Antepartum Fetal Surveillance Research Articles

STUDY OF RELATIONSHIP OF DAILY FETAL MOVEMENT COUNT, AMNIOTIC FLUID INDEX, COLOUR DOPPLER WITH PERINATAL OUTCOME

Background: In 2015 there were 2.6 million stillbirths globally, with more than 7178 deaths a day. Because more than 75% fetal death occur before the onset of labor and IUGR constitutes 5% of perinatal morbidity and mortality, it would be essential to extend the principle of intrapartum fetal heart rate monitoring to the antepartum period in an effort to prevent these fetal deaths and morbidity. Here comes the importance of Antepartum Fetal Surveillance (AFS). Antepartum Fetal Surveillance (AFS) is the assessment of fetal wellbeing in utero before the onset of labour. The main aim of antepartum fetal surveillance is to reduce perinatal mortality and morbidity and to avoid fetal death. Methods It is Prospective study conducted in Department of Obstetrics and Gynaecology, M.G.M. Medical College and M.Y. Hospital, Indore (M.P.) during the period from April 2015 to March 2016. The study has been started after the approval of topic by ethical and scientific review committee of MGM MEDICAL College, Indore. Results All the three seen to have significant correlation with perinatal outcome. Conclusion: In our study, all the three indices when abnormal were significantly associated with poor perinatal outcome. DFMC seen to be highly sensitive with more than half of the still births reporting with chief complaint of loss of fetal movements. So it can be considered as the earliest marker of fetal wellbeing with Color Doppler being highly specific predictor for early detection of IUGR.

Comparative study on ultrasonic placental grading among normotensive pregnancy and pregnancy-induced hypertension and its correlation with fetal outcome

Background: Placenta is essential for the fetal well-being, growth, and development which can be evidenced as early as possible through ultrasound at 6 weeks of gestation. The placenta mediates the intrauterine interaction between a mother and her baby. Aims and Objectives: This study aims to compare the pattern of placental grading among normotensive and pre-eclampsia mothers in a tertiary care hospital. Materials and Methods: This hospital-based observational analytical study has been conducted in the labor ward and outpatient department of the Department of Obstetrics and Gynaecology, Bankura Sammilani Medical College and Hospital from April 2021 to September 2022. A total of 69 pre-eclampsia mothers (study group) and 69 normotensive mothers (control group) who fulfill inclusion and exclusion criteria were included in the study. Template was generated and analysis was done on Statistical Package for the Social Sciences software. Results: A total of 138 pregnant women with 69 pregnant normotensive and 69 pregnant preeclampsia mothers were included in the study. The mean age of the study participants was 21.3 years (standard deviation=3.6). About 81.2% and 89.9% of the normotensive and hypertensive mothers, respectively, resided in rural areas. Cesarean/instrumental delivery was higher among the hypertensive pregnant women (42.0%) when compared to normotensive pregnant women (27.5%) and it was found to be statistically significant. Birth asphyxia was observed to be higher among the neonates in the hypertensive group (15.9%) when compared to the normotensive group (4.3%) and it was found to be statistically significant. Neonatal intensive care unit admission was more among the neonates of the mother with hypertension and it was found to be statistically significant. There was no significant difference in the birth weight of the newborn with the placental grading among the normotensive pregnant women. Conclusion: Ultrasonographic placental grading could be used as a screening tool for antepartum fetal surveillance in the obstetric population. Placental grading will help us to early diagnosis and to formulate line of management and timely intervention to reduce maternal and perinatal complications.

Antepartum Fetal Surveillance and Optimal Timing of Delivery in Diabetic Women: A Narrative Review.

Antepartum fetal surveillance (AFS) is essential for pregnant women with diabetes to mitigate the risk of stillbirth. However, there is still no universal consensus on the optimal testing method, testing frequency, and delivery timing. This review aims to comprehensively analyze the evidence concerning AFS and the most advantageous timing for delivery in both gestational and pregestational diabetes mellitus cases. This review's methodology involved an extensive literature search encompassing international diabetes guidelines and scientific databases, including PubMed, MEDLINE, Google Scholar, and Scopus. The review process meticulously identified and utilized pertinent articles for analysis. Within the scope of this review, a thorough examination revealed five prominent international guidelines predominantly addressing gestational diabetes. These guidelines discuss the utility and timing of fetal well-being assessments and recommendations for optimal pregnancy resolution timing. However, the scarcity of clinical trials directly focused on this subject led to a reliance on observational studies as the basis for most recommendations. Glucose control, maternal comorbidities, and the medical management received are crucial in making decisions regarding AFS and determining the appropriate delivery timing.

Efficacy of antepartum fetal surveillance for stillbirth prevention

Objective In 2019 the American College of Obstetricians and Gynecologists (ACOG) issued specific recommendations for performance of antepartum fetal surveillance (AFS) based on individual risk factors. As similar recommendations were already in place at our institution, we have evaluated the impact of AFS on stillbirth (SB) occurrence in a 5-year cohort. Methods Retrospective cohort study of all deliveries between 7/1/2013 and 6/30/2018. Excluded were multiples, anomalous fetuses or newborns, and deliveries before 32 0/7 weeks’ gestation. AFS was conducted from 32 weeks with a modified biophysical profile, with a complete biophysical profile as back-up for non-reactive non-stress tests. All cases of SB were prospectively identified and individually reviewed to verify the presence of risk factors, the results of fetal testing if done, and calculate the interval between last fetal test and delivery. The electronic medical records during the study period were queried to identify women who underwent AFS and those who did not. Chi-square was used to compare the rates of SB between the two groups. Results 16,827 women fulfilled the study inclusion and exclusion criteria, 5711 (34%) had risk factors which prompted AFS; 37% had 2 or more risk factors. SB occurred in 1.8‰ of them (10/5711) (3 had 1 risk factor, 5 had 2, and 2 had 3 risk factors). Rates of SB at ≥32.0 weeks were similar between women who had AFS and those who did not (1.8 vs. 2.3‰, p = 0.51, OR = 0.75, 95%CI 0.36–1.55). The false-negative rate at <7 days of a reassuring AFS among compliant women was 1.4‰ (8/5711). Rates of preterm delivery were similar in the tested vs untested population (6.5 vs. 6.0%, p = 0.22). Conclusion Implementation of AFS in women with risk factors similar to those recommended by the ACOG may lower the risk of SB from 32 weeks to that of low-risk pregnancies.

Cerebroplacental Ratio as a Predictor of Perinatal Outcome in Hypertensive Disorders of Pregnancy and Its Comparison With Its Constituent Doppler Indices.

Objective Doppler velocimetry is an established method of antepartum fetal surveillance in pre-eclampsia. Cerebroplacental ratio detects the centralization of fetal blood flow and the insufficiency in placental circulation. It is postulated to be a better marker of perinatal outcome than either vessel Doppler alone. The current study aims to assess the cerebroplacental ratio as a predictor of adverse perinatal outcomes and compare it to the systolic/diastolic (S/D) ratio of umbilical artery (UA) and middle cerebral artery (MCA) in hypertensive disorders of pregnancy. Material and methods The present prospective observational cohort study included 100 patients with hypertensive disorders of pregnancies between 32 and 37 weeks. Ultrasound with Doppler was done and the following parameters were assessed: fetal biometry, amniotic fluid index, umbilical artery pulsatility index, middle cerebral artery pulsatility index, S/D ratio of umbilical artery, S/D ratio of middle cerebral artery, and cerebroplacental ratio. Sensitivity, specificity, positive and negative predictive values were calculated for the cerebroplacental ratio and S/D ratios of umbilical and middle cerebral arteries. McNemar's test was used for the comparison of sensitivity and specificity. Results Thirty-two patients had an abnormal cerebroplacental ratio. Adverse perinatal outcomes such as a cesarean section for fetal distress, small for gestational age, APGAR < 7 at 1 and 5 minutes, NICU admission, and perinatal mortality were more in the group with abnormal cerebraplacental ratio and the difference was statistically significant. Conclusion The cerebroplacental ratio is a more reliable predictor of adverse perinatal outcomes and should be routinely calculated during obstetrical Doppler for antepartum fetal surveillance in case of hypertensive disorders of pregnancy. It suggested that the cerebroplacental ratio may be calibrated in the software of the Doppler ultrasonography machine for routine use in high-risk pregnancies.

Role of Ultrasonography and Color Doppler in the Assessment of High-Risk Pregnancies and Their Accuracy in Predicting Fetal Outcome.

Introduction Various methods are employed to evaluate the well-being of the fetus in high-risk pregnancies which consists of a biophysical profile (BPP), a non-stress test (NST), and daily fetal movements. Detection of aberrant blood flow in fetoplacental beds has been revolutionized by recent developments in ultrasound technology, such as color Doppler flow velocimetry. The cornerstone of maternal and fetal care is lowering maternal and perinatal mortality and morbidity is antepartum fetal surveillance. Doppler ultrasound is a non-invasive way of obtaining a qualitative and quantitative evaluation of maternal and fetal circulation and is utilized to investigate complications like fetal growth restriction (FGR) and fetal distress.Thus, it is useful in making distinctions between fetuses that are truly growth restricted and small for gestational age and healthy fetuses. The aim of the current study was to determine the role of Doppler indices in high-risk pregnancies and their accuracy in predicting fetal outcomes. Material and methods This prospective cohort studyincluded 90 high-risk pregnancies in the III trimester (after 28 weeks of gestation) on whom ultrasonography and Doppler were performed.Ultrasonography was performed using PHILIPS EPIQ 5, a curvilinear probe of frequency 2-5MHz. Gestational age was determined with a biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femoral length (FL). Placental grading and position werenoted. Estimated fetal weight and the amniotic fluid index were calculated. BPP scoring was done. Doppler study was conducted and the findings of Doppler indices that is pulsatility index (PI) and resistive index (RI) of the middle cerebral artery (MCA), umbilical artery (UA), and uterine artery (UTA), and cerebroplacental (CP) ratio in these high-risk pregnancies were documented and compared with standard. The flow patterns in MCA, UA, and UTA were also assessed. These findings were correlated with fetal outcomes. Results Among 90 cases, the common high-risk factor in pregnancy was preeclampsia without severe features (30%). Growth lag was present in 43 (47.8%) participants. Among the study population, HC/AC ratio was increased in 19 (21.1%) participants which indicatesasymmetrical intrauterine growth restriction. Adverse fetal outcomes were seen in 59 (65.6%) of the subjects. CP ratioand UA PIhad better sensitivity (83.05% and 79.66%, respectively) and positive predictive value (PPV) (87.50% and 90.38%, respectively) in identifying the adverse fetal outcomes. Diagnostic accuracy of CP ratio and UA PI (Accuracy=81.11%) was highest in predicting adverse outcomes than all the other parameters. Conclusion CP ratio and UA PI had better sensitivity, PPV, and diagnostic accuracy in identifying adverse fetal outcomes than other parameters. The study's findings support that the use of color Doppler imaging in high-risk pregnancies will help in the early identification of adverse fetal outcomes and aid in early intervention. This study is non-invasive, simple, safe, and reproducible. This study can also be performed bedside in high risk and unstable patients.This study is required to accurately assess fetal well-being in all high-risk pregnancies in order to improve fetal outcomes and to incorporate this procedure as a part of the protocol for the assessment of fetal well-being in these patients.

“STUDY OF MATERNAL AND FETAL OUTCOME IN TERM PRELABOR RUPTURE OF MEMBRANES STRATIFIED WITH AFI SCORE.”

Background: Amniotic uid index (AFI), a component of modied Biophysical prole, is commonly used for antepartum fetal surveillance, and can be considered an essential parameter to predict adverse fetal and maternal outcome in patients with PROM. The present study is Objective: undertaken to study the feto-maternal outcome in patients with term PROM by stratifying them into two groups with AFI &lt;5 and AFI ≥5. Methodology: Prospective cross-sectional study was conducted on 151 pregnant term, singleton live gestation with cephalic presentation with PROM admitted to the labor ward in Department of OBG at ESIC &amp; PGIMSR. On admission based on amniotic uid index measured by ultrasonography the study population was grouped as Group A with AFI &lt; 5cm and Group B with AFI ≥5 cm. Patients with AFI &lt;5 cm Results: (Group A) had higher febrile morbidity (p-0.0001). Caesarean delivery was signicantly higher in Group A (50%, p-0.0001), most common indication was fetal distress (60.9 %). Group A also had higher incidence of wound infection (9.8%, p-0.008) and increased duration of hospital stay (p-0.0001). More patients in Group B had successful induced vaginal delivery (82.6%). Higher incidence of perinatal morbidity with APGAR&lt;7 (p-0.032) and prolonged NICU admissions were observed in Group A (p - 0.0001). The present study co Conclusion: ncludes that AFI stratication in patients with term PROM on admission is useful to predict maternal and neonatal outcomes

Detection of Suspicious Cardiotocographic Recordings by Means of a Machine Learning Classifier.

Cardiotocography (CTG) is one of the fundamental prenatal diagnostic methods for both antepartum and intrapartum fetal surveillance. Although it has allowed a significant reduction in intrapartum and neonatal mortality and morbidity, its diagnostic accuracy is, however, still far from being fully satisfactory. In particular, the identification of uncertain and suspicious CTG traces remains a challenging task for gynecologists. The introduction of computerized analysis systems has enabled more objective evaluations, possibly leading to more accurate diagnoses. In this work, the problem of classifying suspicious CTG recordings was addressed through a machine learning approach. A machine-based labeling was proposed, and a binary classification was carried out using a support vector machine (SVM) classifier to distinguish between suspicious and normal CTG traces. The best classification metrics showed accuracy, sensitivity, and specificity values of 92%, 92%, and 90%, respectively. The main results were compared both with results obtained by considering a more unbalanced dataset and with relevant literature studies in the field. The use of the SVM proved to be promising in the field of CTG classification. However, appropriate feature selection and dataset balancing are crucial to achieve satisfactory performance of the classifier.

MODIFIED BIOPHYSICAL PROFILE IN HIGH RISK PREGNANCY AND ITS FETAL OUTCOME

Background: High risk pregnancies are at increased risk of maternal and neonatal morbidity and mortality. Modied biophysical prole (MBPP) is one of the best method used in antepartum fetal surveillance which comprises of Non stress test (NST) and Amniotic uid index (AFI). Our main aim is to evaluate the efcacy of modied biophysical prole in predicting perinatal outcome in high risk pregnancy &amp; to prevent perinatal morbidity &amp; mortality by intervention done in time. Methods: A prospective cohort study was conducted in our hospital from February 2021 to January 2022. In this study 200 high risk pregnant women with term pregnancy, attending the antenatal outpatient clinic or admitted in the ward were evaluated with the modied biophysical prole consisting of NST recording for 20 minutes, followed by ultrasound assessment of amniotic uid volume, using four quadrant technique. Results:Among 200 high risk pregnant women, Modied biophysical prole in high risk pregnancy showed amniotic uid index &lt; 5 in 4.5% cases, 26 % cases had AFI 6 to 8 and 69.5 % cases had AFI 8 to 24 ; CTG showed 23 % cases were found to have non-reactive &amp; 77% cases were reactive. When AFI &amp; CTG was combined, non-reactive CTG is more among cases with AFI &lt; 5 and it was statistically signicant (P Value =0.05). The rate of LSCS, Neonatal resuscitation and Admission was increased when there was abnormal MBPP. Conclusion: Modied biophysical prole is the best method for antepartum fetal surveillance. It can be used to predict perinatal outcome and provide timely intervention in high risk pregnancies

The Relationship Between the Full Biophysical Profile and Rapid Biophysical Profile in Antepartum Fetal Surveillance

Background: One of the best tests for the assessment of a fetus is the biophysical profile test which has a significant effect on the fetus’s health and the outcome of pregnancy. The present study was designed to determine the relationship between the full biophysical profile (FBP) and the rapid biophysical profile (RBP) tests in antepartum fetal surveillance. Methods: In this prospective study, Singleton pregnancies (n=209) with more than 34 weeks of gestational age were chosen. Both FBP and RBP tests were performed for all the patients. The main outcome is the Apgar score and neonatal intensive care unit admission analyzed by SPSS software, version 24. The sensitivity, specificity, positive predictive value, and negative predictive value of RBP were calculated. Findings: Out of 209 people who entered the study, 48 women (23.0%) had gestational diabetes, 84 women (40.2%) had hypertension pregnancy (preeclampsia), 45 people (21.5%) had intrauterine growth restriction, and 45 women (21.5%) had post-date pregnancy. For predicting adverse fetal outcomes of pregnancy, the sensitivity, specificity, positive predictive value, and negative predictive value of RBP were 95%, 73%, 52%, and 98%, respectively. Conclusion: According to the statistically significant positive correlation between RBP and FBP and its simple and rapid application, RBP might be an acceptable alternative method for primary antepartum fetal screening tests in overcrowded obstetrics centers.

ROLE OF MODIFIED BIOPHYSICAL PROFILE IN PREDICTING PERINATAL OUTCOME IN HIGH RISK PREGNANCY

Background: In order to achieve the target of having a healthy mother and healthy baby there is a need to identify pregnant woman with high risk factors.Ante natal foetal monitoring is aimed at identifying foetus that are at high risk of suffering from intrauterine hypoxia. Aims and Objectives: To evaluate the role of modified biophysical profile in predicting perinatal outcome in high risk pregnant women Material and methods: This is a hospital based observational study in the department of Obstetrics and Gynaecology , Victoria Government Hospital , Visakhapatnam, from January 2022 to May 2022.A total of 96 high risk pregnant women were included in this study. Inclusion criteria was Singleton pregnancy ,risk factors like[pre eclampsia,gestational hypertension,diabetes mellitus,anemia,past dates,post cesarian section.breech,bad obstetric history and pre term,Exclusion criteria was multifetal gestation,intrauterine death,fetal anomalies. Detailed history was taken and relavent investigations were sent. Results: 16.9% of cases had meconium stained liquor (normal CTG and AFI), 36% with meconium stained liquor had normal AFI but abnormal CTG, 40% with meconium stained liquor had abnormal AFI but normal CTG, 50% with meconium stained liquor had abnormal AFI and abnormal CTG 0% of babies had perinatal death when AFI and CTG was normal, 100% of babies had perinatal death when AFI and CTG was abnormal Conclusion: Modified bio physical profile is a easy ,time saving and cost effective procedure and can used as a test of antepartum fetal surveillance in order to predict perinatal outcome in high risk pregnancy.

Association of Prenatal Care Services, Maternal Morbidity, and Perinatal Mortality With the Advanced Maternal Age Cutoff of 35 Years

Maternal and perinatal mortality remain high in the US despite growing rates of prenatal services and spending, and little rigorous evidence exists regarding the impact of prenatal care intensity on pregnancy outcomes. Patients with an expected date of delivery just after their 35th birthday may receive more intensive care owing to the advanced maternal age (AMA) designation; whether this increase in prenatal care is associated with improvements in outcomes has not been explored. To determine the association between the AMA designation and prenatal care services, severe maternal morbidity, and perinatal mortality. This cross-sectional study used a regression discontinuity design to compare individuals just above vs just below the 35-year AMA cutoff, using unidentifiable administrative claims data from a large, nationwide commercial insurer. All individuals with a delivery between January 1, 2008, and December 31, 2019, who were aged 35 years within 120 days of their expected date of delivery were included in the study. Analyses were performed from July 1, 2020, to February 1, 2021. Individuals who were aged 35.0 through 35.3 years on the expected date of delivery were designated as AMA. Outcomes were visits with specialists (obstetrician-gynecologists and maternal-fetal medicine), ultrasound scan use, antepartum fetal surveillance, aneuploidy screening, severe maternal morbidity, preterm birth or low birth weight, and perinatal mortality. The analysis included 51 290 individuals (mean [SD] age; 34.5 [0.5] years); 26 108 individuals (50.9%) were aged 34.7 to 34.9 years and 25 182 individuals (49.1%) were aged 35.0 to 35.3 years on the expected date of delivery. A total of 2407 pregnant individuals (4.7%) had multiple gestation, 2438 (4.8%) had pregestational diabetes, 2265 (4.4%) had chronic hypertension, and 4963 (9.7%) had obesity. Advanced maternal age was associated with a 4.27 percentage point increase in maternal-fetal medicine visits (95% CI, 2.27-6.26 percentage points; P < .001), a 0.21 unit increase in total ultrasound scans (95% CI, 0.06-0.37; P = .006), a 15.67 percentage point increase in detailed ultrasound scans (95% CI, 13.68-17.66 percentage points; P < .001), and a 4.86 percentage point increase in antepartum surveillance (95% CI, 2.83-6.89 percentage points; P < .001). The AMA designation was associated with a 0.39 percentage point decline in perinatal mortality (95% CI, -0.77 to -0.01 percentage points; P = .04). In this cross-sectional study, the AMA designation at age 35 years was associated with an increase in receipt of prenatal monitoring and a small decrease in perinatal mortality, suggesting that the AMA designation may be associated with clinical decision-making, with individuals just older than 35 years receiving more prenatal monitoring. These results suggest that increases in prenatal care services stemming from the AMA designation may have important benefits for fetal and infant survival for patients in this age range.

To evaluate the tests of antepartum fetal surveillance for predicting adverse perinatal outcome in pregnancy with IUGR

IUGR is one of the most common pregnancy complications which substantially increase risk of adverse neonatal outcome. The sequelae of IUGR include stillbirth, neuro-developmental delay in childhood and high risk of diseases like hypertension, diabetes in adulthood. Therefore, IUGR in pregnancy warrants intensive antepartum fetal surveillance to ensure optimal perinatal outcome.To evaluate the tests of antepartum fetal surveillance like AFI, BPS and Doppler ultrasound, alone and in combination for predicting adverse perinatal outcome in pregnancy with IUGR.This was a prospective observational study done on 100 pregnant IUGR women &amp;#62; 34weeks of gestation, at a tertiary care centre in Karnataka, from June 2017 till December 2018. They were monitored by tests of fetal surveillance like Amniotic Fluid Index (AFI), Bio Physical score (BPS) and Doppler ultrasound. Tests done within 48 hours before labour and its relation to perinatal outcome were assessed. Continuous data such as age, height, weight were described by mean and standard deviation. The sensitivity specificity, positive and negative predictive value were calculated for each test.The statistical difference between the normal and abnormal tests of antepartum fetal surveillance in relation to perinatal outcome was significant. Diagnostic accuracy of Doppler was 67%, BPS and AFI was 69%. In case of combination of findings of BPS and Doppler, the accuracy rose to 75%.Biophysical profile was most reliable diagnostic method than Doppler in predicting adverse outcome. Sensitivity increased when BPS and Doppler was combined which is beneficial in predicting perinatal outcome.

English

BACKGROUND The American College of Obstetricians and Gynecologists (ACOG) and WHO (World Health Organization) define a pregnancy continuing two weeks beyond expected date of delivery as post term pregnancy. Any pregnancy which has passed beyond the expected delivery date is defined as prolonged or post-dated pregnancy. Application of Doppler ultrasound allows for examination of blood flow direction, velocity and volume of various vessels. Doppler velocimetry of umbilical artery in post-dated pregnancy has been suggested as a means of assessing fetal wellbeing. In prolonged pregnancy, the first step of management is an accurate diagnosis and antenatal care includes accurate dating of pregnancy, fetal surveillance and the option of induction of labour or expectant management or Caesarean section. We wanted to analyse the blood flow in umbilical artery using Doppler ultrasound in post-dated pregnancy and analyse the perinatal outcome in post-dated pregnancies with respect to normal and abnormal doppler wave forms. METHODS This is a prospective study conducted at Department of Obstetrics and Gynaecology, Government Victoria Hospital (GVH), Visakhapatnam, from April 2016 to April 2017. 110 pregnant women who were beyond the expected date of delivery (EDD) according to menstrual history and early weeks scan were selected from the antenatal ward and labour room. RESULTS In the present study, 52.73 % women with prolonged pregnancy were primi gravida and 67.27 % women were between the gestational ages of 40 - 41 weeks. Doppler studies were abnormal in 13.64 % (15 women). 78.1 % women with prolonged pregnancy had normal vaginal delivery, Caesarean section was done in 17.3 % and 4.6 % had instrumental delivery. 99.09 % of babies were live born and one was stillborn. Two babies died in early neonatal period due to meconium aspiration. CONCLUSIONS Doppler study of umbilical arteries is a useful noninvasive procedure to reduce the perinatal morbidity and mortality in prolonged pregnancy. KEY WORDS Antepartum Fetal Surveillance, Birth Asphyxia, Doppler Study, Intrauterine Death, Perinatal Outcome, Prolonged Pregnancy, Pulsatility Index, Resistance Index

Antepartum Fetal Surveillance: ACOG Practice Bulletin, Number 229.

The goal of antepartum fetal surveillance is to reduce the risk of stillbirth. Antepartum fetal surveillance techniques based on assessment of fetal heart rate (FHR) patterns have been in clinical use for almost four decades and are used along with real-time ultrasonography and umbilical artery Doppler velocimetry to evaluate fetal well-being. Antepartum fetal surveillance techniques are routinely used to assess the risk of fetal death in pregnancies complicated by preexisting maternal conditions (eg, diabetes mellitus) as well as those in which complications have developed (eg, fetal growth restriction). The purpose of this document is to provide a review of the current indications for and techniques of antepartum fetal surveillance and outline management guidelines for antepartum fetal surveillance that are consistent with the best scientific evidence.

EVALUATION OF AMNIOTIC FLUID INDEX AND ITS PREGNANCY OUTCOME IN A TERTIARY CARE CENTER.

Background: Amniotic fluid assessment is an integral part of the antenatal evaluation of pregnancies at risk for an adverse pregnancy outcome especially in the third trimester. Methods: This was prospective observational study conducted at tertiary teaching institute from January 2018 to December 2020.Total 350 patients were included in the study. On the basis of amniotic fluid index (AFI),patients were categorized in 3 groups, Normal AFI (6-24 cm), oligohydramnios (AFI &lt;5cm) and polyhydramnios (AFI &gt; = 25 cm). Results were analysed in the form of incidence, mode of delivery and perinatal outcome which includes preterm, low birth weight,still births,NICU admissions and neonatal deaths in all the 3 groups Results: Out of 350 patients, there was 270 cases of normal AFI, 57 cases of oligohydramnios and 23 cases of polyhydramnios.PIH was the most common etiological factor found in oligohydramnios (33.3%) and in polyhydramnios idiopathic cause (56.5%) was most common.Incidence of NICU admission was 32.4% in oligohydramnios and 55.5% in polyhydramnios group in comparison to 12.4% in normal AFI group. Conclusions: Amniotic fluid index is an important part of antepartum fetal surveillance. Abnormalities of AFI are associated with high perinatal morbidity and mortality and maternal morbidity.

A CROSS-SECTIONAL STUDY OF PREGNANCY AND ITS OUTCOME WITH SPECIAL REFERENCE TO OLIGOHYDRAMNIOS AND POLYHYDRAMNIOS AT JLNMCH, BHAGALPUR, BIHAR

Background: The importance of amniotic uid volume as an indicator of fetal wellbeing has made its assessment an important part of antenatal fetal surveillance, also the level of amniotic uid affect the fetal well being so the present study was conducted to study the pregnancy and its outcome with special reference to oligohydramnios and polyhydramnios. Methodology: We studied 200 clinically suspected cases of oligohydramnios and polyhydramnios of more than 28 weeks of gestational age at Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College &amp; Hospital, Bhagalpur, Bihar. All these clinically suspected patients were further examined by ultrasonography for fetal surveillance, AFI calculation and conrmation of amniotic uid level abnormality. Result: The study revealed that predisposing factors and complications associated with oligohydramnios were – post term pregnancies, PROM, PIH, chronic abruption placentae while for polyhydramnios they were preeclampsia, PROM, preterm labour, abruption placentae, malpresentation. There were no maternal high risk factors seen in oligohydramnios but polyhydramnios was observed with anemia, Rh factor incompatibility, PIH, gestational diabetes mellitus and multifetal gestation. The proportion of C-section for fetal distress was higher in oligohydramnios. Conclusion: We concluded from this study that there were many predisposing factors for both oligohydramnios and polyhydramnios they should be addressed judiciously to reduce their higher proportion. Hence it is essential to evaluate amniotic uid volume during ante partum fetal surveillance, while maternal examination should look for high risk factors to avoid untoward complications beforehand. Thus management of women with oligohydramnios and polyhydramnios should be indivisualised with careful monitoring during labour, judicious and active intervention timely gives margin of safety

Evaluation of Modified Biophysical Profile in Pre-Eclamptic Patients and Measure its Impact on Perinatal Outcome

Introduction: Hypertensive disorders in pregnancy are a major cause of maternal and perinatal morbidity and mortality worldwide. Modified biophysical profile (MBPP) combines Non stress test as a short term marker of fetal status and the amniotic fluid index as a marker of long term placental function which is easier to perform and less time consuming. Aim: To study the antepartum fetal surveillance with modified biophysical profile and perinatal outcome in pre-eclamptic women. Materials and Methods: Prospective descriptive study of perinatal outcome included 150 ANC patients gestational age between 34 to 40 weeks both primi gravida and multigravida with pre-eclampsia admitted in SMIMER hospital during January 2017 to June 2018. Patients were treated in line with standard protocol and perinatal outcome were then studied. Results: Of the 150 NST’s in MBPP, 77% were reactive and 23% were non-reactive. When the MBPP was abnormal with respect to both parameters 60% of the cases had LSCS and 40% of them had vaginal delivery. When both parameters were normal there were only 3.63% cases were MSL. When NST was abnormal and AFI normal 45.45% cases were MSL and when NST was normal and AFI abnormal 42.8% cases were MSL. When both the parameters were abnormal 63.6% of the cases had APGAR &lt;7 `whereas when NST was normal and AFI was abnormal 2(28.5%) the cases had APGAR &lt;7. When AFI was normal and NST was abnormal 36.3% of the cases had APGAR &lt;7. Conclusions: Modified biophysical profile (MBPP) is easier, less time consuming, cost effective and patient compliant test.

Role of non stress test in monitoring antenatal fetal well being in high risk pregnancy

Antepartum evaluation of the fetus at risk for damage or death in utero remains a major challenge in modern obstetrics. Freeman &amp; Lee (1975) and colleagues introduced the non-stress test to describe acceleration of fetal heart rate is a sign of fetal health in response to fetal movement. Role of Non stress test in antepartum fetal surveillance and perinatal outcome in high risk pregnancy. To prove the efficacy of NST as an effective tool for evaluation of fetal well-being. To decrease perinatal morbidity and mortality. Hospital based prospective study. 50 pregnant women with high risk factors as study group and 50 healthy pregnant women as control group were randomly selected from period of July 2015 to December 2015 in the department of Obst &amp; Gynae Dr. S. N. Medical college Jodhpur. Non stress test performed and results were analysed.Non stress test as screening test for antenatal fetal surveillance has high specificity and high negative predictive value.The ideal test for fetal reserve should be safe, inexpensive, readily available, quickly exerted and devoid of either false positive or false negative results. As yet no such test exists which is perfect, still NST has been shown to be most acceptable modality for evaluating the fetus in utero.

A Survey of Labor and Delivery Practices in New York City during the COVID-19 Pandemic.

Recently, a novel coronavirus, precisely severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), that causes the disease novel coronavirus disease 2019 (COVID-19) has been declared a worldwide pandemic. Over a million cases have been confirmed in the United States. As of May 5, 2020, New York State has had over 300,000 cases and 24,000 deaths with more than half of the cases and deaths occurring in New York City (NYC). Little is known, however, of how this virus impacts pregnancy. Given this lack of data and the risk for severe disease in this relatively immunocompromised population, further understanding of the obstetrical management of COVID-19, as well as hospital level preparation for its control, is crucial. Guidance has come from expert opinion, professional societies and public health agencies, but to date, there is no report on how obstetrical practices have adapted these recommendations to their local situations. We therefore developed an internet-based survey to elucidate the practices put into place to guide the care of obstetrical patients during the COVID-19 pandemic. We surveyed obstetrical leaders in four academic medical centers in NYC who were implementing and testing protocols at the height of the pandemic. We found that all sites made changes to their practices, and that there appeared to be agreement with screening and testing for COVID-19, as well as labor and delivery protocols, for SARS-CoV-2-positive patients. We found less consensus with respect to inpatient antepartum fetal surveillance. We hope that this experience is useful to other centers as they formulate their plans to face this pandemic. Key Points Practices changed to accommodate public health needs.Most practices are screened for novel COVID-19 on admission.Fetal testing in COVID-19 patients varied.