Fetal Surveillance Practice Guideline

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Fetal SurveillancePractice Guideline

• Evidence-based Workshop
• Fetal Surveillance
• 1-2 December 2005
• Assoc.Prof. Pannee Sirivatanapa
• MFM Unit, Dept. OB-GYN
• Fac. Med., Chiang Mai University

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Existent Fetal Monitor inVarious OB-Service

• Nothing
• NST (non-stress test)
• SP (sound provoke)
• U/S (ultrasound)
• NST, SP
• NST, U/S
• U/S, SP
• NST, U/S, SP

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Fetal Surveillance Practice Guideline
All pregnant women
Risk screening
Low risk
High risk
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Fetal Surveillance Practice Guideline (cont.)
Low risk pregnant women
lt10 counts in 4 hrs
gt10 counts in 4 hrs

• Routine ANC

More tests as high risk
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Fetal Surveillance Practice Guideline (cont.)
High risk pregnant women

• NST SP U/S NST NST U/S
  NST
• SP
  U/S SP U/S
• SP

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Sequence of Fetal Surveillance

• Fetal Movement Count
• NST SP Rapid AST
• BPP
• Modified or Full BPP
• Doppler
• (CST for OB-service having NST only)

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Sequence of Fetal Surveillance (cont.)

• ?NST (non stress test)
• - fetal heart beat pattern, fetal movement
• ? AST (acoustic stimulation test)
• - NST, sound provoke
• ? SP (sound provoke)
• - sound stimulation, maternal perception of
  fetal movement
• ? Rapid BPP (rapid biophysical profile)
• - sound provoke, ultrasound detection of
• fetal movement, amniotic fluid assessment

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Sequence of fetal Surveillance (cont.)

• ? Modified BPP (modified biophysical profile)
• - fetal breathing, body movement, fetal
• tone, amniotic fluid assessment
• ? Full BPP (full biophysical profile)
• - modified BPP, NST
• ? CST (contraction stress test)
• - uterine contraction, fetal heart beat
  pattern

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Case 1 (Private Clinic)

• Age 35 yrs G2P1001 NL-full term 6 yrs
• BW 43 kgs Ht 151 cm
• Hb 12.0 g. Hct 36 Bl.gr. B
• OFT -ve DCIP -ve
• VDRL -ve HIV -ve HBsAg -ve
• 1st ANC GA 12-13 wks (U/S 10 wk)

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Case 1 (cont.)
ANC GA (LMP) BW A/S BP FH (CM)
1 12 44 -ve 110/70 U/S10 wks
2 16 45 -ve 130/70 14
3 20 45 -ve 120/70 18 U/S 16-17 wks amniocentesis
4 24 44 -ve 130/80 20
5 28 45 -ve 110/70 23 U/S 24 wks
6 32 46 -ve 110/70 26
7 34 47 -ve 110/70 28
8 36 48 -ve 110/70 30
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Case 1 (cont.)

• Risks ? Age 35 yrs
• ? BMI 18.8 (low BMI)
• ? Low weight gain
• ? IUGR

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Case 2 (Community Hospital)

• Age 23 yrs G2P0101 NL 1,500 gm 5 yrs
• BW 83 kgs Ht 159 cm
• Hb - Hct 38 Bl.gr 0
• OFT -ve DCIP -
• VDRL -ve HIV -ve HBsAg -ve
• 1st ANC GA 25-26 wks

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Case 2 (cont.)
ANC GA (LMP) BW A/S BP FH (cm)
1 25 95 -ve 110/70 2 FB,22
2 30 97 -ve 110/70 2/4, 33
3 32 97.5 -ve 140/90 ¾, 32
4 35 98 -ve 130/90 ¾, 36
5 36 102 -ve 140/100 ¾ , 40
6 37 104 -ve 130/100 ¾, 42
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Case 2 (cont.)

• Risks ? Hx of low birth weight newborn
• ? BMI 32.8 (obesity)
• ? Thalassemic fetus
• ? Hypertension
• ? Difficult labor

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Case 3 (Maharaj)

• Age 35 yrs G2P1001 NLfull term 13 yrs
• BW 81 kgs Ht 160 cm
• Hb 11.5 g Hct - Bl.gr. AB
• OFT ve HbE -ve
• VDRL -ve HIV -ve HBsAg -ve
• 1st ANC GA 9-10 wks

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Case 3 (cont.)
ANC GA(LMP) BW A/S BP FH (cm)
1 9 82.5 -ve 130/70 PV 8-10
2 13 28.5 -ve 140/80 18 U/S 19-20 wks amniocentesis
3 17 24.9 -ve 110/70 3FB
4 21 87.4 -ve 100/60 28
5 23 88.2 -ve 105/50 29
6 25 89.6 -ve 120/70 31 GCT 113
7 27 91.7 -ve 110/70 32
8 29 92.7 -ve 120/70 34
9 30 93.5 -ve 120/80 34
10 31 95.2 -ve 120/70 37
11 32 96.7 -ve 120/80 40
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Case 3 (cont.)

• Risks ? Age 35 yrs
• ? BMI 31.6 (obesity)
• ? Thalassemic fetus
• ? Excessive weight gain
• ? Difficult labor

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Case 4 (community hospital)

• Age 16 yrs G1 P 0000
• BW 44 kgs Ht 154 cm
• Hb - Hct 30 g Bl.gr AB
• OFT -ve HbE -ve
• VDRL -ve HIV ve HBsAg ve
• 1st ANC GA 15-16 wks

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Case 4 (cont.)
ANC GA (LMP) BW A/S BP FH (cm)
1 15 45 -ve 100/60 -
2 20 46 -ve 90/50 -
3 24 47 -ve 90/60 17
4 30 48 -ve 87/59 20
5 35 49 -ve 90/60 22
6 36 50 -ve 100/70 28
7 41 48.4 -ve 120/80 32
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Case 4 (cont.)

• Risks ? Age 16 yrs
• ? BMI 18.5 (low BMI)
• ? Anemia
• ? Low weight gain
• ? IUGR

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Case 5 (Maharaj)

• Age 25 yrs G1 P0000
• BW 48 kgs Ht 158 cm
• Hb 12.8 g Hct - Bl.gr. A
• OFT -ve Hb E -ve
• VDRL -ve HIV -ve HBsAg ve
• 1 st ANC GA 12 wks

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Case 5 (cont.)
ANC GA(LMP) BW A/S BP FH(cm)
1 12 54.2 -ve 100/60 PV 8-10 U/S 11.2 wks
2 16 55.5 -ve 120/70 2/3 SP
3 20 56.7 -ve 120/80 20
4 24 58 -ve 120/78 24
5 28 60 -ve 110/80 28
6 32 62.9 -ve 110/80 31
7 34 62.2 -ve 110/70 33 FMC
8 36 62.7 -ve 120/80 34
9 38 64.3 -ve 120/80 35
10 39 64.2 -ve 120/80 35
11 40 64.5 -ve 125/80 35
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• Case 5 (cont.)

Risks no (BMI 19.2 normal)
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Case 6 (Maharaj)

• Age 33 yrs G3P1011 NL-full term 8 yrs
• BW 50 kgs Ht 152 cm
• Hb 12.4 g Hct - Bl.gr. A
• OFT -ve HbE -ve
• VDRL -ve HIV -ve HBsAg -ve
• 1 st ANC GA unknown

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Case 6 (cont.)
ANC GA (U/S) BW A/S BP FH(cm)
1 11 51 -ve - PV 10-12 U/S 11 wks
2 17 54.3 -ve 90/60 15
3 21 55.8 -ve 90/60 21
4 25 57.7 -ve 90/60 24 GCT 166 OGTT 106,254,187
5 28 58 -ve 11/70 26
6 30 58 -ve 100/70 30 FMC
7 32 59.8 -ve 110/70 31 NST q 1 wks
8 34 60.2 -ve 110/70 35
9 36 31.6 -ve 110/80 35
10 37 61.2 -ve 100/70 35
11 38 61.7 -ve 110/70 36
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Case 6 (cont.)

• Risks ? Unknown date
• ? BMI 21.6 (normal)
• ? GDM class A2

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• ? ??????????????????????
• ? ????????????????????
• ? ???? lt 16 ?? ???? gt 40 ??
• ? ????????????????? lt 2,500 ???? ???? gt 4,000
  ????
• ? ?????????????????
• ? ????????????
• ? ?????????????????, ???????, ????????
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• ????????????
• ? ???????????????????????????? 30 ???????

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????????????????????????????????????????

• ? ???????????? lt 45 ????????
• ? ???????????? lt 145 ?????????
• ? ???????????????? lt 18.5
• ? ????????????????? lt 10 ????????
• ? ?????????
• ? ??????????????

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• Case 1 NL ? 1,750 g 6 ? 10
• Case 2 NL ? 3,300 g 9 ? 10
• Case 3 NL ? 3,220 g 10 ? 10
• Case 4 NL ? 2,550 g 9 ? 10
• Case 5 NL ? 2,950 g 9 ? 10
• Case 6 FE ? 3,150 g 10 ? 10 (Fetal distress)