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Comprehensive Guide to Fetal Monitoring in Obstetrics

Learn about aims, methods, and limitations of fetal monitoring to prevent fetal death and avoid unnecessary interventions. Explore the role of gestation, assessment methods, and final recommendations in antepartum and intrapartum care.

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Comprehensive Guide to Fetal Monitoring in Obstetrics

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  1. Fetal Monitoring Dr. AnjooAgarwal Professor Dept of Obs & gyn KGMU, Lucknow

  2. Objectives • Understand aims of fetal monitoring • Understand methods of fetal monitoring • Understand limitations of fetal monitoring

  3. Aims of Fetal Monitoring • Prevention of fetal death • Avoidance of unnecessary interventions ACOG, AAP 2012

  4. 23 yrs old woman G2P1+0 (1st FTND, A&H) presents at 38 wks pregnancy with C/o diminished fetal moments since 2 days. Q. How significant do you think the problem is & what should be your next step?

  5. Significance • Diminished fetal activity, may be a harbinger of impending fetal death Sadovsky, 1973

  6. Low Risk vs High Risk • Any pregnancy may become high risk any time • C/o diminished fetal activity important in all cases

  7. Role of Gestation ? • Fetal activity starts at 7 wks • General body movements become organised 20-30 wks • Fetal movement maturation continues till 36 wks • Criteria for interpretation of tests varies with gestation • Fetal viability an important consideration

  8. Methods of Assessment Antepartum : • DFMC • NST • CST • Biophysical Profile • Doppler Velocimetry Intrapartum: • External or Indirect • Internal or Direct • Fetal scalp blood sampling

  9. DFMC • Cardiff “Count to 10” • One hour after each meal

  10. NST • FHR Acceleration in response to fetal movements • Test of fetal condition Normal – reactive Abnormal – non reactive

  11. Reactive NST • ≥ 32 weeks – 2 accelerations ≥ 15 bpm ≥ 15 sec during 20 min • < 32 wks – 2 accelerations ≥ 10 bpm ≥ 10 sec during 20 min

  12. Fetal Heart Rate Acceleration

  13. Electronic Fetal Monitoring

  14. No Variability

  15. Minimal Variability

  16. Moderate Variability

  17. Increased Variability

  18. Saltatory Pattern

  19. CST/OCT • Tests uteroplacental function contraction stimulated by oxytocin infusion • Late decelerations indicate positive test

  20. Biophysical Profile • Nonstress test • Fetal breathing • Fetal movement • Fetal tone • Amniotic fluid volume

  21. Modified Biophysical Profile • NST + AFI (cut off 5 cm)

  22. Doppler Velocimetry • Umbilical artery • MCA • DuctusVenosus

  23. Umbilical Artery Doppler • Abnormal if – • S/D > 95% percentile for GA • Absent end diastolic flow – 10% PM • Reversed end diastolic flow – 33% PM • Utility only in FGR

  24. MCA • Fetal Hypoxia → brain sparing → ↑ Cerebro vascular resistance (RI) • Also useful in fetal anaemia where ↑ PSV

  25. DuctusVenosus • Good correlation with perinatal outcome • But by the time affected it is too late • Still in experimental stage

  26. Final Recommendations • Start at 32-34 weeks in HR cases • Severe complications may require testing at 26-28 weeks • Repeat weekly/ every 7 days • Most commonly used – modified biophysical profile

  27. MCQ NST is used to test 1 uteroplacentalbloodflow 2 fetal condition 3 response to uterine contractions 4 fetal anaemia

  28. MCQ A 35 yr old G1 P0+0 presents at 34 wks with GDM. It is recommended that she be monitored by 1 weekly NST 2 DFMC 3 Daily doppler 4 all of the above

  29. MCQ The acceleration of FHR in NST should be of 1 at least 20 min duration 2 at least 20 sec duration 3 at least 15 sec duration 4 at least 15 min duration

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