Assessment of Fetal Well Being
The guidelines recommend management of common obstetric conditions at primary and referral level, based on local experience and evidence-based practice. They are not intended as strict protocols nor as standard operating procedures, but rather as a guide to safe effective management of common obstetric problems. The guidelines should be most useful to interns, medical officers and registrars.
ULTRASOUND SCANS
Ultrasound scans are done only for certain clinical indications.
- Women who book at ≤24 weeks at the hospital (high risk conditions)
- Doubt about gestational age after clinical assessment, e.g. wrong dates, or possible twin pregnancy, suspected intrauterine growth restriction (IUGR)
- Fetal movements not felt and fetal heart not heard, at ≥22 weeks
- Significant risk for IUGR (e.g. hypertensive) or macrosomia (e.g. diabetic)
- Previous or family history of congenital abnormalities
- Poor obstetric history (two or more previous pregnancy losses)
- History of antepartum haemorrhage
- Malpresentation, from 36 weeks
- Two or more previous caesarean sections
- Doubt about post-term pregnancy, to measure amniotic fluid volume
NON-STRESS TESTS
Very few antenatal women require a non-stress test (NST). Indications include:
- Reduced fetal movements at any time after 28 weeks
- Previous unexplained stillbirth at term: weekly from 36 weeks
- Conditions where the fetus is considered to be at risk, e.g. diabetes mellitus after 36 weeks, suspected IUGR or suspected post-term pregnancy
- Antepartum bleeding
There is no indication for routine NST at 39-40 weeks
FETAL MOVEMENT COUNTING
This is only indicated for high risk pregnancies, e.g. diabetes mellitus, suspected IUGR, previous unexplained stillbirth.
- Ask the woman to count fetal movements (not just kicks) for one hour at the same time every day, usually after breakfast
- The number of movements should be recorded on a fetal movement chart
- If there are 4 or more movements in one hour, the count is repeated at the same time on the next day
- If there are less than 4 movements in one hour, or less than half of the hourly average (after about a week of counting), the woman should count fetal movements for one more hour
- In the second hour, if there are still less than 4 movements or less than half of the hourly average, NST is indicated to assess fetal well-being. Delivery may be necessary
Fetal movement chart
| Date | Time Started | Movements in first hour | N.B. | Movements in second hour | N.B. |
| If <4 movements in the first hour go on to the second hour and count again | If <4 movements in the second hour please go to your clinic or hospital for help | ||||