Fetal Movements Assessed by maternal perception (quickening-after 4 to 5 month) choose a time when baby is normally active t...
Fetal Movements
Assessed by
- maternal perception (quickening-after 4 to 5 month)
- choose a time when baby is normally active to count movements
- if < 6 movements in 2 hours, notify MD
- 10 movements in 12 hour period is lower limit of normal (32 weeks and over)
- palpation
- U/S
- routinely done at 4-5 month to assess fetal growth and anatomy
- earlier or subsequent U/S only when medically indicated
- confirm intrauterine pregnancy
- identify multiple pregnancy
- past history of early fetal losses
- bleeding or other complications
- measure fetal growth and identify IUGR
- placental localization
- determine gestational age (most accurately determined through measurement of crown-rump length prior to 11-12 weeks gestational age)
Non-Stress Test (NST)
- constant fetal heart rate (FHR) tracing using an external doppler to assess fetal heart rate and its relationship to fetal movement (see Intrapartum Fetal Cardiotocography)
- indicated when there is any suggestion of uteroplacental insufficiency or suspected fetal distress
- reactive NST (normal)
observation of two accelerations of FHR > 15 bpm from the baseline lasting >15 seconds in 20 minutes
- nonreactive NST (abnormal)
one or no FHR acceleration of at least 15 bpm and 15 seconds duration associated with fetal movement in 40 minutes
if no observed accelerations or fetal movement in the first 20 minutes, stimulate fetus (fundal pressure, acoustic/vibratory stimulation) and continue monitoring for 30 minutes
if NST nonreactive then perform BPP
Biophysical Profile (BPP)
- consists of NST and 30 minute ultrasound assessment of the fetus five scored parameters of BPP (see Table 2)
- scores
8-10 perinatal mortality rate 1: 1000 repeat BPP as clinically indicated
6 perinatal mortality 31:1000 repeat BPP in 24 hours
0-4 perinatal mortality rate 200:1000 deliver fetus if mature
- AFV (Amniotic Fluid Volume) a marker of chronic hypoxia, all other parameters indicative of acute hypoxia
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