Antenatal Assessment of Fetal

Well Being

1
Antenatal Assessment….

• Majority (80%) of fetal deaths occur in the

antepartum period

• The important causes of deaths are

• Chronic fetal hypoxia (IUGR)
• Maternal complications
• e.g. diabetes, hypertension, infection
• Fetal congenital malformation
• Unexplained cause
2
Antenatal Assessment….
• About
• 30% of antepartum fetal deaths are due to asphyxia (IUGR,
post dates)
• 30% due to maternal complications (pre-eclampsia, placental
abruption, diabetes mellitus)
• 15% to congenital malformations and chromosomal
abnormalities
• 5% to infection
• 20% of stillbirths have no obvious cause
3
Antenatal Assessment….

• There is progressive decline in maternal deaths all

over the world
• But a decline in neonatal death is a little bit less
than maternal death

• Currently more interest is focused to evaluate the fetal

health

• The primary objective of antenatal fetal assessment is

to avoid fetal death 4
Aims of antenatal fetal monitoring:

• To ensure satisfactory growth and well being of the

fetus throughout pregnancy

• To screen out the high risk factors that affect the

growth of the fetus

5
Indications of AFS
• Antepartum fetal surveillance (AFS) is encouraged to all
pregnant women

• However AFS may be beneficial in obstetrical history and

current pregnancy conditions associated with increased
perinatal morbidity and mortality:
• Hypertensive disorders of pregnancy
• DM

• Post term pregnancy

• IUGR
• Previous still birth
6
Indications AFS …….
• Renal disease
• Hemolytic incompatibility
• Multiple gestation
• APH (placenta abnormalities)
• Decrease fetal movement
• As routine ante natal procedure

7
Conditions Predicted by AFS

• Prenatal death and IUGR

• Non reassuring fetal heart rate pattern (NRFHRP)

• Neonatal asphyxia

• Premature delivery

• Congenital abnormality

8
Antenatal Assessment….

9
Antenatal Assessment….

10
Antepartum Fetal Surveillance….

Types of Antepartum Fetal Surveillance

• The following are considered to be types of fetal

surveillances:
1. Fetal movement monitoring (FMM)
2. Non stress test (NST)
3. Contraction stress test (CST)
4. Biophysical profile (BPP)
5. Amniotic fluid volume index (AFI)
45
1. Fetal Movement Monitoring (Kick Chart)
• Decreased placental perfusion and fetal acidosis are
associated with decreased fetal movements
• This is the basis for maternal monitoring of fetal
movements or “the fetal movement count test”
• It requires no technology and is available to all women
• Test should done after 28 weeks of gestations
• It is known that
• The fetus stop to move if he has an attempt to
reduce O2 consumption
• Fetal movement increase with hypoglycemia
• Fetal movement monitoring (FMM) is appreciated by
the mother and its peak movement at the late evening
46
Fetal Movement Monitoring…..
Procedure and types of FMM
Any of the two methods can be applied:
1. Daily fetal movement count (DFMC)
• The mother counts the FMs she feels in 3 hours during the
period of 12 hours
• E.g. from 9 am to 9 pm (one hour at the beginning, one
hour at the middle and one hour at the end of this period)
• OR morning, afternoon and evening
• The count is multiplied by 4 to get the fetal movements in
12 hours
2. Count - to - ten Cardiff systems:
• The mother counts the fetal movements from 9 am till she
reaches 10 movements
• No further count is needed unless she did not count 10
movements in up to 12 hours 47
Fetal Movement Monitoring…..

Interpretation of FMM

Normal FMM is when:

• Daily fetal movement count (DFMC)

• Three counts each of one hour duration (morning,
noon and evening) are recommended

• Count - to - ten Cardiff systems

• > 10 movements per 12 hours
48
Fetal Movement Monitoring…..
Interpretation of FMM….
Abnormal FMM is when:
• Daily fetal movement count (DFMC)
• If there is decrease of the number of ‘kicks’ to less
than 10 in 12 hours (or less than 3 in each hour), it
indicates fetal compromise
• Count - to - ten Cardiff systems
• Less than 10 movements occur during 12 hours on
2 successive days or (no movement is perceived
even after 12 hours in a single day)
• It is an alarming sign and non-stress test is indicated

49
Factors affecting fetal kick perception:

• If the placenta is anterior, maternal perception of fetal

movements may be decreased
• Hydramnios reduces the mother's appreciation of fetal
activity
• Anomalies of the CNS are most commonly associated
with decreased activity

• Maternal activity (kick better felt at rest)

• Obesity reduces the mother's appreciation of fetal
activity
• Medications - maternal medications such as narcotics
or barbiturates may depress fetal movement
50
2. Non Stress Test (NST)
• Means observing acceleration of the FHR following fetal
activity

• There is an observed association of FHR acceleration with

fetal movements, which when present, indicates a healthy
fetus

• It should be emphasized that the test is valuable to identify

the fetal wellness rather than illness

• Absent FHR acceleration is found in case of quite fetal

sleep, CNS depression, IUGR, smokers, fetal acidosis,
oligohydramnios
51
Non Stress Test (NST)…..

• A Doppler ultrasound are used to monitor the fetal heart rate

and fetal activity simultaneously

• Done in outpatient and it takes 10 – 15 min

• No contra indication

• Testing should be started after 30 weeks and frequency should

be twice weekly

• Done in sitting or left lateral position (LLP)

• B/P every 10 – 15 min

• Recorded by patient or staff

52
Non Stress Test…..
Interpretation of NST
• Reactive/reassuring NST (normal result):
• If there is at least two acceleration of peak 15 bpm
above the baseline lasting 15 or more seconds in a 20
minute observation
• Non reactive/non-reassuring NST (abnormal)
• No acceleration (repeated after 20 min)
NOTE:
• A reactive NST should be repeated 3 or 4 days
• If the NST remains non reactive after 20 min
• CST and BPP should be done
53
3. Contraction Stress Test (Oxytocin Challenge Test)

• Interpretation of late declaration with the presence of uterine

contraction

• Nipple stimulation or Oxytocin 0.5 mµ/min to a maximum of

16mµ/min to achieve 3 contractions per 10min which lasts 40 – 60
sec
• If no contraction the amount is double every 15 to 20 min starting from
0.5mµ/min till maximum dose

• Can be done in labor ward with left lateral position (LLP)

• Monitor FHB by ultrasound and uterine contraction by

tocodynomometer 54
Contraction Stress Test…..

• CST carries a small risk of uterine hyper stimulation,

and it is contraindicated in patients who are:
At high risk for premature labor
A classic uterine scar
Or full-thickness scar from uterine surgery other
than a low transverse cesarean section
Those who have placenta previa

55
Contraction Stress Test…..
Interpretation CST
• Negative (Normal) – No late declaration
• Positive (Abnormal) – Consistent and persistent late
deceleration of FHR
• So that utero placental insufficiency is diagnosed
and delivery by caesarean section is recommended
• Suspicious – Inconsistent late declaration
• Hyper stimulation – 5 contraction in 10 min lasts > 90
sec
• Unsatisfactory stimulation – if 3 contraction per 10 min
which lasts 40 – 60 sec is not obtained

56
4. Amniotic Fluid Volume Index

• The sum of the four quadrant of the abdominal measurement of

the vertical depth of amniotic fluid pocket has been termed as
AFI

• Ultrasound examination is used

Interpretation of AFI

• AFI in between 10 – 12cm (Single vertical pocket > 2cm)  Is

normal

• AFI less than 5 - 8cm  Oligohydramnios

• AFI above 20 – 24cm  Polyhydramnios

57
5. Biophysical Profile (BPP)

• Ultrasound examination of the following features

composes the biophysical profile:

1. Fetal breathing movements (FBM)

2. Gross body movement (GBM)

3. Fetal tone (FT)

4. Amniotic fluid volume index (AFI)

5. NST
58
Biophysical Profile…..
• Each element is scored 0, 1 or 2 over 30 minutes giving
a maximum possible score of 10 (2X5)
• A score of <6 BPP indicate
• An evidence of fetal compromise
Function of BPP
Tells integrity of CNS by using:
Various reflex activities based on US
FHR monitoring based on US
Tocodynomometer for uterine contraction 59
N BPP 0 1 2
1 FBM If No One FBM lasts < 60 One FBM lasts > 60 sec in
FBM sec in 30 min 30 min duration
observation
2 GBM If No Only 1-2 movement in At least 3 discrete body
GBM 30 min movement in 30 minute
observation
3 FT No FT Only one episode of One episode of flexion
flexion and extension and extension of both
either the spine or spine and extremities in
extremities in 30 min 30 min. observation
observation
4 NST Non Less than 2 episode of More than 2 episode of
reactive acceleration of 15 BPM acceleration of 15 BPM
or no lasts 15 sec in 30 min from the normal baseline
acceleratio observation lasts 15 sec In 30 min
n observation
5 AFI - Single vertical pocket Single vertical pocket >
< 2cm 2cm

60
Biophysical Profile…..
Components and normal finding of BPP (in 30 min)
1. Fetal breathing movement (FBM)
• At least one episode > 60 second in 30 min observation
2. Gross body movement (GBM)
• At least 3 discrete body movement in 30 minute
3. Fetal tone
• At least one episode of active flexion and extension of both
spine and extremities
4. Amniotic fluid volume index
• If a single vertical pocket > 2 cm
5. NST
• At least more than 2 episodes of acceleration > 15 bpm lasts
15 sec in 30 min observation.
61
Biophysical Profile…..

Interpretation of BPP

• 8-10 BPP score is reassuring (normal)

• Repeat the test after a week

• 4-6 BPP score is non reassuring (abnormal)

• Deliver the fetus if gestation > 36 weeks and Cx is
favorable and lung maturity is confirmed

• 0-2 BPP score is also non reassuring

• Needing immediate delivery regardless of gestational age
62
63
Intrapartum Fetal Monitoring

64
Introduction

Intrapartum FHR monitoring

• Intrapartum FHR monitoring is used to assess fetal well-being

during labor

• It closely interprets the normal and abnormal FHR

Results of Intrapartum FHR monitoring

• Reassuring FHR pattern (RFHRP) = Uncompromised FHR
OR absence fetal acidosis
• Non reassuring FHR pattern(NRFHRP)= Compromised FHR
OR presence fetal acidosis
65
Reassuring FHR pattern (RFHRP)

• A reassuring FHR pattern is usually associated with

adequate oxygenation of the fetus and a newborn that
is energetic at birth

• When the FHR pattern is reassuring:

• A midwife can safely allow labor to proceed
• There is a low risk of perinatal asphyxia, which
refers to acidemia, hypoxia, and metabolic acidosis

66
Non reassuring FHR pattern (NRFHRP)

• A non-reassuring FHR pattern is a sign of potential

hypoxia

• When the FHR pattern is non-reassuring:

• A midwife must obtain other reassurance of fetal well-

being

• It may be necessary to expedite delivery

67
Methods of Fetal Heart Rate Monitoring
• Two ways
• Continuous monitoring FHR
• Intermittent FHR auscultation
A. Continuous monitoring/Electronic fetal monitoring
(CTG)
• Continuous recording & graphical representation of FHR &
uterine contractions
• Continuous monitoring is more commonly used in the
developed world
• The FHR pattern can be continuously evaluated in two ways
1. An external Electronic fetal monitoring
2. Internal Electronic fetal monitoring (A fetal scalp
electrode)
68
1. External Electronic fetal monitoring (EFM)

FHR is detected through maternal abdominal wall

using the ultrasound doppler principle
Doppler US signal Reflected signals from
moving fetal heart valves analyzed by
Microprocessor  Converted to FHR

69
70
External Electronic fetal monitoring…

Advantages
Noninvasive, less risk of trauma and infection to the
mother and fetus
No need of Membrane rupture
Minimizes Fear of vertical transmission of
HIV,HCV,HSV
Disadvantage
Less accurate
71
 2. Internal Electronic fetal monitoring (A
fetal scalp electrode)
FHR
 Bipolar Spiral electrode are applied directly to the fetal scalp
& second reference electrode is placed up on maternal thigh
 Internal electrodes detect Fetal ECG RR interval
processed into FHR

Uterine contraction
 Intra uterine pressure catheters are inserted trans cervically
beyond and above the presenting part
72
Internal Electronic fetal monitoring….

Advantage

 Accurate FHR & measurement of uterine pressure

Disadvantage

 Invasive procedure & use resitricted to intrapartum

period

73
74
B. Intermittent FHR auscultation
• This method is equivalent to continuous monitoring in
assessing fetal condition
• When performed at specific intervals with a 1:1
midwife-patient ratio
• However, intermittent monitoring is more commonly
used in the developing world because it is convenient
and less expensive
Materials used to Intermittent FHR auscultation
• Pinards Stethoscope
• Doppler
• Ultrasound
• Stethoscope
75
Types of Intrapartum Fetal Surveillance
I. The baseline FHR
• Is when the heart rate recorded in between the uterine
contraction
Types of baseline FHR
1. Normal: 120 - 160 bpm (< 120 bpm Bradycardia / >
160 bpm Tachycardia)
2. Moderate Tachycardia: 161 – 180 bpm
3. Marked Tachycardia: > 180 bpm
4. Moderate Bradycardia: 100 to 119 bpm
5. Marked Bradycardia: < 100 bpm
76
NOTE

During labor

• Moderate Tachycardia (161 – 180 bpm)

and Moderate Bradycardia (100 to 119
bpm) are reassuring

77
Normal tracing

78
II. The periodic FHR changes
• Are those that occur in association with a uterine
contraction
Types of periodic FHR changes
1. Accelerations: Increase 15 bpm from the normal
baseline
2. Deceleration: A reduced FHR from the normal baseline
• Further divided in to three:
 Early deceleration: Decreased 20-30 bpm = Head
compression
 Late deceleration: Decreased 30 -40 bpm = UPI
 Variable deceleration: Deceased 10-60 bpm =
Cord compression

79
Accelerations

80
Early deceleration

81
Late deceleration

82
Variable decelerations

83
III. Baseline variability (Beat to beat variability)

• Attributed to the interaction of autonomic nervous

systems (ANS) in controlling the normal FHB

IV. Sinusoidal/ Salutatory/ FHR Pattern

• Here there is stable or fixed baseline with absent

acceleration

84
Reduced variability

85
Causes and Intervention for abnormal
Intrapartum Fetal Surveillance

86
I. The Base Line FHR
• FHR in between the uterine contraction
A. Marked Bradycardia
Is when FHR is <100 bpm
Causes of Bradycardia
• Anaesthesia and uterine hyperactivity
• Head compression • Abruptio placenta
• Congenital heart block • Maternal hypothermia
• Fetal compromise • Maternal hypotension and
hypoxia
• Cord compression and uterine
rupture
87
B. Marked Tachycardia

Is when FHR is >180bpm

Causes of Tachycardia

• Maternal fever (common)

• Drugs like atropine

• Fetal anaemia
• Thyrotoxicosis • Congenital heart disease
• Prematurity • Maternal hypotension
88
II. The Periodic FHR Changes
• The periodic FHR refers to devotions from the baseline that is
related to uterine contraction
A. Acceleration
• Is an abrupt increase in the fetal heart rate baseline at least
15 bpm for 15 sec in 20 min interval

Acceleration usually associated with:

• Fetal movement (common)
• Stimulation by uterine contractions
• Temporary umbilical cord occlusion
• Fetal stimulation during pelvic exam
• Acceleration is always reassuring (No fetal distress)
• Confirms that the fetus is not acidemic at that time 89
B. Deceleration
• Deceleration means a decrease below the baseline rate
• Deceleration further divided in to early, late and
variable deceleration
• Deceleration can be describes pathological events
(Late and variable deceleration)
• i.e.
• Early deceleration termed as a head compression
• Late deceleration are termed as uteroplacental
insufficiency
• Variable deceleration become a cord compression
patterns

90
i. Early deceleration (Head compression)

• Is smooth deceleration that begins and ends at the

same time as the contraction

• This pattern has no clinical significances and does

not indicate that fetal distress is present
• i.e. Not associated with fetal hypoxia, acidemia
or low APGAR scores

91
Characteristics of early deceleration

• Come due to vagal (10th CN) stimulation secondary to

head compression

• Symmetric and shallow which reach nadir at the same

time with contractions (same at the beginning and ending
of uterine contraction)

• Rarely fall < 100 - 110 bpm or 20-30 bpm below

baseline

• Good out come and no intervention needed

92
ii. Late deceleration (Uteroplacental insufficiency)
• Is a smooth gradual symmetrical decrease FHR
beginning at or after the peak of the contraction
• Usually about 30 seconds after the onset of the
contraction
• Their nadir is after the peak of the contraction
• Returning to baseline only after the contraction has
ended
• Is the most ominous/threatening FHR pattern even when
the decrease is beats per minute is quite small fetal
hypoxemia should present
• Late decelerations associated with direct myocardial
depression and can be seen with prolonged hypoxia
and acidemia
93
Late deceleration……
Mechanism
• ↓In arterial O2 tension  Detected by O2 sensors in
the brain ↑Sympathetic neuronal response
Increase fetal BPDetected by barorereceptors
Protective slowing in FHR
 Complex “double reflex", takes time-delay (Late
decelerate)
• As hypoxia becomes more severe ” direct
myocardial depression” may cause late
decelerations
• Barorereceptors: a sensory nerve ending in the
arteries that is sensitive to changes blood pressure
94
Late deceleration……
Causes of Late deceleration
• Uteroplacental insufficiency, which results from
decreased uterine perfusion or decreased placental
function, can lead to repetitive late decelerations
• Conditions that may lead to uteroplacental insufficiency
include:
• Postdates pregnancy
• Maternal diabetes mellitus
• Maternal hypertension (chronic or pregnancy induced)
• Abruptio placenta
• Maternal anemia
• Maternal sepsis
• Hypertonia (excessive uterine tone)
• Hyperstimulation (excessive uterine contractions)
95
Management in late deceleration

• Discontinue oxytocin

• Oxygen (6-8 Lt/min)

• Left lateral position

• Fluid and electrolyte

• Correct causes

• Use tocolysis

96
iii. Variable deceleration (Cord compression)

• Which occurs at any time in relation to the uterine

contraction
• It occurs before, during and after contraction

• Always it is abrupt in onset and abrupt in it’s return to

the baseline

• It is the most common types of deceleration are usually

preceding/following accelerations and has favourable
outcome
97
Variable deceleration …..

Mechanism
Umbilical cord compression Umbilical vein collapse
Decrease blood flow returning to the fetus  Decrease
Venus return  Decrease cardiac out put  Fetal
hypotension  Barorereceptors Protective increase FHR

 Further Umbilical cord compression  Umbilical arteries

compressed  Increase systemic vascular resistance (SVR)
 Fetal hypertension Barorereceptors reflex  Protective
decrease FHR
98
Causes of Variable deceleration
• Variable decelerations are generally caused by
umbilical cord compression between fetal parts or
between fetal parts and the uterine wall or pelvis
• They can also be seen in patients with
oligohydramnios
• Conditions that may lead to cord compression
include:
• Uterine contraction
• Cord entanglement (Twist)
• Supine position
• Descent and early release of AF (Early ARM)
• Cord prolapse and cord presentation
99
Management of Variable deceleration

• Change of position

• Left lateral position

• Alleviate cord compression

• Amino - infusion

• If persists management as late deceleration

100
III. Beat to Beat Variability (Baseline Variability)

• Regulated largely by the autonomic nervous system

• That is, a sympathetic (↑FHR) and parasympathetic
(↓FHR) “push and pull” mediated via the sinoatrial node
(Node in between superior venacava and right atrium)

• Produces moment-to-moment or beat-to-beat change of the

heart rate that fluctuates above and below the baseline

• Reflection of an intact and active CNS and normal cardiac

responsiveness
101
III. Beat to Beat Variability….

Interpretation of Beat to Beat Variability

• Normal: If there is a change of 5-10 beats/minute

every minute in FHR

• Absence of this beat - to - beat variation indicates

fetal compromise

102
Normal tracing

103
 Baseline Variability....

Good variability reliably excludes hypoxia

Absence of variability – Fetal compromise

 Interpretation is also quite subjective

FHR variability defined as follow:

Absent: Amplitude undetectable

Minimal: >Undetectable and < 5bpm

Normal: 5 to 10bpm

Moderate: Amplitude 11 to 25bpm

Marked: >25bpm 104

Causes of abnormal variability

• Fetal Hypoxia and acidosis

• Maternal stress

• Prematurity

• A fetus that is sleep

• Sedatives

• CNS anomaly

• Fetal movement

• Maternal hypoxia and acidosis 105

IV. Sinusoidal Pattern

• The criteria to define sinusoidal pattern are the base line

should be stable at 120-160 bpm with absent acceleration

Cause of sinusoidal Pattern

• Severely anaemic fetus (Due to Rh- diseases, Abruptio

placenta and vasa previa)

• Fetal hypoxia and acidosis

• Chorioamnionitis

106
Summary of Fetal heart rate patterns
• FHR pattern is categorized as reassuring or non reassuring
A. Reassuring fetal heart rate patterns
• When FHR are reassuring, midwife allow labor to
continue is an indicative of fetal well-being
Characteristics of RFHRP
• A baseline fetal heart rate of 120 to 160 bpm
• Absence of late and variable decelerations
• Normal FHR variability (5 to 10 bpm)
• FHR accelerations
• Early decelerations
• Moderate Bradycardia of 100 to 119 bpm
• Moderate Tachycardia (161 – 180 bpm)
107
Non reassuring fetal heart rate patterns
• Non reassuring FHR patterns are nonspecific and
require further evaluation
• The fetus may be acidotic that may result in fetal
acidosis
Characteristics NRFHRP
• Abnormal baseline FHR (Marked bradycardia and
tachycardia )
• Absence of accelerations
• Loss of beat to beat variability
• Repetitive late decelerations
• Repetitive variable decelerations
108
Further evaluation of Non reassuring FHR patterns

• Evaluate for the potential causes of the non

reassuring FHR pattern
• Obtain information and reassurance about the
fetal well-being
• Perform intrauterine resuscitation to
improve placental perfusion and oxygen
transfer to the fetus
109
Management of women with NRFHR
patterns
1. Change in maternal position
• In the supine position, the uterus obstructs blood
flow through the aorta and the inferior vena cava,
potentially leading to decreased placental perfusion
• Placement in a lateral recumbent position during
labor causes the uterus to fall away from the great
vessels, which should improve fetal oxygenation
2. Oxygenation
• Maternal hyperoxia may increase the maternal-
fetal oxygen gradient, potentially improving the
FHR pattern
• Oxygen should be given by mask
110
Management….

3. Regulation of uterine activity

• Hyperstimulation or multiple uterine contractions
from prostaglandin or oxytocin stimulation may lead
to incomplete uterine relaxation and possibly
decreased fetal oxygenation
• Intravenous hydration, discontinuation of the
uterotonic agent, or uterine relaxation with
terbutaline (tocolytics) may improve the FHR
pattern 111
Management….

4. Correction of cord compression

• Change in maternal position, which may relieve
the compression
• Amnio infusion, with an intrauterine catheter
through which saline is infused into the uterine
cavity

112
Management ……

5. Reversal of anesthetic effects

• Anesthesia may result in decreased venous return
and cardiac output that leads to maternal
hypotension, and decreased uteroplacental perfusion
• Administration of intravenous fluids or ephedrine
to the mother may improve uterine blood flow

113
Further assessment of fetal well-being
1. Vibro-acoustic stimuli (VAS)

• An artificial larynx is placed on the maternal skin over

the fetal head, and the fetus is stimulated by noise for 1
second
• The presence of fetal accelerations in response to VAS is
considered reassuring
• The fetus is re-stimulated if no accelerations occur within 10
seconds
• The VAS test may be repeated up to four times 114
Further assessment of fetal well-being….
2. Scalp stimulation test
• The examiner rubs the fetal scalp during a digital
examination
• An acceleration is usually seen in the FHR tracing
of the uncompromised, non acidotic fetus

• The presence of an acceleration is associated with

• An intact ANS
• A fetal scalp blood pH greater than 7.20
• If an acceleration is not obtained after scalp
stimulation, fetal scalp blood can be sampled

115
3. Fetal scalp blood sampling

• The fetal scalp is visualized through the dilated cervix,

and punctured by sharp lancet then blood is collected
by capillary tubes

• The normal fetal capillary pH is 7.25 to 7.35

• A fetal scalp pH greater than or equal to 7.20 is reassurance
that the fetus is not acidotic
• A pH of less than 7.20 may represent significant acidosis
• Delivery is thus indicated immediately by cesarean
section if the women is in first stage
• Vacuum or forceps in second stage
116
Meconium in the liquor amnii
• Meconium in the liquor amnii is a potential sign of fetal
hypoxia
• It acts as a toxin if the fetus aspirate this particulate
matter
• Hypoxia → (↑) Vagal response→(↑) Peristaltic activity
and relaxation of the anal sphincter → Passage of
meconium
• Meconium staining liquor observed in about 10–20
percent of labors
• Presence of meconium and non-reassuring FHR pattern
necessitates urgent intervention
• On the other hand reassuring FHR pattern and thin
meconium can be managed expectantly 117
Meconium in the liquor amnii…

• The vicious circle is :

• Placental insufficiency → Oligohydramnios → Cord
compression → Hypoxia → Thick meconium →

Gasping breath → Meconium aspiration

118