3/4/2013

Indications
Maternal age <16 or >35
Chronic disease hypertension, diabetes, cardiovascular or renal
disease, thyroid disorder
Pre-eclampsia
Rh isoimmunization
History of stillbirth
IUGR
Post term pregnancy 2wks past the due date
Multiple gestation

Dr. Myo Hla Myint Reduced fetal movement

Assessment of foetal wellbeing

Clinical assessment

1. Monitoring of foetal movements

2. SFH measurement (Abdominal palpation & customised
fundal height chart and customised SFH chart is
adjusted for physiological variables such as maternal
height, weight, parity and ethnic group)
3. Auscultation of foetal heart sounds

Apparatus of FHR monitoring Oftenly used to assess foetal health

1. Ultrasound assessment of foetal growth
2. Amniotic fluid volume
3. Umblical atrery doppler recordings
4. Measurement of middle cerebral artery blood flow
5. Measurement of ductus venosus blood flow
6. Uterine artery doppler recordings
7. Foetal heart rate recordings
8. Biophysical profile testing

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USG
Early identification of pregnancy Cardiotocogram
Observation of FHR and breathing movements
Measurements CRL, BPD, FL, AC, HC, EFW
Detection of anomalies
AFI
Location of placenta
Fetal Echocardiography- identify cardiac anomalies-
during 2nd and 3rd trimester

Foetal heart rate monitoring Standardised CTG machine

Paper speed 1 cm/min
Sensitivity display -
20 bpm/cm
FHR range displays of -
50-210 bpm

Base line fetal heart rate

Variability
Acceleration
Deceleration

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Fetal Acoustic & Vibroacoustic Stimulation Umbilical artery Doppler

Handheld device that generates a low frequency vibration
and buzzing sound
Applied to maternal abdomen for 2-5 seconds up to 3 times
Stimulates fetal movement - acceleration of FHR
In normal pregnancy, there is a progressive increase in EDF
due to growth and dilatation of the umbilical circulation.
The resistance index therefore falls.
In some pregnancies with fetal growth restriction and/or
preeclampsia, there is a reduction in the diastolic velocity
and in severe cases, there is absent or reversed end
diastolic velocity.

Physiologic change in vascular resistance of the uteroplacental

circulation with advancing gestational age as observed on spectral
doppler of the uterine artery Uterine artery doppler wave
Normal flow velocity
waveform from the
uterine artery at 24
weeks of gestation.

Uterine artery doppler wave

Positive end-diastolic flow
Flow velocity waveform
from the uterine artery at
24 weeks of gestation in
a pregnancy with
impaired placentation;
in early diastole there is a
notch (yellow arrow) and
in late diastole there is
decreased flow (orange
arrow).

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Absent end-diastolic flow Reversed end-diastolic flow

Biophysical Profile
Assessment of 5 biophysical variables
1) Fetal breathing movement
2) Fetal movement of body or limbs
3) Fetal tone (extension and flexion of extremities)
4) Amniotic fluid volume
5) Reactive NST with activity
Scoring Between 8-10 is good
2 is given for normal
0 is given for an abnormal finding

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Doppler of veins

Lig venosum

Fetal structure Adult remant

Normal doppler wave form of ductus venosus.

Doppler examination of the ductus venosus with

normal flow velocity waveforms & Abnormal waveform
with reversal of flow during atrial contraction in a
growth-restricted fetus.

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Middle Cerebral Artery:

Internal foetal scalp electrode and

Interuterine pressure catheter Foetal scalp blood sampling

http://www.womensimagingservices.com.au/Image-
Gallery/Fetal-anatomy-survey-.aspx
http://www.fetalmedicine.com/fmf/training-
certification/certificates-of-competence/11-13-week-
scan/assessment-of-ductus-venosus-flow/
http://abcnews.go.com/Video/playerIndex?id=547567
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