Antenatal Fetal Surveillance

Question 1

What is “quickening” and when does it occur?

Answer 1

1) The first noticed fetal movement

2) Generally first noticed between 18 and 20 weeks
- may be 1-2 weeks earlier in multigravidas
- may be 1-2 weeks later if placenta is implanted on the anterior wall of the uterus

Question 2

What is the differential for decreased fetal movement?

Answer 2

DASH

• Death of fetus
• Amniotic fluid decrease
• Sleep cycle
• Hunger/Thirst

Question 3

What is a fetal movement count? What results are normal?

Answer 3

• Count of fetal movements over 2 hours
• Done if concerned, subjective decrease in movement, or high risk pregnancy.
• Woman should drink juice/eat, change position, and move to a quiet room and count fetal movements over 2hr

NORMAL: 6+ in 2hr

Question 4

What is a non stress test?

Answer 4

• Fetal heart rate tracing done using an external doppler and its relationship to fetal movement
• Done for at least 20 minutes

Question 5

What would you expect to see in a normal non-stress test?

Answer 5

2 accelerations that are:

• Greater than 15 bpm from their baseline
• Lasting Greater than 15 seconds
• Over a 20 minute period

Question 6

What is a normal fetal baseline heart rate?

Answer 6

110-160 bpm

Question 7

If there are no accelerations in the first 20 minutes of a non stress test what do you do?

Answer 7

• Stimulate the fetus with fundal pressure or vibration

- Monitor an additional 30 minutes

Question 8

What do you do following an abnormal non-stress test?

Answer 8

Biophysical profile

Question 9

What are the components of a biophysical profile?

Answer 9

LAMB

1) Limb extention and Flexion
- 1+ episode of limb extension followed by flexion
2) Amniotic fluid volume
- Fluid pocket of 2cm in 2 axis
3) Movement
- 3 discrete movements
4) Breathing
- At least 1 episode of breathing lasting 30+ seconds

Question 10

With which BPP score would you want to repeat it in 24hrs?

Answer 10

about 6/8

- Not so concerning that you would deliver but not reassuring enough to follow-up as needed

Question 11

With which BPP score would you consider delivery?

Answer 11

4/8

- Weigh risks and benefits of delivery

Question 12

Fill in the following for a Normal NST

1) Baseline
2) Variability
3) Decelerations
4) Accelerations

Answer 12

1) Baseline
- 110-160
2) Variability
- 6-25 BPM
- Will tolerate absent or minimal (less than 5bpm) for < 40 minutes
3) Decelerations
- None
- OR occational variable lasting under 30 seconds
4) Accelerations
- Term: 2+ of 15BPM or more, lasting 15 seconds in 20 minutes

Question 13

Fill in the following for a Normal NST

1) Baseline
2) Variability
3) Decelerations
4) Accelerations

Answer 13

1) Baseline
- 100-110
- Or > 160 bpm for under 30 mins
2) Variability
- less than 5bpm for 40-80 minutes
3) Decelerations
- Variable decelerations 30-60 seconds
4) Accelerations
- under 2 accelerations over 15bpm lasting over 15 seconds over a 20 minute period after observing for 40-80 minutes