Antenatal Fetal Surveillance

Clinical description

Fetal surveillance aims to evaluate fetal well-being. During antenatal care, the fetal heart is assessed using a fetoscope (≥ 20 wks gestation) or Doppler (≥ 12 wks gestation). For abnormalities or complicated pregnancies, use cardiotocogram (CTG), non stress test (NST), or biophysical profile (BPP).

Method Indication/ Procedure Interpretation and Management Non Stress Test Indications:all pregnant women at risk for • Reactive test has ≥ 2 accelerations (15 bpm above baseline x 15 sec) in 20 (NST) intrauterine fetal compromise minutes with moderate variability and baseline range from 110- 160 bpm

• Prolonged pregnancy • Non-reactive test requires BPP
• Maternal hypertensive disorders
• Diabetes mellitus
• RH sensitization
• Maternal hemoglbinopathies
• Renal disease
• Fetal anomalies
• Poor prior obstetric history
• Reported decrease in perceived fetal

movements Procedure:

• Place CTG on abdomen for ≥ 20 min
• Observe up to 40 min if non-reactive (may be

due to fetal sleep cycle or normal period of fetal inactivity) Biophysical Use NST and real-time U/S to evaluate: • Assign 2 points if present and 0 points if absent for US components Profile (BPP) • Fetal breathing (1 breathing cycle ≥ 30 sec • Assign 2 points if reactive NST and 0 points if non-reactive NST during 30 min period) • Score ≤ 6 (out of 10) is suspicious for fetal hypoxemia

• Gross body movements (3 discrete body or limb •

movements)

• Fetal tone (1 episode of extension or flexion of

limbs or trunk, or opening or closing of hand)

• Amniotic fluid volume (1 pocket ≥ 2 cm in 2

perpendicular planes) Modified BPP BPP is labour intensive; therefore, modified BPP • Normal if AFI > 5 cm and reactive NST may be used:

• Amniotic Fluid Index (AFI) with NST

Clinical description

Intrapartum fetal • Evaluate fetal heart rate for ≥ 1 min for all • Requires CTG/Moyo heart monitoring women in admission with fetoscope or Doppler • Normal includes fetal heart rate that increases or decreases with contraction but

• Evaluate fetal heart rate before, during, and after recovers to baseline after contraction

a contraction every 30 min of active phase of • Abnormal includes bradycardia, tachycardia, and decelerations in the absence of labour a contraction or persisting after a contraction:

• Record fetal heart rate in active phase on o Evaluate for maternal fever, hypotension, and medications

partograph o Evaluate for placental abruption and chorioamnionitis Cardiotocogram Indications: • Normal includes (CTG)/Moyo • Augmentation with Oxytocin o Baseline rate of 110-160 bpm with variability of 5-25 bpm monitoring • Induction of labour with Misoprostol after each o Accelerations administration of Misoprostol and at onset of o Early decelerations (often due to fetal head compression) contractions • Abnormal includes

• Pprolonged labour o Late decelerations (suspicious for fetal hypoxia and acidosis due to
• Suspicion of fetal distress on FHR auscultation placental insufficiency)
• Oligohydramnios o Sinusoidal if fetal anaemia
• IUGR o Variable decelerations (often due to cord compression and may not require

intervention)

• Preterm delivery
• Management of abnormal CTG
• Previous caesarean in active phase of labour
• Evaluate for possible aetiology

awaiting theatre (or VBAC)

• Place woman in left lateral position
• Meconium stained liquor
• Stop oxytocin if applicable
• Treat with tocolytic (i.e,. nifedipine) if hyperstimulation (> 5

Procedure contractions in 10 min)

• Place fetal heart monitor on abdomen so
• Treat with NS 500 ml IV bolus if hypotension

that heart beat is detected easily

• Treat with oxygen by mask if available
• Place monitor for detection of contractions at
• Elevate the presenting part if cord prolapse

top of the fundus

• Consider Caesarean or operative vaginal delivery

Fetal surveillance in the absence of CTG/Moyo monitoring:

For all pregnancies:

• Determine gestational age and SFH at every visit; if discrepancy ultrasound scan for fetal growth, AFI if possible
• Refer if abnormal fetal growth or abnormal liquor
• Auscultate FHR at every antenatal visit
• Ask patient about perceived fetal movements

For high risk pregnancies:

• Refer to tertiary hospital

If Gestational age is 40 weeks and above, please see protocol for Post-Term Pregnancy.