Antenatal Monitoring

Posted by e-Medical PPT
Two thirds of fetal deaths occur before the onset of labor.
Many antepartum deaths occur in women at risk for uteroplacental insufficiency.
Ideal test: allows intervention before fetal death or damage from asphyxia.

Uteroplacental insufficiency
 Inadequate delivery of nutritive or respiratory substances to appropriate fetal tissues.
 Inadequate exchange within the placenta due to decreased blood flow, decreased surface area or increased membrane thickness.
 Inadequate maternal delivery of nutrients or oxygen to the placenta or to problems of inadequate fetal uptake.

Conditions placing the fetus at risk for Uteroplacental insufficiency
Preeclampsia, chronic hypertension,
Collagen vascular disease, diabetes mellitus, renal disease,
Fetal or maternal anemia, blood group sensitization,
Hyperthyroidism, thrombophilia, cyanotic heart disease,
Postdate pregnancy,
Fetal growth restriction

Methods for antepartum fetal assessment
 Fetal movement counting
Maternal perception of a decrease in fetal movements / change in the pattern of fetal movements may be a sign of impending fetal compromise.
Cardiff “count to ten” : 10 movements in 12 hours.
Kick charts

 Assessment of uterine growth
Symphysiofundal height
General rule: fundal height in centimeters will equal the weeks of gestation.
Exceptions: maternal obesity, multiple gestation, polyhydramnios, abnormal fetal lie, oligohydramnios, low fetal station, and fetal growth restriction.
Customized chart :Abnormalities of fundal height should lead to further investigation.

 Antepartum fetal heart rate testing
Initial observational studies showed a strong correlation between the abnormal CTG and poor fetal outcome
Widely used as the primary method of
   antenatal fetal assessment
Poor predictive value
High inter-observer inconsistencies

 Biophysical profile
Described by Manning (1980)
The number of biophysical activities that could be recorded increased with real time ultrasound:
Fetal movement (FM)
Fetal tone (FT)
Fetal breathing movements (FB)
Amniotic fluid volume (AFV)
 Doppler velocimetry

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