Assessment of fetal

wellbeing in pregnancy

Dr Ban Hadi 2020

 Factors which influence a woman’s
perception of this activity
Fetal ‘sleep’cycles .1
Maternal position .2
Drugs, smoking.3
Maternal blood glucose.4
Administration of corticosteroids.5
Fetal malformations, position.6
 How can fetal movements be
?assessed
Subjective maternal perception of fetal.1
movements
Objective assessments of fetal movements use .2
Doppler or real-time ultrasound
 Management of women with
RFM
: History.1
a. Risk factors for fetal growth restriction and intrauyerine
fetal death, duration of RFM
.b. Kick count: reassuring if 4 or more movements in 1 hr
or less indicate further assessment 3

A second approach is to have the mother begin counting fetal

movements when she wakes up in the morning and record the
number of hours required to feel 10 movements. On average, this
takes 2 to 3 hours. Again, maternal reports of decreased
movement should prompt further testing
:Examination.2
The key priority when a woman presents with RFM is
to confirm fetal viability. In most cases, a handheld
Doppler device will confirm the presence of the fetal
heart beat
General: BMI, general health
Vital signs: blood pressure
Abdominal exam. measurement of symphysis–fundal
height to detect small for gestation fetuses
CTG cardiotocography:.3
Non stress test
After fetal viability has been confirmed and
history confirms a decrease in fetal
movements, arrangements should be made
for the woman to have a CTG to exclude
fetal compromise if the pregnancy is over
28+0 weeks of gestation
At least two or more accelerations with fetal
movement in 20 min. by at least 15 bpm for 15
sec. is considered as reactive NST
Before 32 weeks, accelerations are defined as
having an acceleration that is 10 bpm or more
above baseline for 10 seconds or longer
.
A reactive NST is highly predictive of low risk
for fetal mortality in the subsequent 72 to 96
.hours and is still predictive at 1 week

After 32 weeks, a nonreactive tracing should

prompt further evaluation of fetal well-being,
such as measuring a biophysical profile
:Ultrasound.4
Ultrasound scan assessment should be undertaken
as part of the preliminary investigations of a
woman presenting with RFM after 28+0 weeks of
:gestation if
The perception of RFM persists despite a normal.1
CTG or
If there are any additional risk factors for.2
.FGR/stillbirth
Ultrasound scan assessment should include fetal
biometry: the assessment of abdominal
circumference and/or estimated fetal weight to
detect the SGA fetus, and the assessment of
.amniotic fluid volume

Ultrasound should include assessment of fetal

morphology if this has not previously been
performed
 Ultrasound.4
:Biophysical profile
A score of 6 raises concern, and the BPP should
be repeated in 6 to 24 hours, especially in
fetuses over 32 weeks' gestation. If the score
does not improve, delivery should be
considered, depending on gestational age and
individual circumstances. Scores of 4 or below
are worrisome, and delivery should be
considered, again depending on gestational age
and clinical context
Non stress Test and Amniotic Fluid Index (AFI). This
test is also known as the modified biophysical
.profile
In the third trimester, an AFI and NST are often
used together to assess fetal well-being. The AFI is
the sum of the maximum vertical pockets of
umbilical-cord-free amniotic fluid in each of the
four quadrants of the uterus. In general, the AFI
reflects fetal perfusion, and, if decreased, raises
.suspicion for placental insufficiency
A normal test has a reactive NST and an AFI greater
than 5 (and less than 25). An abnormal test lacks
.one or both of these findings
Doppler study: of the umbilical
.and middle cerebral art
A Normal diastolic flow
B Reduced diastolic flow
C Reversed diastolic flow
 :Contraction stress test.5
A positive‌CST is one in which late decelerations occur
with more than 50% of contractions. Late decelerations
are decelerations that reach their nadir after the peak of
.the contraction
Thank you