Tn: Prenatal Fetal Monitoring

Front 1

When do patients typically notice fetal movements ("quickening")?

Back 1

• 18-20 weeks in primigravidas
  
• can occur 1-2 weeks earlier in multigravidas
  
• can occur 1-2 wk later if placenta implanted on anterior wall of uterus
  

Front 2

What to do if patient is concerned about decreased fetal movement?

Back 2

• counseled to choose a time when fetus is normally active to count movements (usually recommended after 26 weeks)
  
• all high risk women should be told to do FM counts
  

Front 3

What to do if there is a subjective decrease in fetal movements?

Back 3

• >/= 6 movements in 2 h expected
  
• < 6 movement counts in 2 h, patients should present to labour and delivery triage
  

Front 4

DDx of decreased fetal movements?

Back 4

DASH

• Death of fetus
  
• Amniotic fluid decreased
  
• Sleep cycle of fetus
  
• Hunger/Thirst
  

Front 5

Definition of non-stress test

Back 5

FHR tracing ≥20 min using an external Doppler to assess FHR and its relationship to fetalmovement

Front 6

Indications for non-stress test?

Back 6

Any suggestion of uteroplacental insufficiency or suspected compromise in fetal well-being

Front 7

What is a normal NST?

Back 7

2 accels, > 15 bpm from baseline, lasting > 15 s in 20 min

Front 8

Normal NST baseline

Back 8

110-160 bpm

Front 9

Normal NST variability

Back 9

• 6-25 bpm (moderate)
  
• ≤5 (absent or minimal) for<40 min
  

Front 10

Normal NST decelerations

Back 10

None or occasional variable < 30 seconds

Front 11

Normal NST accelerations in term fetus

Back 11

2 accelerations with acme of≥15 bpm, lasting 15 seconds over<40 min of testing

Front 12

Normal NST accelerations in preterm fetus?

Back 12

>2 accelerations with acme of>10 bpm, lasting 10 s in<40 min

Front 13

Normal NST action?

Back 13

FURTHER ASSESSMENTOPTIONAL, based on totalclinical picture

Front 14

Atypical NST baseline?

Back 14

100-110 bpm or >160 bpm for<30 minRising baseline

Front 15

Atypical NST variability?

Back 15

5 (absent or minimal) for40-80 min

Front 16

Atypical NST decelerations?

Back 16

Variable decelerations30-60 s duration

Front 17

Atypical NST accelerations in term fetus

Back 17

2 accelerations with acme of≥15 bpm, lasting 15 s in40-80 min

Front 18

Atypical NST accelerations in preterm fetus (<32 wks)

Back 18

<2 accelerations with acme of>10 bpm, lasting 10 s in40-80 min

Front 19

Atypical NST action?

Back 19

FURTHER ASSESSMENTREQUIRED

Front 20

Abnormal NST baseline?

Back 20

Bradycardia <100 bpmTachycardia >160 for >30 minErratic baseline

Front 21

Abnormal NST variability?

Back 21

≤5 for 80 minSinusoidal25 bpm for >10 min

Front 22

Abnormal NST decelerations

Back 22

Variable decelerations >60 sLate deceleration(s)

Front 23

Abnormal NST accelerations in term fetus?

Back 23

<2 accelerations with acme of≥15 bpm, lasting 15 s in>80 min

Front 24

Abnormal NST accelerations in preterm fetus (< 32 weeks)

Back 24

<2 accelerations with acme of>10 bpm, lasting 10 s in>80 min

Front 25

Abnormal NST action?

Back 25

URGENT ACTION REQUIREDAn overall assessment of thesituation and further investigationwith U/S or BPP is required; somesituations will require delivery

Front 26

How to interpret normal NST?

Back 26

at least 2 accelerations of FHR >15 bpm from the baseline lasting >15 s, in 20 min

Front 27

How to interpret abnormal NST?

Back 27

<2 accelerations of FHR in 40 min

Front 28

What to do if no observed accels/fetal movements in first 20 min?

Back 28

stimulate fetus (fundal pressure, acoustic/vibratory stimulation) and continue monitoring for 30 min

Front 29

What to do if NST abnormal?

Back 29

perform BPP

Front 30

What is a BPP?

Back 30

US assessment of fetus +/- NST

Front 31

Indications for BPP?

Back 31

• abnormal or atypical NST
  
• post-term pregnancy
  
• decreased fetal movement
  
• any other suggestion of fetal distress or uteroplacental insufficiency
  

Front 32

What is a reassuring BPP?
AFV, breathing, Limb movement, and fetal tone?

Back 32

• AFV = fluid pocket of 2 cm in 2 axes
  
• Breathing = at least one episode of breathing lasting at least 30 s
  
• Limb movement = three discrete movements
  
• Fetal tone = at least one episode of limb extension followed by flexion
  

Front 33

What is a non reassuring BPP?

Back 33

• AFV = oligohydramnios
  
• Breathing = no breathing
  
• Limb movement = two or less
  
• Fetal tone = no movement
  

Front 34

BPP of 8?

Back 34

perinatal mortality rate 1:1,000; repeat BPP as clinically indicated

Front 35

BPP of 6?

Back 35

perinatal mortality 31:1,000; repeat BPP in 24 h

Front 36

BPP of 0-4?

Back 36

perinatal mortality rate 200:1,000; deliver fetus if benefits of delivery outweigh risks

Front 37

Mnemonic for reassuring BPP? (8/8) LAMB

Back 37

LAMB

• Limb extension + flexion
  
• AFV 2 cm x 2 cm
  
• Movement (3 discrete)
  
• Breathing (one episode x 30 s)