| Background | Techniques | Results | Abnormal |
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Antepartum testing is based on the premise that the fetus responds to THIS with biophysical changes such as THESE
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What are kick counts?
Decreased FM may precede fetal death. No standard protocol exists. Ex: 10 movements in up to 2hrs (may stop after 10; mean time to 10 was 20.9min) Decreased fetal movement is an indication for further fetal assessment.
Maternal perception of fetal movement.
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What is a reactive NST?
24yo G1P0 at 38wk2d with THIS
CEFM: baseline 145, moderate variability, 3 accelerations of 15 bmp for 15s, no decelerations. Toco: quiet |
What is oligohydramnios?
DVP>2cm AFI>5cm Level A evidence supports the use of DVP over AFI to dx oligo. DVP associated with reduction in unnecessary interventions without increase in adverse perinatal outcomes.
Amniotic fluid volume of 2cm in the single deepest vertical pocket (not containing cord or fetal extremities).
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What is high false positive rate, low positive predictive value, and another fetal surveillance test. This minimizes the potential for unnecessary deliveries.
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Since antepartum fetal surveillance tests have THIS test quality and THIS test value, abnormal tests are usually followed by THIS.
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What is an NST, semi-Fowler or lateral recumbent position, at least 20 minutes, vibroacoustic stimulation?
CEFM + Toco for 20-40min, +/- vibro. stim (abdominal "buzz" for 1-2s, may repeat up to 3 times for progressively longer up to 3s).
Since fetal heart rate reactivity is an indication of normal autonomic function, THIS test may be performed with the patient in THIS position and over THIS period of time without or without THIS stimulation.
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What is a negative CST?
35yo G4P3002 at 37wk1d presents with painful regular contractions every 3 minutes and THIS
CEFM: baseline 145, moderate variability, +accelerations, no decelerations |
What is a non-reactive NST?
Accels GA >32wks accels = 15x15 GA <32wks accels = 10x10
29yo G1 at 35wk3d with THIS after 1hr and vibroacoustic stimulation.
CEFM: baseline 145, moderate variability, 2 accelerations of 10 bmp for 10s, no decelerations. Toco: quiet |
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What is timing, frequency and duration of testing?
There is no strong evidence to support THESE aspects of antepartum fetal surveillance testing therefore clinical judgement may be used considering gestational age, indication for testing, and when delivery would be considered.
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What is an CST, contraction, late decelerations?
CEFM + Toco for 10 minutes with at least 3 contractions of at least 40s each. Contractions may be spontaneous or induced by either nipple stimulation or oxytocin.
THIS test relies on the premise that fetal oxygenation will be transiently worse with THIS stimulation in a sub-optimally oxygenated fetus and will exhibit THIS FHR pattern.
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What is an unsatisfactory CST?
25yo G2P1001 at 38wk0d after nipple stimulation has THIS
CEFM: baseline 145, moderate variability, +accelerations, no decelerations. Toco: quiet |
What is a positive CST?
Late decels 50% or more of ctx even if there are <3 ctx in 10 min.
35yo G4P3002 at 37wk1d presents with painful regular contractions every 3 minutes and THIS
CEFM: baseline 145, moderate variability, +accelerations, and late decelerations with 50% of the contractions. |
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What are relative indications for antenatal fetal surveillance? Since antepartum fetal surveillance results have not been definitively demonstrated to improve outcome all indications are relative.
Pregestational and gestational DM, cHTN, gHTN, SLE, CKD, antiphospholipid syndrome, hypertheyroidism, preE, decreased fetal movement, oligo, IUGR, postterm, isoimmunization, h/o IUFD, etc.
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What is an BPP, 30 minutes, fetal breathing movements, body or limb movements, and extremity extension and return to flexion or opening/closing of a hand.
Each component is assigned a score of 2 (present) or 0 (absent).
THIS test is conducted in THIS time period and consists of an NST, assessment of amniotic fluid volume, 1 or more of THESE movements for 30s, 3 or more of THESE movements, and 1 or more of THESE movements.
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What a normal modified BPP?
32yo G3P2002 at 36wk6d with THIS
CEFM: baseline 145, moderate variability, 3 accelerations of 15 bmp for 15s, no decelerations. Toco: quiet AND a deepest vertical amniotic fluid pocket of 5. |
What is an equivocal BPP and should be repeated in 24hrs?
38yo G3P2002 at 34wk3d with THIS: reactive NST, DVP 5, no breathing movements, 1 body movement, and opening of the hand; should do THIS next.
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What is 6.2/1000, 1.9/1000, 0.3/1000, 0.8/1000, and 0.8/1000?
This gives a NPP of 99.8% for NST and 99.9% for the CST, BPP, and modified BPP.
The stillbirth rate in the general population is THIS compared to corrected rates after a normal antepartum fetal surveillance test within 1 week after an NST is THIS, CST is THIS, BPP is THIS, and modified BPP is THIS.
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What is umbilical artery doppler velocimetry, umbilical flow velocity, high-velocity diastolic flow, decreased?
Doppler US is used to assess hemodynamic components of vascular resistance in pregnancies c/b fetal growth restriction.
THIS test is based on THIS waveform which is characterized by THIS flow in normal fetuses and THIS flow in growth restricted fetuses.
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What is a 10/10 BPP?
Normal BPP 8/10 or greater Equivocal 6/10 Abnormal 4/10 or less
19yo G1 at 38wk5d with THIS
A reactive NST, DVP of 3, two 45s breathing movements, 3 body movements, and opening and closing of both hands. |
What is absent or reverse and delivery?
SMFM suggest: absent end-diastolic flow -> delivery at or beyond 34wk0d reversed end-diastolic flow -> delivery at or beyond 32wk0d
31yo G5P1122 at 35wk4d with EFW in the 3rd%ile and THIS end-diastolic flow should be considered for THIS.
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When was 1972?
The CST was the first antenatal surveillance test that was developed after the development of the cardiotocograph and was first described in this year.
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