ANTENATAL ASSESSMENT

FETAL WELLBEING
Introduction
• 80% of fetal deaths occur in the antepartum period.
• There is a progressive decline in maternal deaths all over
the world.Currently,more interest is focused to evaluate
fetal health
• Primary objective is to avoid fetal death.
Aims of antenatal fetal monitoring
• To ensure satisfactory growth and wellbeing of the fetus
throughout the pregnancy.
• To screen out the high-risk factors that affect the growth of
the fetus.
Methods
Clinical monitoring
• Maternal weight gain
• Blood pressure
• Assessment of size of uterus and height of fundus
• Clinical assessment of liquor
• Documentation of abdominal girth in last trimester
Biophysical tests used
• Fetal movement count
• Ultrasonography
• Cardiotocography
• Non-stress test(NST)
• Fetal biophysical profile
• Doppler ultrasound
• Vibroacoustic stimulation test
• Contraction stress test(CST)
• Amniotic fluid volume
Non-stress test
• HISTORY: Freeman , Lee and collegues (1975)
introduced not stress test to describe FHR acceleration in
response to fetal movements as a sign of fetal health.
• It is continuous electronic monitoring of the fetal heart
rate along with recording of fetal movements.
• It is a non invasive screening test valuable to identify the
fetal wellness rather than illness.
When to perform NST

• After 32 weeks
• Twice weekly in high risk pregnancy.
• High risk : Post term pregnancy
Multifetal pregnancy
DM type 1
Fetal growth restrictions
Gestational Hypertension
• Additional testing for maternal or fetal deterioration
• Done frequently or daily in sever preeclampsia ,and
uncontrolled diabetes.
• Routinely done once weekly.
Principle of NST
• Fetal activity reflex acceleration in heart rate

• Required fetal maturity is reached approximately 32

weeks of gestation, hence performed thereafter.
Components Of NST
• Fetal heart rate : 110-160 bpm

Causes of fetal bradycardia <110

Fetal - Fetal hypoxia , Fetal arrhythmia
Maternal - Maternal hypotension
Abruptio placenta
Uterine rupture
Hyperstimulation of uterus

Causes of fetal tachycardia :>160

Fetal – hypoxia , anemia , cardiac arrythmia
Maternal –Fever , infection, Anxiety, anaemia,
drugs like anticholinergic (atropine)
,
dehydration
Beat to beat variability
Normal -5 to 25bpm
Absent or <5 marker of fetal distress

Sine wave pattern:Sinusoidal pattern

Indicates fetal anemia , seen in
• Vasa previa
• Twin to twin transfusion Syndrome
• Rh isoimmunization

Management – immediate termination of pregnancy / emergency

c - section
Fetal heart rate acceleration :

When fetal movement occurs

|
FHR increases by 15 bpm × 15 secs
It denotes a healthy fetus
Procedure

• Transducer for FHR

• Transducer for contractions
• Marker buttons for recording
fetal movements
• Test takes 20-60 minutes.
Graph : upper 2/3 - FHR
lower 1/3 - uterine contractions
y axis – FHR in bpm each small box : 10bpm
x axis – time each small box : 10seconds

Baseline
Interpretations
• Reactive(reassuring):
Two or more accelerations of more than 15 bpm
above baseline and lasting more than 15 seconds or more
,and all occurring within 20 minute observation.
• Non-reactive (non reassuring):
Absence of any fetal reactivity.
• Non reactive results are observed when fetus is asleep,
fetal hypoxia, maternal smoking, maternal use of
medications and fetal neurological or cardiac anomalies.
• Non reactive tests need further evaluations.
Advantages Disadvantages

Significant imrovement of perinatal

Observations error in interpretations
mortality.

Accurate monitoring of uterine Cesarian rates high due to

contractions interpretation error.

Can detect hypoxia early & non-

invasive procedure
Thank you !!