Fetal Assessment

DR. SAIMA ASHRAF

M.B.B.S (Gold medalist), F.C.P.S (Gold medalist), AdCMT
Associate Professor
Head of Department. Gynae Unit III
Nishtar Medical University Multan
Aims of Fetal Assessment

1. To ensure satisfactory growth and well being of fetus.

2. To screen risk factors that affect the growth.

3. To avoid fetal death.

Early Pregnancy Assessment
Ultrasound
1. Early dating scan 10^6 weeks to 13^6 weeks
2. Anomaly scan 18^6 weeks to 22 weeks
We access by scan
Gestational Amenorrhea
Heart Activity
Amniotic Fluid
OBS Ultrasound
Amniotic Fluid

Accessed in 2nd and Early 3rd Trimester

1. Maximum vertical pool

2. Amniotic fluid index(10-25 cm)

 Less than 10 cm(Reduced amniotic fluid)

 Less than 5 cm(Oligo hydromnios)

 Greater than 25 cm(Poly hydromnios)

Cardiotocograph

Continuous tracing of fetal heart rate(30

minutes)
It includes four parameters
1. Base line heart rate(110-160 BPM)
2. Base line variability
3. Accelerations
4. Decelerations
Base line heart rate

 110-160 bpm ( Normal)

 Less than 110 bpm

(Bradycardia)

 Greater than 160

bpm(Tachycardia)
Variability

 Beat to beat variability in one

minute strip

 Difference between highest and

lowest beat

 Normal 5-25 bpm

Accelerations

 Increase in heart rate of 15 bpm

in 15 s

 2 or 3 accelerations in a normal
CTG trace
Decelerations
 Decrease in heart rate of 15 bpm
in 15 s

 There should be no deceleration

in a normal CTG trace
Interpretation of CTG

Interpretation Features
Normal All four features are
normal
Suspicious One feature is abnormal
Pathological Two or more features
abnormal
Biophysical Profile

A biophysical profile is a way to check on

overall fetal health. It consists of two
painless, noninvasive tests: fetal
monitoring and ultrasound. Typically, it
takes about 30 to 70 minutes to complete
 Scoring System
Parameter Score 2 Score 0
Non-stress CTG Reactive Fewer than two
accelerations in 40 minutes
Fetal breathing movements ≥ 30 movements in 30 Fewer than 30 seconds of
minutes fetal breathing in 30
minutes

Fetal body movements ≥ 3 movements in 30 Two of fewer gross body

minutes movements in 30 minutes

Fetal tone One episode of limb No evidence of fetal

flexion movement or flexion
Amniotic fluid volume Large cord free pocket Less than 1 cm pocket of
over 1 cm fluid
Interpretation
Score Interpretation It is time

8-10 Normal consuming and

affected by fetal

0,2,4 Abnormal sleep activity that’s

why it is not

6 Repeat reliable.
Doppler Study

 Used to access placental insufficiency

 It gives idea of resistance to blood flow

It includes

 Umbilical Artery Doppler

 Middle Cerebral Artery Doppler

 Uterine Artery Doppler

Abnormal UA Doppler Waveform depends on the
severity of disease

Normal pregnancy Reduced end diastolic

velocity

Absent end diastolic velocity Reversed end diastolic

velocity
 Invasive Procedures

These are used to access the karyotype for different genetic diseases

 Amniocentesis

 Chorionic Villous Sampling

 Cordocentesis
Amniocentesis

 Done at 15 weeks

 Risk od miscarriage is 1%
Chorionic Villous Sampling

 Done at 11 weeks

 Risk of miscarriage is 1-2 %

Cordocentesis

 Done at 20 weeks

 To see Alloimmune Thrombopenia

 Risk of miscarriage is 2-5%

Dr. Saima Ashraf
Head of Department. Gynae Unit III
Nishtar Medical University Multan