Ultrasound can be used to assess fetal wellbeing by measuring various parameters of the fetus such as the fetal heart rate, amniotic fluid volume, and fetal movements. Fetal Heart Rate (FHR) : A normal FHR is usually between 120-160 beats per minute (bpm) and it can be assessed using ultrasound. Abnormal FHR patterns such as tachycardia or bradycardia may indicate fetal distress and require further evaluation. Amniotic Fluid Volume (AFV) : A normal AFV is essential for fetal wellbeing as it cushions the fetus and allows for proper fetal movement and growth. An abnormal AFV such as oligohydramnios (low fluid) or polyhydramnios (excess fluid) can indicate a problem with the fetus or the placenta. Fetal Movements : Fetal movements can be observed using ultrasound, and a lack of fetal movement can indicate fetal distress. Biometric parameters such as the measurement of the head, abdominal circumference, femur length, and others can be used to assess fetal growth and development.

1. ASSESSMENT OF
FETAL WELLBEING

2. ASSESSMENT TOOLS
• Ultrasound (amniotic fluid , fetal growth )
• CTG
• Biophysical profile
• Doppler ultrasound

3. CTG (CARDIOTOCOGRAPHY)
Fetal cardiac behaviour is regulated through the autonomic nervous system and by
vasomotor, chemoreceptor and baroreceptor mechanisms.
Pathological events, such as fetal hypoxia, modify these signals and hence cardiac
response including variation in heart rate patterns, which can be detected and
recorded in the CTG

4. COMPONENTS OF CTG
• Baseline rate.
• Baseline variability.
• Accelerations.
• Decelerations

5. BASELINE HEART RATE
• Normally from 100-160 beat / min
• Increased in cases of maternal tachycardia (fever , thyrotoxicosis , cardiac
diseases)
• Increased in fetal infection , fetal anemia , fetal asphyxia
• It decreases with gestational age due to maturation of parasympathetic system
with advancing age
(of course will not decrease than the normal range above at any gestational age )

7. ACCELERATION
• Defined as increases in baseline more than 15 beats for at least 15 seconds
• The presence of two or more accelerations on a 20–30-minute antepartum fetal
CTG defines a reactive trace and is indicative of a non-hypoxic fetus (i.e. they are
a positive sign of fetal health)

8. BASELINE VARIABILITY
• Normal baseline variability reflects a normal fetal autonomic nervous system
• Fluctuation of fetal heart baseline between 5-25 beat but for less than 15 sec
• Its considered decreased if less than 10 beats variability
• Reduced in sleep (20-30 min) and hypoxia , fetal infections , maternal use of
opiods

10. FETAL HEART RATE DECELERATIONS
• reductions in fetal heart rate of 15 bpm or more, lasting for more than 15 seconds
• Types and causes : important !
A. Early
B. Variable
C. Late
Early starts with contractions ……. Head compression
Late start after contraction …… uteroplacental insufficiency as in abruptio
placenta ,IUGR, fetal asphyxia (cord prolapse )
Variable is not related to contractions …… cord compression

11. Early decertation

12. SINUSOIDAL PATTERN
• Sever Fetal anemia
• Bleeding from vasa previa

13. PROLONGED DECELERATION
• Typically its from 3 minutes to less than 10 minutes
• More than 10 minutes is bradycardia

14. EXAMPLES OF CTG

15. ???

16. ???

20. FETAL ANEMIA –HEMORRHAGE

21. BIOPHYSICAL PROFILE

22. SCORE OF BIOPHYCICAL PROFILE
• 8-10 normal
• 6 borderline (repeat it )
• 4 or less abnormal

23. DOPPLER STUDY
• Assess placental and fetal vessels :
Uterine artery
Umbilical artery
Middle cerebral artery
Ductus venosus

24. UTERINE ARTERY DOPPLER
• Uterine artery should be of a high capacitance and low resistance (more flow )
due to trophoblastic invasion of the spiral arterioles .
• If uterine artery shows high resistance this means that this pregnancy maybe
complicated by uteroplacental insufficiency
• Used to predict preeclampsia and IUGR early in pregnancy (20-24 week )
• Abnormal if diastolic notch or high resistance index (RI)

25. UTERINE ARTERY DOPPLER
• Give an idea on the placental function
• Normally, flow to the placenta is of low resistance and the placenta take this
blood easily from the fetus back to the mother
• In abnormal pregnancy where placenta is abnormal it will not take the blood
easily showing resistance to umbilical artery blood flow .

26. ABNORMAL UMBILICAL ARTERY
High resistance index (PI,RI)
Decreased end diastolic flow
Absent diastolic flow
Reversed diastolic flow
This means decreased blood that is going to the placenta from fetal blood ,or even
revered back to the fetus
Its use decreases perinatal death in IUGR and PET pregnancies in HIGH RISK patients

27. FETAL VESSELS
• During stress periods as in uteroplacental insufficiency (eg.IUGR) ,
REDISTRIBUTION of blood occur in the fetus favoring the vital organs as brain
(CENTRALIZATION) and decreasing blood flow to less vital organs like kidneys ,
limbs and skin
• This will increase the flow through cerebral arteries and decreases flow in central
venous
• Increasing the FLOW and decreasing the Resistance in cerebral artery (early
IUGR and anemia )
• Increasing resistance and decreasing flow in aortic arterial , ductus venosus ,
venous flow

28. CEREBROPLACENTAL RATIO
• It’s a good tool in IUGR , giving a ratio in PI between cerebral and umbilical flow
• In stress cerebral PI will decrease (decreased resistance and more flow due to
centralization )
• PI in umbilical artery will increase (more resistance , low flow )
• If increased it carries a worse perinatal outcome .