Antepartum fetal suriveillance

Question 1

Nonstress test

Answer 1

Mother is resting in lateral tilt position
-monitor FHR w/ Doppler and contractions w/ tocodynamometer

Results:

• Reactive = normal. 2 accelerations > 15bpm above baselines lasting at least 15 seconds in a 20 minute period
• Nonreactive: <32wks, sedative/narcotic administration

Question 2

Contraction stress test

Answer 2

Measure of FHR during spontaneous or induced (via oxytocin or nipple stimulation) contractions

Positive: late decelerations in >50% of contractions in 10 minute window. Concerning for fetal compromise, may warrant delivery
Negative: No late or significant variable decelerations in 20 minute window w/ at least 3 contractions. Highly predictive of fetal well being

Question 3

BPP

Answer 3

Biophysical profile:

• Tone, breathing, movement, amniotic fluid, NST
• 2 points if normal, 0 points if abnormal
• 8-10 points = reassuring
• 6 points = equivocol
• 0-4 points = extremely worrisome for asphyxia

Question 4

AFI

Answer 4

Amniotic fluid index

-measure amniotic fluid depth in all 4 quadrants

Question 5

mBPP

Answer 5

Modified biophysical profile

• AFI + NST
• normal = nl NST and AFI > 5cm

Question 6

Umbilical artery Doppler velocimetry

Answer 6

Only used if IUGR is suspected

IUGR = reduction or even reversal of umbilical artery diastolic flow