Fetal Assessment and

wellbeing in pregnancy
(Fetal surveillance). BY
DR ADDAH A.O.
Definition : fetal surveillance
encompasses all measures taken in
pregnancy to determine the well being of
the fetus inutero up to delivery of the
baby.

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Definition of terms.
 Low birth wt – weighing less than 2500g at birth. Major
cause of perinatal mortality. If identified in pregnancy
need fetal surveillance.
 Preterm infants – born before 37 weeks gestation. They
are important contributor to LBW.
 Small for gestational age (SGA) – Defined as bt wt
(anthropometric measurement) less than 10th percentile
of its specific GA. Some SGA infants may be
constitutionally small and may represent only the tail end
of normal distribution.
 Intrauterine growth retardation – (IUGR)- A fetus is
growth retarded when it fails to achieve its genetic
potential. Such a fetus may still weigh 2500g or more and
not fit in the category of SGA. High risk of perinatal
mortality.

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Fetal surveillance in two parts,

 Ante - partum fetal surveillance.

 Intra - partum fetal surveillance –uterine
contractions introduce a further risk of
fetal hypoxia.

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Aim of fetal surveillance

 To prevent fetal death or damage from

chronic hypoxaemia.
 To avoid unecessary intervention and so
limit iatrogenic prematurity and
unwanted operative delivery.

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Aetiology of fetal compromise.
 The cause of stillbirth unknown in
majority of cases. To mount a high level
of fetal surveillance in all pregnancies to
reduce neonatal morbidity/ mortality then
becomes difficult,
 A more practical step would be to
identify the conditions which are
associated with fetal growth restriction,
fetal loss or damage and low birth wt
(risk factors).
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Aetiology of fetal compromise
contd.
 Identifying the mother at risk gives no
guarantee of success. A condition known
to put the fetus at high risk may
sometimes have no effect whatsoever
while on the other hand some
pregnancies with no perceived risk may
be complicated by IUGR and even
death. In view of this even the low risk
mothers should have some level of
surveillance.
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Risk factors for fetal
compromise.
 Maternal factors.
 Fetal factors.
 Placental factors.
 Environmental factors.

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Maternal factors.

 Demographic factors
 Extreme of ages – less than 16 years and
over 40s.
 Nulliparity and grandmultiparity.
 Race .

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Maternal risk factors contd.

 Medical condition.
 Factors that affect uteroplacental
circulation.
 Chronic hypertension.
 Early onset pre – eclampsia.
 Renal disease.

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Maternal risk factors continued

 Maternal Hypoaxemia: severe Hypoxic

conditions e.g
 chronic severe anaemia
 Chronic pulmonary disease. E.g bronchial
asthma.
 Cyanotic cardiac diseases.

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Maternal risk factors continue

 Nutrition – severe maternal nutritional

deprivation.
 Maternal infections e.g malaria,
toxoplasmosis. Also viral infection e.g
CMV, varicella zoster, HIV infection.
 Drugs – Alcohol, Cocaine, cigarette
smoking

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Placental Factors

 Abnormal Placental implantation.

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Environmental Factors

 High altittude is associated with low

birth weight

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Detecting the fetus at risk

 To detect the high risk pregnancy from

maternal risk factors, past obstetric
history, as well as those risk factors
developing during the pregnancy.
 To implement appropriate antenatal care
for high risk as well as the low risk
pregnancy in order to detect fetal
compromise.

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Detecting the fetus at risk
contd.
 Booking visit –
 Pregnancy dating (LMP) – decisions on
intervention require accurate knowledge of
the gestational age of the pregnancy
 Early ultrasound.
 Home based mothers records – A protocol
developed by obstetric units to identify high
risk mothers.

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Detecting the fetus at risk
contd.
 Continued antenatal care
 Check maternal well-being and weight
gain/attained weight in pregnancy.
 Excluding infection such as malaria and UTI.
 Excluding severe anaemia
 Checking for fetal well-being indicated by fetal
movements over a period of time
 Symphysio fundal height measurements- single or
serial measurement may be needed to detect
IUGR.

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 Serial measurement of fetal growth
 Measurement of specific fetal sections on
ultrasound and compare it to the centile
distribution for that gestation
 Measurements of biparietal or head
circumference to that of the abdominal
circumference is used in the diagnosis of
IUGR on ultralsound.

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 Amniotic fluid volume (AFV)- In the absence of
fetal anomaly and ruptured fetal membranes,
AFV may give an indication of the extent of the
fetal cardiovascular response to chronic hypoxic
stress. Exact mechanism not known.
 Fetal movement counting
 Not apparent to the mother until 16th to 20 weeks
gestation. There is a positive correlation between
fetal movement and fetal health.
 To monitor fetal movements several may be used
but quite popular is the “Cardiff count to ten”. The
woman is trained to record on a chart the time
interval required to feel term fetal movement. The
minimum number of fetal movement considered
acceptable ranges from 3 – in one hour to ten – in
24hrs. The perception of less than 10 movements
in 10hrs is an indication for NST.

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Fetal cardiotocography
 NST-
 Does not require any external fetal or maternal
stimulation.
 Simply a continuous recording of fetal heart rate
and uterine contraction over a period of time
usually 20 – 30 mins.
 The rational behind this text is that it gives an
indication via cerebrocardiac responses of fetal
cerebral fetal activity which will become modified in
the presence of fetal hypoxia.
 The conclusion that can be drawn from the normal
test is that at best the baby satisfactorily
oxygenated at worst the level of hypoxia is not
severe enough to produce brain dysfunction

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 Criteria for a reactive or normal CTG –
A normal base line heart rate of 110 - 150
beats per minute.
 A baseline variability of 5 – 25 beats/minute

 At least two accelerations of an amplitude of

10 – 15 beats minute over a period of 15 – 20
minute.
 When CTG trace is abnormal other fetal
assessment are carried out if time permits e.g
fetal PH assessment before intervention.

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The contraction stress test

 NST + Oxytocin
 Only practiced in the USA.
 It is invasive and time consuming.

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Fetal biophysical profile
scoring
 Attributes measures
 Fetal heart rate on CTG
 Fetal breathing movements
 Fetal tone
 Fetal body movements
 Amniotic fluid volume
 A score of 0 – 2 for each attributes given a
score of 10 as normal.

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Thank you!

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