ANTEPARTUM FETAL

SURVEILLANCE TESTS AND

ABNORMALITY
pathology
Daily Fetal Movement Count
Fetal movement counting
Decreased placental perfusion and fetal acidemia and acidosis are associated with decreased
fetal movements
Diminished fetal activity may be a harbinger of impending fetal death(Sadovosky,1973)
causes for decreased perception of fetal movement-
Fetal sleep
Maternal activity
Obesity
Medications
smoking
Non-stress Test
Abnormal Nonstress Tests
May be seen with a sleeping fetus.
Nonstress test which is nonreactive for 90 minutes almost invariably (93%) associated with
significant perinatal pathology.(Devoe and coworkers)
 Fetal tachycardia
(ACOG)
Baseline heart rate > 160 bpm
Mild-160 to 180 bpm
Severe ->180 bpm
Tachyarrhythmia >200
Causes of fetal tachycardia:
Maternal fever
Fetal hypoxia
Hyperthyroidism
Maternal or fetal anemia
Parasympatholytic drugs- atropine/ hydroxyzine
Sympathomimetic drugs- terbutaline/ ritondrine
Chorioamnionitis
Fetal tachyarrhythmia
Prematurity
Fetal bradycardia
 Baseline heart rate less than 110 bpm.

Causes of prolonged severe bradycardia(<80 bpm lasting>3min):

prolonged cord compression
 cord prolapse
uterine hyperstimulation
paracervical block, epidural and spinal anesthesia,
maternal seizures
 rapid descent
Fetal congenital heart block
SLE in mother
If the cause cannot be identified and corrected, immediate delivery is recommended .
 Sinusoidal pattern
Undulating heart rate pattern with absent variability
High rates of fetal morbidity and mortality
Associated with
•fetal anemia
•Fetal asphyxia
•Congenital malformations
•Medications such as narcotics
Arrhythmia:
TACHYARRHYTHMIA:

Fetal ventricular rate > 200 beats /min

CAUSES:
Paroxysmal supraventricular tachycardia
Atrial flutter
TX:
Digoxin
Sotalol or Flecainide i/c/o immune hydrops
BRADYARRHYTHMIA
Fetal heart rate is <100 bpm secondary to atrioventricular block

CAUSES:
•Fetal cardiac anomalies
•Maternal SS-A and SS-B antibodies
•Fetal hydrops

Treatment:
•Beta agonists
•Steroid / Immunoglobulin
Decelerations during Nonstress test
Decelerations during Nonstress test
Variable decelerations , if nonrepetitive and brief , less than 30 seconds, do not indicate fetal
compromise and there is no need for obstetrical intervention.( ACOG 2016)
Repetitive variable decelerations at least three in 20 minutes , even if mild have been associated
with a greater risk of caesarean delivery for fetal distress.
Decelerations lasting 1 minute and longer have been reported to have an even worse prognosis.
(Bourgeois,1984; Druzin,1981;Pazos,1982).
Severe variable decelerations during nonstress test with AFI <5 cm resulted in 75% caesarean
delivery in a study by Hoskins and associates(1991).
Silent oscillatory pattern
Dangerous
It consists of a fetal heart rate baseline that
oscillated less than 5 bpm and absent of
accelerations and loss of beat-to-beat variability.
Saltatory pattern
Increased variability in the baseline FHR -the oscillations
exceed 25 bpm 
Cause-acute hypoxia or umbilical cord compression
ABNORMAL BIOPHYSICAL
PROFILE
 MANAGEMENT BASED ON BPP:
SCORE INTERPRETATION MANAGEMENT

10 Normal/low risk Weekly to twice weekly

8 Normal /low risk Weekly to twice weekly

6 Suspect chronic asphyxia
4 Suspect chronic asphyxia
>\=36-37 wks or <36wks with fetal pulmonary maturity +ve consider
delivery
<36wks /fetal pulmonary maturity is –ve repeat BPP in 4-6 hrs ,deliver if
oligohydramnios is present
>\= 36 wks deliver
<32wks repeat score

0-2 Strongly suspect chronic asphyxia Extend testing time -120 min , if persistent score is </=4 deliver regardless
of gestational age
Take home message
Antepartum fetal surveillance is initiated at the gestational age when an increased risk of fetal
demise is identified and delivery for perinatal benefit would be considered if test results are
abnormal .
In most pregnancies it is started from 32 weeks of period of gestation.
Testing is typically performed weekly , but frequency is increased if pregnancy is very high risk or
previous non reassuring type of test results.
Abnormal test result is generally followed by additional testing with different test eg nonreactive
NST to be followed by CST or BPP.
Abnormal test result due to temporary maternal condition requires prompt action to improve
fetal oxygenation . In chronic conditions we need to consider case specific factors.
Thank you