Antenatal Monitoring

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[ ] Start @ 32 weeks (28 if super-high risk)

High negative predictive value (>99%) for fetal demise in next week
Reflect longer-term uteroplacental status (1 wk) & cant rule out fetal demise from acute events (trauma, abruption etc..)

[ ] Choose the 'standard of care' in your area - theyre all pretty good

Types

[ ] Fetal Kick Counts (10 movements in 2 hours)


[ ] NST Short-Term acid base status

Results
Reactive 2 FHR accelerations in 20min. (Accel is 15 bpm for 15 seconds)
May be elicited by vibroacoustic stim (1-3 sec.)
<28wks, half wont have accel and be fine
28-32wks accel is 10 seconds going up 10 beats
Nonreactive <2 FHR accelerations in 40min.
Variable decel (<30 sec, nonreptitive = ok, if >3 in 20 min, could be a problem)
Decel >1min are associated with nonreassuring FHR, fetal demise and risk of Cesarean Delivery

[ ] CST / Contraction Stress Test

Contraindicated if you dont want them contracting..
Adequate if 3 contractions lasting 40 seconds in 10 min period
May induce with Nipple Stimulation or Oxytocin
Nipple stimulation is usually faster
Results
Negative (No late or significant variable decels)
Positive (Late decels after 50% or more of ctx)
Equivocal/Suspicious (Intermittent Lates / Suspicious Variables)
Equivocal (FHR decel occur w/ ctx more frequent than q2 min or lasting >90sec)
Unsatisfactory (<3ctx in 10 min or uninterpretable)


[ ] BPP

[ ] mBPP

[ ] Umbilical Artery dopplers


References

ACOG antepartum fetal surveillence

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