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ASSESSMENT OF FETAL WELLBEING
Max Brinsmead MB BS PhDMay 2015
The fetus is unique because... He or she cannot signal health by way of history We can only examine through his or her mother Non-invasive evaluation includes...
Documentation of size and growth Fetal movements & reaction to stimuli Fetal heart rate studies using CTG Amniotic fluid volume study Looking at placental morphology by ultrasound Study of blood flow in various fetal and maternal
vessels – Doppler studies Placental endocrine studies in maternal blood and
urine
Pregnancies can be divided into those that are High or Low Risk of Fetal Compromise/Death High risk pregnancies include those that...
Occur with conditions known to impair feto-placental function e.g. Maternal hypertensive conditions, Auto immune disease
Depart from normal growth on clinical assessment i.e. “Too big” or “Too small”
There is a poor obstetric history Multiple pregnancy Occur with multiple risk factors e.g. Low
social class, ethnic risk, smoking or other drug use etc
Umbilical Artery Doppler Study
Upper panel represents peak (systolic) and trough (diastolic) flow often expressed as S/D ratio
Lower panel is constant flow through a uterine vein
UA Doppler reflects downstream placental resistance
Is the 1st change to occur with placental disease
Umbilical Artery Doppler changes with Gestation
Abnormal UA Doppler Flows
When flow ceases in the diastolic phase (AEDF) the S/D ratio is very high (∞)
Flow may even reverse in the diastolic phase (RDF) as shown opposite
Uterine Artery Dopplers…
Are of limited use when…▪ The fetus is very premature (<30 weeks)▪ Pregnancy is prolonged (>40 weeks)▪ It is a low risk pregnancy
▪ 5% will be high but normal
▪ Are useful in High Risk Pregnancies▪ May be used to prolong pregnancy with
immature fetus and apparent IUGR▪ Have a high negative predictive value for fetal
death▪ Will change 4 – 7 days before other
changes in fetal wellbeing e.g. Biophysical Profile
Other Pregnancy Doppler Studies
Fetal Middle Cerebral Artery Resistance falls as brain-sparing IUGR begins Strong correlation with fetal HB Of particular use in monitoring intrauterine
haemolysis
Fetal Ductus Venosus Resistance rises as the placenta deteriorates
Maternal Uterine Arteries Increased resistance with bilateral notching at
12 – 24w predicts early (but not late) onset pre eclampsia with ≈ 60% sensitivity
Uterine Artery Doppler
Fetal Biophysical Profile
Ultrasound for… Fetal Breathing Fetal Movements Fetal Tone Amniotic Fluid Volume
Non Stress CTG Looking at fetal heart short term variability and
accelerations Assigns a score of 0,1,2 to each of
these five measures as with the Apgar Score
Scores ≤ 6 are abnormal
Fetal Biophysical Profile (Manning)
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