TIGHT CORD LOOP LIKR 8ROUND YHE NECK ARE PROBLEMS

as fetal movements are decreasing ask patient to look over the movement also do Usg still it goes on decreasing discuss with patient about the risk and as PT is primi we can try for vaginal delivery but if movements goes on decreasing then just inform PT and can go with section without wasting time

decrease fetal movement near term may not cause anxiety if AFI , CTG,fetal Doppler are normal .fetal kick count & close monitoring in low risk cases.In high risk cases one has to consider other factors .

decrease FMS NEAR TERM IS NORMAL AS PRESENTING IS ENGAGED OR FRANK BREECH, HERE IS MATERNAL PERCEPTION IS OF SIGNIFICANCE ESPECIALLY NEAR TERM. EVEN OLIGO THE MOVEMENTS PERCEIVED BY MOTHER BUT FETAL HYPOXIA leads to decreased fms .
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This is a reactive NST, no decelerations but excessive fetal movement present. repeat CTG more frequently. Other wise u can wait for pt to set in for spontaneous labour .

fetal movement may be decreased after engagement of head,which occurs at term in primi ,As usg with Doppler and CTG is normal we will not expect placental insufficiency.single round of cord will not pose any problem till pt is not in labour.so wait for onset of labor, weekly NST can be done ,but Intrapartum CTG monitoring should be done

if she entered active labour whether natural or induced strict vigilance with guidance of PARTOGRAM&FETAL MONITORING THROUGH OUT THE LABOUR.

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