10. Biophysical Tests
• Fetal moment count
• USG
• CTG (cardiotocography)
• Non-stress test
• Fetal BPP
• Doppler USG
• Vibroacoustic stimulation Test
• Contraction Stress Test
• Amniotic fluid Volume
11. Fetal moment count
1. Cardif Count 10’ formula:
• Starting at 9 am →end as soon as 10
movements perceived.
• Report physician if-(i) ˂ 10 m/ 12 hours on 2
successive days
(ii) No movement during 12 hours in one day
2. Daily fetal momement count (DFMC)
• 3 counts each of 1 hour duration (mor, noon,
eve)→ total count x 4= DFMC in 12 HOURS
• ˂ 10 m/ 12 hours (or ˂ 3 in each hour)
indicates fetal compromise.
12.
13.
14.
15.
16. A normal, healthy fetal heart rate should possess average or moderate variability.
Decreasing variability is an indicator of possible stress.
17. • Accelerations: The fetal heart rate will normally remain
steady or accelerate during uterine contractions. Look at the
fetal heart rate and what is happening with contractions.
18.
19.
20. · An early deceleration begins at or after the onset of a
contraction and returns
to the baseline rate by the time the contraction has finished
and produces a mirror
image of the contraction.
· Early decelerations are not a sign of fetal problems.
21. Late Decelerations: Late decelerations are transitory decreases in heart rate caused
by uteroplacental insufficiency, a compromised blood flow to the baby that does not
deliver the amount of oxygen needed to withstand the stress of labor.
The late deceleration begins after the onset of the peak or middle of the contraction
and ends after the contraction.
· A late deceleration begins during or after a contraction and has not recovered by
the time that the contraction has ended. A late deceleration indicates decreased blood
flow during uterine contraction. Note: Persistent late decelerations are ominous
22. Variable Decelerations: Variable decelerations are transitory decreases in fetal heart rate
caused by umbilical cord compression.
A variable deceleration is unrelated to contractions. They mean umbilical cord
compression.
· They may appear V-shaped or U-shaped
If the baseline fetal heart rate remains stable and the variability remains good,
variable decelerations are not associated with poor fetal outcome.
·They indicate possible compromise if they become prolonged or are persistent.
23.
24.
25. Assessing Fetal Well-Being
Vibroacoustic Stimulation:
• Acoustic stimulation (artificial larynx)
applied to abdomen to produce a sharp
sound, startling and waking the fetus.
USG: MANY PARAMETERS
Contraction Stress Testing:
• FHR is analyzed in conjunction with
contractions.
• Mother stimulates the nipple which
releases oxytocin which initiates uterine
contractions
26. Assessing Fetal Well-Being
ECG at week 11 of pregnancy (inaccurate
before week 20 because fetal electrical
conduction is weak).
MRI used to diagnose ectopic pregnancy or
trophoblastic disease.
Maternal Serum Alpha-Fetoprotein is a
substance produced by the fetal liver that is
present in amniotic fluid and maternal
serum. Begins to rise at week 11.
• Detects Down Syndrome, open spinal or
abdominal defects.
27. Assessing Fetal Well-Being
Triple Screening - analysis of 3 indicators:
• Maternal serum Alpha-fetoprotein
• unconjugated estriol
• hCG
• used for Downs syndrome
Chorionic Villi Sampling (CVS)
• biopsy and analysis for chromosomes done
at week 10 to 12.
28. Assessing Fetal Well-Being
Amniocentesis:
• aspiration of amniotic fluid from the uterus
for examination.
• Week 12 to 13
• 1 mL of fluid is needed
• 20 to 22 gauge spinal needle
• woman rest for 30 minutes after the
procedure
• constant monitoring for FHR and
contractions
• if Rh-neg. blood give RhoGAM
29.
30.
31.
32. Components of the Biophysical Profile Score
Component Definition
Non-stress test
Two or more fetal heart rate accelerations peak (but do not
necessarily remain) at least 15 beats per minute above the
baseline and last 15 seconds from baseline to baseline within
a 20-minute period with or without fetal movement discernible
by the woman.
Amniotic fluid
volume
A single 2 cm x 2 cm pocket is considered adequate or AFI
greater than 5.0 cm .
Fetal breathing
movements
One or more episodes of rhythmic fetal breathing movements
of 30 seconds or more within 30 minutes.
Hiccups are considered breathing activity.
Fetal movements
At least three discrete body or limb movements.
Episodes of continuous movement are considered as a single
movement.
Fetal tone
One or more episodes of extension of a fetal extremity or
trunk with return to flexion, or opening or closing of a hand
33. Perinatal Mortality and the Biophysical Profile Score
Score Interpretation Perinatal Mortality/1000
8- 10 Normal 1.86*
6 Equivocal 9.76
4 Abnormal 26.3
2 Abnormal 94.0
0 Abnormal 285.7
*The perinatal mortality is 0.8/1000 for structurally normal fetuses with a normal test within 7
days.
34.
35.
36.
37.
38. Rh Factor
• 4 blood types in humans
– A, B, AB, O
• Rh factor – rhesus factor
– A protein found on the blood cells of most people
– Positive (+) indicates you have the factor (85%)
– Negative (-) indicates you do not have the factors (15%)
• Transfusion
– Across blood types stimulates recipient’s immune system
to produce antibodies to destroy donor’s blood cells.
39. Rh Incompatibility
• In first offspring…
– Fetal and maternal circulation do not usually mix under normal
circumstances
– Fetal blood cells may enter mother’s circulation by escaping from
broken vessels in placental villa just before delivery.
– Mother doesn’t usually develop antibodies until after baby is born –
sparing 1st offspring.
• In subsequent offspring…
– Mother will illicit antibody reaction
– To prevent this, mother is given anti-D IgG immunoglobulin
immediately after first delivery (within 72 hours).
– Deaths from Rh incompatibility: 0.5%
40. Rh Incompatibility
• Erythroblastosis fetalis
– Disease of Rh+ newborn exposed to antibodies of Rh-
mother
– Characteristics
• Anemia
• Immature red blood cells
• Edema
• Jaundice
43. Umbilical Artery Doppler Assesment
• It is used in surveillance of fetal well-being in the
third trimester of pregnancy.
• Abnormal umbilical artery Doppler is a marker
of uteroplacental insufficiency , intrauterine growth
restriction (IUGR) or suspected pre-eclampsia.
INDICATIONS (Maternal conditions)
• diabetes mellitus
• chronic kidney disease
• hypertension
• prothrombotic states
44. INDICATIONS (Pregnancy related conditions)
• suspected IUGR
• previous pregnancy with IUGR or fetal death in utero
• decreased fetal movement
• oligohydramnios
• polyhydramnios
• multifetal pregnancy
• ↓ resistance index (RI) and ↓pulsatility index (PI)→ ↑ gestation
due to progressive maturation of the placenta and increase in the
number of tertiary stem villi.
• Parameters
• The Doppler indices have been found to decline gradually with
gestational age:
• S/D ratio mean value decreases from 3.5 to 2.5
• RI mean value decreases from 0.75 to 0.60
• PI main value decreases from 1.27 to 0.96
45. • reduction in end diastolic flow: increasing RI
values, PI values and S/D ratio
• absent end diastolic flow (AEDF): RI = 1
• reversal of end diastolic flow (REDF)
46.
47. middle cerebral arterial (MCA)
Doppler assessment
• It is an important part of assessing fetal
cardiovascular distress, fetal anaemia or fetal
hypoxia.
• In the appropriate situation it is a very useful
adjunct to umbilical artery Doppler assessment.
Used to Follow up in:
• intra-uterine growth restriction (IUGR)
• twin to twin transfusion syndrome (TTTS)
• twin anaemia polycythaemia sequence (TAPS)
48. Parameters used include:
• fetal MCA pulsatility index (PI)
• fetal MCA peak systolic velocity (PSV): the highest
velocity should be recorded
• fetal MCA systolic/diastolic (S/D) ratio: a normal
fetal MCA S/D ratio should always be higher than
the umbilical arterial S/D ratio
• cerebroplacental ratio (CPR): ratio of pulsatility
index of MCA and umbilical artery. >1:1 is normal
and <1:1 is abnormal
• Normal MCA=↑ resistance index, ↓diastolic flow
• Abnormal condition: low resistance flow mainly as a
result of the fetal head sparing theory
49.
50.
51.
52.
53.
54.
55. • Fetal ductus venosus flow assessment can be
sonographically assessed in a number of situations
in fetal ultrasound:
• first trimester screening for aneuploidic anomalies
• second trimester scanning when there are concerns
regarding
– intrauterine growth restriction (IUGR)
– fetal cardiac compromise
• Of all the pre-cardial veins, the ductus venosus
allows the most accurate interpretation of fetal
cardiac function as well as myocardial
haemodynamics .
56. Abnormal waveforms include:
• reduced flow in ductus venosus A wave
• absent flow in ductus venosus A wave
• reversal of flow in ductus venosus A wave
• abnormal indices:
– abnormal pulsatility index (PI)
– abnormal S wave to A wave ratio (S:A)
– abnormal peak velocity index
57.
58.
59.
60.
61. • Pulsating blood velocity in the umbilical vein
defined as a decrease in velocity by more than
15% of the maximal velocity
• Pulsations corresponding to atrial contractions
were defined as single
• pulsations corresponding to both end-systole
and to atrial contractions as double.
• The UV pulsation was defined as triple if the
waveform is three-phase
