Antepartum fetal testing

1. ANTEPARTUM
FETAL TESTING
M. Kamil

2. Goals of antepartum fetal testing
◦ To assess fetal well-being and prediction of future
fetal condition
◦ To prevent/ identify fetuses at risk
◦ Intrauterine death (IUD)
◦ Complications of intrauterine asphyxia
◦ For early intervention to prevent IUD or complication
of IU asphyxia

3. Tests
◦ Subjective maternal perception of fetal
activity
◦ Fetal movement counting
◦ Objective tests
◦ Non stress test (NST)
◦ Contraction stress test (CST)
◦ Biophysical profile (BPP)
◦ Umbilical artery blood flow velocity

5. 1. Fetal movement counting
◦ Clinically important parameter of fetal wellbeing
◦ The EASIEST & MOST AVAILABLE
◦ Assessed by mother subjectively
◦ Number of movements “kick counts”/ hour

7. 2. Non stress test (NST)
◦ Study the response of FHR to fetal
movements.
TEST FOR FETAL CONDITION

8. Non stress test: Prep

9. Non stress test: Result
◦ Normal/R
◦ 2 accelerations of the FHR in 20 min
◦ At least 15 beats above the baseline HR
◦ Last for at least 15 seconds
◦ Abnormal/NR
◦ No FHR accelerations over a 40 min period
◦ Presence of decelerations with fetal movement

10. Non-stress test: Example

11. 3. Contraction Stress Test
◦ Measure fetal response to a transient reduction in fetal
oxygen delivery during uterine contractions
◦ Induce with
◦ Nipple stimulation
◦ Infusion of dilute oxytocin solution 0.5 mU/min
TEST OF UTEROPLACENTAL FUNCTION

12. CST: Interpretation
Cunningham, F., & Williams, J. (2014). Williams obstetrics. (24th ed. / [edited by] F. Gary Cunningham et al.
ed.). New York ; London: McGraw-Hill Medical.
Normal
Abnormal

13. 4.Biophysical profile (BPP)
◦ More accurate.
◦ Consist 5 assessments
Cunningham, F., & Williams, J. (2014). Williams obstetrics. (24th ed. / [edited by] F. Gary Cunningham et al. ed.). New York ; London:
McGraw-Hill Medical.

14. Fetal breathing
◦Characteristic:
◦ Paradoxical
chest wall
movement
Cunningham, F., & Williams, J. (2014). Williams obstetrics. (24th ed. /
[edited by] F. Gary Cunningham et al. ed.). New York ; London:
McGraw-Hill Medical.

15. Interpretation of BPP
Cunningham, F., & Williams, J. (2014). Williams obstetrics. (24th ed. / [edited by] F. Gary Cunningham et al. ed.). New York ; London:
McGraw-Hill Medical.

16. Modified BPP
◦The most predictive of outcome:
◦Non stress test
◦Amniotic fluid index

17. ◦ Most commonly used index:
Systolic/diastolic ratio
◦ Quantify the flow velocity
waveform.
5. Umbilical artery
blood flow velocity

18. Conclusion
◦ Fetal well being assessment are important in all
pregnancy.
◦ AFT comprise few important tests that will
benefit mostly towards high risk pregnancy.
◦ Also important for monitoring the fetal
condition and early detection of fetal
abnormalities.

19. References
◦ Beckmann, C., Herbert, W., Laube, D., Ling, F., Smith, R., & American College of
Obstetricians Gynecologists. (2014). Obstetrics and gynecology (7th ed.).
◦ http://www.uptodate.com/contents/nonstress-test-and-contraction-stress-
test?source=see_link&sectionName=Nonstress+test&anchor=H10#H10
◦ Callahan, T., & Caughey, A. (2007). Blueprints obstetrics & gynecology (4th ed. /
Tamara L. Callahan, Aaron B. Caughey. ed., Blueprints). Philadelphia ; London:
Lippincott Williams & Wilkins.
◦ https://www.youtube.com/watch?v=NJEAQSyGmI0
◦ http://www.uptodate.com/contents/nonstress-test-and-contraction-stress-
test?source=see_link&sectionName=Nonstress+test&anchor=H10#H13
◦ Cunningham, F., & Williams, J. (2014). Williams obstetrics. (24th ed. / [edited by] F.
Gary Cunningham et al. ed.). New York ; London: McGraw-Hill Medical.
◦ http://www.girldocs.com/obsterical/fetal-movement-counts/
◦ https://www.uptodate.com/contents/decreased-fetal-movement-diagnosis-
evaluation-and-
management?source=search_result&search=fetal+movement&selectedTitle=1~127

20. THANK YOU


25. CHOICE OF TEST
◦ depends on multiple factors, including gestational age (up to 50 percent
of NSTs are not reactive in healthy 24 to 28 weeks fetuses [47]),
availability, desire for fetal biometry or follow-up of a congenital
anomaly, ability to monitor the fetal heart rate (eg, the NST and CST may
not be interpretable in a fetus with an arrhythmia), and cost.
◦ Doppler assessment of the umbilical artery should be used to monitor
the growth-restricted fetus, given its proven efficacy in reducing
perinatal death in this setting when used with standard fetal testing
(NST, BPP) and appropriate intervention [48]. It has only modest ability
to predict fetal compromise in other high-risk pregnancies

30. ◦ Antepartum Fetal testing
◦ Oligohydramnios & IUGR
◦ Third trimester bleeding (Placenta Previa vs Placenta Abruption)
◦ Molar Pregnancy
◦ Cervical Cancer
◦ Polycystic Ovarian Disease
◦ Infertility