ANTEPARTUM

FETAL PGI PASCUA FLORENCE

ANTHONY C.

ASSESSMENT
 Fetal Movement

Fetal Breathing

ANTEPARTUM Contraction Stress Testing

FETAL
ASSESSMENT Nonstress Test

Biophysical Profile

Amniotic Fluid Volume

 Techniques employed to
evaluate fetal health focus

Antepartum Aims to prevent fetal

Fetal death yet avoid
Assessment unnecessary interventions
normal results is highly
reassuring
 • Commences as
early as 7 weeks
AOG
Fetal Fetal
Behavioral
• 20 to 30 weeks
AOG- organized
Movements States body movements
(rest activity cycle)
• 36 weeks AOG-
behavioral states
 Fetal Behavioral States
State quiescent state—quiet sleep—with a
1F narrow oscillatory bandwidth of the FHR
State frequent gross body movements,
2F continuous eye movements, and wider
Fetal oscillation of the fetal heart rate,
analogous to REM
Movements State continuous eye movements in the
3F absence of body movements and HR
accelerations
State vigorous body movement with
4F continuous eye movements and heart
rate accelerations, corresponds to the
awake state in newborns
Fetal
Movements
Fetal Behavioral
States
• 28 to 30 weeks
AOG- state 1F
and 2F
 Sleep awake cycles (independent of
maternal ones) mean duration of 60
Fetal minutes. (23 minutes- quiet states, 40
minutes- active states)
Movements
determinants Amniotic fluid volume- fetal activity
declined in those with diminished
of fetal amnionic volumes (restricted uterine
space)
activity Patient habits and medications- maternal
smoking, methadone and buprenorphine,
betamethasone decrease fetal movement
while glucose load promote activity
Fetal
Movements
Maternal Perceptions
• weak, strong, and rolling
• as pregnancy advances,
rate of weak movements
drops, and vigorous ones
rise. The latter then
subside at term
• High BMI does not
decrease maternal
perception of fetal
movement
 evaluated as a preventive aid

Fetal
Movements optimal fetal-movement protocol
remains undefined
clinical • quantitative counts (10 movements in 2 hours)
application • mother’s subjective perception

informal maternal impressions were

as valid as recorded fetal movement
counts
 Clinical Applications
• long-standing pillar of
maternal care but may not be
as predictive as thought
Fetal • patient and staff education
Movements and prescriptive management
plan did not reduce stillbirth
incidence
• maternal perception of
reduced fetal activity warrants
further evaluation
Fetal
Breathing
• Small inward and
outward flow of tracheal
fluid, indicating thoracic
movement
• paradoxical chest wall
movement- coughing to
clear amnionic fluid
debris
• exchange of amniotic
fluid- essential for
normal lung
development
 gasps or sighs (frequency of 1 to 4 per
minute) irregular bursts of breathing
(240 cycles per minute)

Fetal fetal respiratory rate declined in

conjunction with increasing respiratory

Breathing volume at 33 to 36 AOG and coincided

with lung maturation

maternal hypoglycemia, sound stimuli,

cigarette smoking, amniocentesis,
impending preterm labor, and labor—
normal for fetal respiration to cease
Fetal
Breathing
interpretation of fetal health
when respirations are absent
may be difficult

diminished breathing during at

night suggests a diurnal pattern

enhanced somewhat following

maternal meals
Contraction Stress Test

lowers blood flow to

uterine contraction
the placenta

*uteroplacental
Brief periods of pathology= late
impaired oxygen decelerations
exchange result *cord compression=
variable decelerations
Contraction
Stress Test
• oxytocin challenge
test
• positive test result-
uniform repetitive
late fetal heart rate
decelerations
• negative CST results-
forecasted fetal
health
 induced with IV oxytocin or nipple stimulation.

At least 3 spontaneous contractions of 40 seconds or

Contraction
longer are present in a 10-min span

Stress Test Nipple stimulation- rub one nipple through clothing for
2 minutes or until contraction begins (induces 3
contractions per 10 min). Can retry after 5-minute rest
interval

20 units oxytocin+1L Ringer solution and initiated at 6

mU/min. Increased by 6 mU/min every 40 minutes.
Contraction Stress Test
 employs phenomenon of fetal
heart rate acceleration in
response to fetal movement

Nonstress a test of fetal condition (CST is

as test of uteroplacental
Test function)

most widely used primary

testing method
Nonstress
Test
Fetal Heart Rate
Acceleration
• HR of a fetus that is not
acidemic will temporarily
accelerate in response to
fetal movement
• at or beyond 32 weeks
AOG= ≥15 bpm above
baseline rate, lasts ≥15
sec but < 2 min
• Before 32 weeks= ≥10
bpm above baseline for
≥10 sec
Nonstress
Test
Reactive Nonstress Test
• requires two or more
accelerations within 20
min (accepted irrespective
of fetal movement)
• if nonreactive, a 40-min
tracing is performed
(accounts for fetal sleep
cycles)
• more likely to be reactive
and have a shorter testing
time in the evening
 Reactive Nonstress Test
• loud external sounds have been
used to startle the fetus and provoke
HR acceleration
Nonstress • acoustic stimulator is positioned on
the maternal abdomen, and a
Test stimulus of 1 to 2 seconds is applied
maybe repeated up to 3 times for up
to 3 seconds
• vibroacoustic stimulation lowered
the average testing time and
incidence of nonreactive test results
 Reactive Nonstress Test
• absence does not invariably
predict fetal compromise
Nonstress • healthy fetuses may not
move for up to 75 min
Test • either the test became
reactive during a period up
to 80 min or the test
remained nonreactive for 120
min, indicated a very ill fetus.
Nonstress
Test
Nonreactive
Nonstress Test
• not always ominous
and can be seen with
a sleeping fetus
• can revert to normal
as fetal condition
changes
Nonstress
Test
Nonreactive Nonstress Test
• Some abnormal patterns
forecast severe fetal jeopardy
• >90 percent of NST results that
were nonreactive for 90 min=
significant perinatal pathology
• terminal cardiotocogram
(1) baseline variability (2) absent
accelerations (3) late
decelerations with spontaneous
uterine contractions
 Interval Between Testing
• Set originally and
arbitrarily at 7 days
• Weekly- stable maternal
Nonstress medical conditions
(pregestational DM,
Test chronic HPN)
• Daily- For high-risk
conditions such as
preeclampsia remote
from term
 Decelerations During
Nonstress Testing
• Variable fetal HR
decelerations during NSTs
were not a sign of fetal
compromise

Nonstress • Nonrepetitive, brief (<30

sec) variable decelerations
do not indicate fetal
Test compromise or the need for
obstetrical intervention
• Repetitive variable
decelerations (at least 3 in
20 min) associated with a
greater risk of CS delivery
for fetal distress
 heart rate acceleration, breathing,
movement, tone, and amnionic fluid
volume
normal variable=2, abnormal
variables=0
Biophysical
Profile 30 min are allotted to perform a BPP
before a score of 0 is assigned to any
component
higher if performed late in the
evening, narcotics and sedatives
lower the score
BIOPHYSICAL
PROFILE
BIOPHYSICAL
PROFILE
 Modified BPP
• NST + AFV assessment
• abbreviated BPP required
approximately 10 min to
Biophysical perform
Profile • considered a superb
antepartum surveillance
• modified BPP are comparable
to other biophysical fetal
surveillance approaches in
predicting fetal well-being
Amniotic Fluid Volume

diminished uteroplacental perfusion

lower fetal renal blood flow

decreased urine production

oligohydramnios
 measured by AFI or by single deepest
vertical pocket (DVP)

Amniotic
An AFI ≤5 cm and a DVP ≤2 cm is
considered abnormal

Fluid AFI led to a higher rate of oligohydramnios

Volume
diagnoses and induction of labor yet
perinatal outcomes were not improved

DVP measurement is associated with fewer

unnecessary interventions but comparable
perinatal outcomes
Thank you!