FETAL ASSESSMENT & MONITORING

Biophysical Profile Scoring

Contraction Stress Text

Fetal Heart Rate Monitoring

Interventions for severe fetal bradycardia

Screening for Congenital Abnormalities

Fetal ECG-Approval recommended by an FDA Panel in 2005 of the "STAN 31" as an adjunct in the evaluation of nonreassuring fetal heart rate tracing.  Monitors fetal ECG and heart rate via a scalp electrode

Fetal Pulse Oximetry

• Use has been associated with reduction in operative deliveries with no increase in maternal or fetal risk in randomized studies (Am. J. Obs. Gyn. 191:1989, 2004--AFP)
• In another study, however, in which 5,341 nullips in early labor were randomized to oximetry vs. none (all had electronic fetal heart rate monitoring), there was no sig. diff. in c/s incidence (26.3% vs. 27.5%) (study presented by Steven Bloom at Soc. for Mat-Fet med, FP News 3/1/06)
• However, in a study in 5,300 nulliparous women in early labor at term randomized to open fetal pulse oximetry (i.e. caregivers were aware of results) vs. masked oximetry).  No sig. diff. seen in incidence of cesarian delivery or instrumental delivery; ditto for subgroup of pts with nonreassuring fetal heart rate patterns.  34.6% of nonreassuring FHR patterns were associated with  low oxygen saturation; 25.1% of normal FHR patterns were associated with low oxygen saturation (NEJM 355:2195, 2006--JW)