Fetal Survailance Flashcards
Normal non-stress tests
Requires two or more accelerations peaking at 15 pbm or more above baseline, each lasting 15 seconds or more, and all occurring within 20 min of beginning the test. (ACOG 2016)
1996 review concluded that 1 acceleration was just as reliable as two in predicting healthy fetal status.
Normal antepartum fetal test result is highly reassuring that a stillbirth will not occur within
1 week
When to initiate antenatal fetal testing (fetal surveillance) for high risk pregnancy ? The frequency of repeating it ?
Begins by 32 to 34 wks GA, pregnancies with severe complications might require testing as early as 26 to 28 weeks.
The frequency for repeating tests has been arbitrarily set at 7 days. But can be more frequent
Terminal cardiotocogram which included:
(1) baseline oscillation of less than 5 pbm
(2) late decelerations with spontaneous uterine contractions.
(3) absent acceleration.
More frequent fetal testing (fetal surveillance) around twice weekly is advocated for women with
- postterm pregnancy
- multifetal gestation
- presentational DM
- FGR
- HTN in pregnancy
(ACOG 2016)
ACOG 2016 has concluded the variable decelerations that doesn’t indicate fetal compromise or the need of obstetrical intervention which are ..
Non- repetitive and brief lasts less than 30 seconds.
In contrast repetitive variable decelerations lasting 1 min or longer have been reported to have even worse prognosis.
What are the five components of fetal biophysical profile ?
(1) heart rate acceleration
(2) breathing
(3) movements
(4) tone
(5) amniotic fluid
Normal score 2
Abnormal score 0
Collective highest score is 10
A total score of 8 or 10 out of 10 points is strongly associated with normal acid–base status, and the predicted perinatal mortality within 1 week is
less than 1 per 1,000.
A BPP score of 6 out of 10, next step?
considered equivocal, as long as amniotic fluid volume is normal, and management is based on gestational age. Further evaluation and consideration of delivery is war-ranted in a fetus at or beyond 37 0/7 weeks of gestation whereas a BPP should be repeated in 24 hours in the fetus below this gestational age.
BPP score of 4, next step?
In pregnancies at or beyond 32 weeks of gestation, a BPP score of 4 usually warrants delivery. In pregnan-cies at less than 32 weeks of gestation, management should be individualized and extended monitoring may be an option. A BPP score of less than 4 should result in delivery in most cases.
he American College of Obstetricians and Gynecologists (2021a) concludes that DVP measurement, as opposed to AFI, is associated with fewer unnecessary interventions but comparable perinatal outcomes (Nabhan, 2008; Reddy, 2014).
In one study of more than 1000 women in which both methods were compared, AFI led to a higher rate of oligohydramnios diagnoses and induction of labor. Despite this, perinatal outcomes were not improved (Kehl, 2016).
According to the American College of Obstetricians and Gynecologists (2021a), a normal antepartum fetal test result is highly reassuring that a stillbirth will not occur within 1 week. What is the Stillbirth Rates within 1 Week of a Normal Antepartum Fetal Surveillance Test?
