OG8.{4,8} | Maternal and Fetal Surveillance — Summary & Reflection

KEY TAKEAWAYS

Maternal-fetal surveillance is a dynamic, hierarchical monitoring programme that detects complications as they develop. Maternal surveillance includes weight gain monitoring (IOM 2009 recommendations: 11.5–16 kg for normal BMI), serial BP measurement (hypertension threshold ≥140/90 mmHg), and urinalysis (proteinuria, glycosuria, bacteriuria) at every ANC contact. Fetal surveillance uses three main tools: (1) Daily Fetal Movement Counting (DFMC): ≥10 movements in 12 hours; reduced DFMC triggers urgent evaluation; (2) Non-Stress Test (NST/CTG): reactive = ≥2 accelerations of ≥15 bpm lasting ≥15 seconds in 20 minutes; non-reactive after 40 minutes → BPP; (3) Biophysical Profile (BPP): five parameters (NST, breathing movements, gross body movement, tone, AFV), each 0 or 2, maximum 10; score 8–10 = reassuring; 6 = equivocal; ≤4 = fetal compromise → deliver at ≥32 weeks. Ultrasound indications by trimester: first trimester (viability, CRL dating, NT, chorionicity); second trimester (anomaly scan 18–20 weeks, placental location); third trimester (growth scan, Doppler, AFI, placenta follow-up). Absent end-diastolic flow = deliver at ≥34 weeks; reversed end-diastolic flow = deliver immediately. Normal AFI 5–24 cm; oligohydramnios <5 cm; polyhydramnios >24 cm.

REFLECT

Return to Meena's case from the opening hook. She presented at 36 weeks with a non-reactive NST, BPP of 4/10, and absent end-diastolic flow — the endpoint of a gradual deterioration. Now reconstruct the surveillance timeline that should have preceded this emergency. At what visit would reduced DFMC have first been reportable? If a NST had been performed two weeks ago when it was normal, what would have changed her management? At what BPP score would you have intervened? What role would a growth scan with Doppler have played at 32–34 weeks? This exercise in retrospective surveillance analysis — working backward from an emergency to the point where intervention would have changed the outcome — is one of the most powerful learning methods in obstetrics. Write out your reconstructed timeline before your next bedside session.