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EVERY ONE
INDICATIONS
Anypatient at risk for developing decreased
utero-placental function, including:
Maternal Disease
Diabetes
Chronic Hypertension
Pregnancy-induced Hypertension, preeclampsia
Renal disease
Collagen dieases
Cardiac disease
Thyroid disease
Significant hematologic disease (severe anemia, etc.)
Thrid-trimester vaginal bleeding
INDICATIONS
History of poor obstetric outcome
Post-dates pregnancy
Fetal indications
Suspected intrauterine growth restriction (IUGR)
Suspected decrease in fetal movement
Irregular or abnormal FHR by auscultation
Suspected Rh sensitization
Multiple gestation with suspected IUGR or discordant
growth
Premature rupture of membranes
Oligohydramnios/Polyhydramnios
Modility
Maternal kick counts
EFM
Fetal blood sampling
Fetal Biophysical Profile
ST-wave forms
Doppler US
MATERNAL KICK COUNTS
Description
Recording the mother’s perception of fetal
activity. This is the oldest and most
inexpensive method of evaluating fetal well-
being.
MATERNAL KICK COUNTS
Interpretation
Definitions of decreased fetal movement
include:
>10 movements in 12 hours
3 or fewer movements per hour
Management
Normal kick count: repeat recordings daily
Decreased or absent fetal movement:
proceed with immediate evaluation and
further testing (NST or BPP)
Fetoscopes
Determinants of FHR
Intrinsic
beating frequency
Action of nerves and hormones on the
heart
EFM: Problems and Realities
Minimal
6
Moderate
Marked
EFM - Accelerations
Functional scan
BPP
Doppler
BIOPHYSICAL PROFILE
BPP is a physical examination of the fetus utilizing real-
time ultrasound in combination with the NST
8-10 1.86
6 9.76
4 26.3
2 94.0
0 285.7
Biophysical profile
Amniotic fluid volume- oligo is frequently associated
with IUGR (↓ blood volume ,↓ renal blood flow, ↓ urine
output)
Perinatal morbidity ↑ 10 times if oligo present.
IUFD in 5 – 10 % if oligo present.
IUFD with Bpp 8/8 is 0.7 in 1000 birth. Vs 40% if score
is 0/8..
False –ve is < than 1 / 1000.
ST-wave forms
Doppler Ultrasound
• Arterier system:
• Middle cerebral artery
• Aorta
• Umbilical artery
• Uterine artery
• Venus system:
• IVC
• Ductus venosus
• Umbilical ven
• Tricasped valve
MCA
Fetal Aorta
Umbilical artery
Uterine artery
DUCTUS VENOSUM
Umblical Vein
FGR
Timeline for Fetal distres
Abnormal arterial
2-8W Doppler
Abnormal venous
Doppler
1-4W
Low BPP
1-2D Score
Non reasuring
12-24H NST
Take-home points
Fetal health surveillance aims at
improving fetal outcomes by
identifying those with hypoxic
acidemia & intervening while it is still
reversible
Take-home points
The reliability, validity, & efficacy of EFM
remain contentious
Fetal biometry and arterial Doppler the
early sign
Venous Doppler, FHR analysis, and the
biophysical profile represent the later
stages(commonly associated with fetal
acidosis)