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Measures the health of the baby (fetus) during

pregnancy.

Done in the last trimester of pregnancy.

Women with high-risk pregnancies may have a BPP

test every week or twice a week in the third trimester

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 Keep track of your baby's health.

 Hyperthyroidism
Bleeding problems.
Chronic kidney disease.
Type 1 diabetes or gestational diabetes.
High blood pressure (hypertension
Preeclampsia
A small amount of amniotic fluid (oligohydramnios) or too
much amniotic fluid (polyhydramnios).
A multiple pregnancy (such as twins or triplets).
A pregnancy that has gone past your due date,
between 40 and 42 weeks.
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Need a full bladder for the test

Women in the third trimester do not need to have

a full bladder.

Stop smoking for 2 hours before the external

monitoring test because smoking decreases
baby's activity.

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1. Ultrasonography
2. Cardiotocography
3. Non stress test
4. Contraction stress test
5. Foetal movement count
6. Amnioscopy
7. Foetoscopy
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“obstetrical ultrasound is a routine procedure
performed throughout pregnancy to evaluate the
health and development of the fetus through
ultrasound images.”

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An obstetrical ultrasound is performed during
pregnancy to monitor the size, age, health and
position of the fetus. 

Pregnant women will undergo several ultrasound

procedures throughout the course of pregnancy to
ensure that the fetus is growing at a healthy rate
with no serious complications.

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Obstetrical ultrasound is a useful clinical test to:

•establish the presence of a living embryo/fetus

•estimate the age of the pregnancy.
•diagnose congenital abnormalities of the fetus.
•evaluate the position of the fetus.
•evaluate the position of the placenta.
•determine if there are multiple pregnancies.
•determine the amount of amniotic fluid around the baby.
•check for opening or shortening of the cervix.
•assess fetal growth.
•assess fetal well-being.
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The patient lies on an exam
table and a clear gel is applied
to the skin of the lower abdominal
area to allow for smooth contact
with the transducer. 

The transducer is then moved

back and forth across the skin
to receive the sound waves o
f the body and convert them into
images that can be viewed on a
computer screen in real time. 

The ultrasound procedure takes about 30-60 minutes to perform.

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Instructions
1
Start the ultrasound report by including the name
of the facility at which the ultrasound was performed.

2
List the name of the mother as well as basic demographic
information. This information should include the reason
for the ultrasound, the due date and the referring physician.
This information is used strictly for logistical purposes,
allowing the report to be combined with other information
about the patient's pregnancy easily.
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 3
Include biometric measures.
The health of the fetus is determined in a large part by
biometric measures.
This measures include the head circumference,
the abdominal circumference and the femur length.
These figures allow the growth of the fetus to be compared
to the expected size of a fetus of that gestational age.
Along with listing the measures, the ultrasound technician
should also make note of any abnormalities or areas of concern.

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 4
Report upon the fetal anatomy.
A thorough examination of the fetal anatomy should
be conducted during each ultrasound.
The list of elements that a technician must check is
extensive and includes all major organs, facial features
and genital regions.
The ultrasound technician should list each area as normal,
or explain the abnormalities noticed during inspection of the areas.

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 5
Measure and list the amniotic fluid amount.
Check the amniotic fluid levels and include information
about the level in your report.
Clearly state whether the levels are on par with what
is to be expected, or if they are excessive or deficient
in any ways.

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 6
Comment upon the placenta location.
Check the fetal attachment to the placenta, and indicate whether
the bond seems to be appropriately sound. Also explain where the
placenta is resting in relation to the cervix.
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Report briefly upon the maternal anatomy.
While you will likely not conduct an exhaustive study of the maternal
anatomy, you should comment upon the elements that you view during
the course of your examination. List any irregularities in abdominal growth,
or any cervical problems that you come across if performing an internal ultrasound.

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 8
Summarize your findings in a concise paragraph.
List any important information, including areas of concern
or places where future investigation may be needed.
This serves as a brief and easily reviewed reporting of your
findings, allowing doctors to quickly reference the information
when necessary.
 

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An obstetrical ultrasound is a non-invasive procedure
that is easy to perform in your doctor’s office and
has been used for over 40 years to monitor the fetus
during pregnancy, with no harm to the patient or fetus. 

This procedure provides detailed information throughout

the course of pregnancy that helps your doctor ensure
a safe and comfortable pregnancy, labor and delivery.

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In medicine (obstetrics), cardiotocography (CTG) is a
technical means of recording (-graphy) the fetal heartbeat
(cardio-) and the uterine contractions (-toco-) during
pregnancy, typically in the third trimester.

The machine used to perform the monitoring is called

a cardiotocograph, more commonly known as an
electronic fetal monitor (EFM).

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Simultaneous recordings are performed by two
separate transducers, one for the measurement
of the fetal heart rate and a second one for the
uterine contractions. Each of the transducers may
be either external or internal

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A typical CTG output for a woman not in labour.

A: Fetal heartbeat;
B: Indicator showing movements felt by mother (caused by pressing a butto
C: Fetal movement; D: Uterine contractions
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•Uterine activity (contractions)
•Baseline fetal heart rate (FHR)
•Baseline FHR variability
•Presence of accelerations
•Periodic or episodic decelerations
•Changes or trends of FHR patterns over time.

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This simple, painless procedure is done during
pregnancy to evaluate your baby's condition.

first while the baby is resting and then while

he's moving.

Just as your heart beats faster when you're

active, your baby's heart rate should go up while
he's moving or kicking.
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•diabetes
• high blood pressure
•gestational hypertension
•baby appears to be small or not growing properly
•baby is less active than normal.
•too much or too little amniotic fluid
•procedure such as an external cephalic version
• past your due date
•previously lost a baby in the second half of pregnancy,.
• baby has been diagnosed with an abnormality or birth\
• defect and needs to be monitored.
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You may be advised to eat a meal just before
the test in the hope that eating will stimulate
baby to move around more.

use the bathroom before the test because you

may be lying for up to an hour.

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A technician straps two devices to
mothers belly

1. contractions are recorded

on paper.

2. The technician listens to and watches

your baby's heartbeat on an electronic screen
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If your baby's not moving, he could be asleep.

Mother is asked to drink some water, juice, or soda

to get him going, or the technician may nudge him
gently through your abdomen or try to wake him with
a buzzer.

In some cases, you'll be asked to press a button

when you feel the baby move.

The test usually takes 20 to 60 minutes.

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A contraction stress test (CST) is performed near
the end of pregnancy to determine how well the fetus
will cope with the contractions of childbirth.

The aim is to induce contractions and monitor the

fetus to check for heart rate abnormalities
using a cardiotocograph

Its purpose is to make sure the baby can get the

oxygen he needs from the placenta during labor.

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During contractions, the flow of blood and oxygen to the
placenta temporarily slows down.

If your placenta is healthy, it has extra stores of blood ready

to provide the baby with the oxygen he needs during
contractions.

So if everything is okay, your baby's heart won't slow

down during or after a contraction.

But if the placenta isn't functioning properly, your baby

won't get enough oxygen and his heart will beat more
slowly after a contraction.
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The contraction stress test is more cumbersome,
expensive, and risky than other similar tests,
so it's not done very often anymore.

But if you're having a high-risk pregnancy, your

healthcare practitioner might recommend it as
you get close to your due date.

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Nipple Stimulation
This is a procedure that relies on endogenous release of
oxytocin following nipple stimulation, and is conducted by
the patient.

The nurse instructs the patient on the procedure, as follows.

One nipple is massaged gently through clothing until a contraction

begins, or for a maximum of 2 minutes.

If at least 3 contractions in 10 minutes is not achieved,

then the patient rests for 5 minutes and the other nipple is stimulated.
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Oxytocin Challenge Test (OCT)
If adequate contractions (at least 3 in 10 minutes) cannot
be achieved with nipple stimulation, an oxytocin challenge
test may be performed.

It involves the intravenous administration of exogenous oxytocin

to the pregnant woman.

The target is to achieve around three contractions every ten minutes.

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*Positive: presence of late decelerations with at least 50% of
the contractions

*Negative: no late or significant variable decelerations

*Equivocal—Suspicious: presence of late decelerations

with fewer than 50% of contractions)
or significant variable decelerations

*Equivocal—Tachysystole: Presence of contractions that

occur more frequently than every
2 minutes or last longer than 90 seconds
in the presence of late decelerations

*Equivocal—Unsatisfactory: Fewer than three contractions occur

within 10 minutes, or a tracing quality that
cannot be interpreted
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Fetal movement refers to motion of a
fetus caused by its own muscle activity

The heart begins to beat on the 23rd day

after conception

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Write in the date and time that you
start the kick count.

Count movements until your baby

moves 10 times.

Make an 'X' next to the minutes it took

your baby to move 10 times.

If you have trouble getting your baby

to move, get up and move around
for a bit and drink fruit juice.

Then, lay down and try counting again.

If there is a significant decrease in your

baby's activity level, or if you cannot get 36
the baby to move, contact your physician.
  Week:   30 Week:   31
 
M T W TH F S S M T W TH F S S
 Tim    
7:30 7:30 7:15 7:20 7:30                  
e

 Min
 10         X        10              
utes

   20     X            20              

   30   X     X          30              
   40           X      40              
   50                50              

 Hou
 1                1              
rs  

   1.5                1.5              
   2                2              

   2.5                2.5              
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The amnioscope is designed to carry out a painless study
of amniotic fluid through the cervix.

This device enables the specialist to get to the bag of waters,

which consists of a thin membrane and is where the amniotic
fluid and the baby is floating.

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•A beam of light is passed the color of amniotic fluid to
check if mother have a:

• yellowish hue that could indicate the presence of

bilirubin, resulting in a blood incompatibility,
• pitch is green could warn of the presence meconium,
which would result in hypoxia,
i.e. there is a deprivation of oxygen
and therefore the possibility of fetal distress is occurring,
• And if amniotic fluid is
reddish this would mean that the fetus is dead.
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A small (3–4 mm) incision is
made in the abdomen,
and an endoscope is inserted
through the abdominal wall
and uterus into the amniotic
cavity

Foetoscope is used to monitor fetal heart rate

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I. Ultrasound in pregnancy
II. Cardiotocography.
III. Contraction stress test.
IV. Non stress test.
V. Foetal movement count.
VI. Amnioscopy.
VII. Foetoscopy.
 
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