[14] Antenatal Fetal Monitoring

Question 1

What is antenatal fetal monitoring a routine part of?

Answer 1

Antenatal care

Question 2

What aspects of antenatal fetal monitoring are part of routine antenatal care?

Answer 2

• Assessment of fetal growth is assessed by palpation of uterine size
• Enquiries regarding fetal activity

Question 3

When is palpation of uterine size and enquiries regarding fetal activity performed?

Answer 3

At every antenatal check

Question 4

Is palpation of uterine size and enquiries about fetal movement sufficient monitoring?

Answer 4

It is in most pregnancies

Question 5

When might more detailed antenatal fetal monitoring be indicated?

Answer 5

• Maternal hypertension
• Reduced fetal activity
• Suspected SGA fetus
• Previous stillbirth/neonatal death
• Post-maturity

Question 6

When are most women aware of fetal movements?

Answer 6

During the second half of pregnancy

Question 7

What is the result of women being aware of fetal movements?

Answer 7

They are able to appreciate when the frequency of fetal movements reduces significantly

Question 8

What should all women be asked to do, regarding fetal movements?

Answer 8

Pay attention to the frequency of fetal movements during the latter stages of pregnancy

Question 9

When is it particularly important for a woman to pay attention to the frequency of fetal movements?

Answer 9

When there has been adverse outcomes to a previous pregnancy, or where there is suspicion of IUGR in previous pregnancy

Question 10

What should be done when a woman reports reduced fetal movements under 24 weeks?

Answer 10

Listen to fetal heart beat with Doptone

Question 11

What should be done if fetal heart beat is heard when a woman presents with RFM under 24 weeks?

Answer 11

Reassure, unless fetal movements have never been felt

Question 12

What should be done if fetal movements have never been felt at 24 weeks?

Answer 12

Referral to exclude fetal neuromuscular abnormality

Question 13

What should be done when a woman reports reduced fetal movements at 24-27 weeks?

Answer 13

Confirm the presence of heart beat with Doptine, and request ultrasound scan for growth and liquor if risk factors for growth restriction, hypertension, or stillbirth

Question 14

What should be done when a woman reports reduced fetal movements at 28+ weeks?

Answer 14

Perform additional fetal monitoring

Question 15

What procedure should be followed when the patient presents requiring additional fetal monitoring?

Answer 15

1. Document reason for increased fetal monitoring
2. Check maternal BP and test urine for protein
3. Palpate the uterus, and measure the symphysis-fundal height and plot on chart
4. Perform CTG for at least 20 minutes

Question 16

What should be done if a woman has presented twice within 1 week complaining of reduced fetal movements?

Answer 16

Scan for fetal biometry and liquor assessment

Question 17

What should be done if a woman presents with RFM, and there is a concern regarding fetal size or significant maternal hypertension or proteinuria?

Answer 17

Commence fortnightly ultrasound scans to determine EFW and liquor volume

Question 18

What should be done if a woman presents with RFM and the fetal weight is below the 5th centile?

Answer 18

Do umbilical artery Doppler studies