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Antepartum Fetal

Surveillance
Journal Report
Tana, Mobbydick G.
Section D
November 7, 2016
American Journal of Obstetrics and Gynecology
March 2015
Brief Background
Antepartum Fetal Surveillance
Fetal movement counting
Non-stress test
Contraction stress test
Biophysical Score
Brief Background
Reduced Fetal Movements
High risk for stillbirth
Fetal growth restriction
Placental dysfunction
Objective:
To evaluate the association of Reduced fetal
movements (RFM) and small-for-gestational-age (SGA)
fetuses at term.
Methodology
P = Singleton pregnancies
O = association of reduced fetal movement with SGA
M = Retrospective Cohort
Methodology
Data Collection
1st visit General Maternal Data
Pregnancy Dating CRL
Methodology
Data Collection
Routine tests
PAPP-A + Screening for Trisomy 21 11-14 weeks
Uterine artery (UtA) Doppler indices 19 23 weeks
UtA Pulsatility index >90th percentile = growth scan at 28 36
weeks
RFM >28 weeks assessment of fetal well being
Computerized cardiotocography, Fetal biometry, AFV and fetal
doppler
Methodology
Statistical analysis
Logistic Regression analysis
Significant if P-value <0.5
Results and Discussion
To evaluate association of Reduced fetal movements (RFM) and small-
for-gestational-age (SGA). Prevalence Rate
SGA at birth
with RFM = 15.6%
without RFM = 7.3%
SGA
Single episode = 9.8%
Repeated episodes = 44.2%
To evaluate association of Reduced fetal movements (RFM) and small-
for-gestational-age (SGA).
To evaluate association of Reduced fetal movements (RFM) and small-
for-gestational-age (SGA).
Discussion
Fetal movement counting
Hypoxemia = decreased fetal movements
Uterine Artery Doppler = impaired placentation

Impaired placentation -> impaired uteroplacental blood flow ->


hypoxemia -> reduced fetal movements, SGA
Conclusion
Repeated Episodes of RFM are more likely to occur in women with
high 2nd trimester UtA Doppler resistance indices and are strongly
associated with the birth of SGA infants.
Women should be treated as being high risk for placental dysfunction
irrespective of the results of prenatal ultrasound and Doppler
assessment.
Clinical Application
Emphasis on Fetal movement counting!!!!!
Antepartum Fetal
Surveillance
Journal Report
Tana, Mobbydick G.
Section D
November 7, 2016