Antenatal surveillance

Composite score of five variables with each receiving a score of 2 points for presence and zero for absence:

Tone: at least one episode of active pmb, trunk or hand extension with return to flexion

Movement: at least 3 discrete body/pmb movements

Breathing: at least one episode of at least 30 seconds duration

Amniotic fluid: at least one single vertical pocket >2 cm

Heart rate: at least 2 accelerations of:

• 10 beats in height lasting for 10 seconds (at 24-28 weeks)
• 15 beats in height lasting for 15 seconds (at 28-34 weeks)
• 20 beats in height lasting for 20 seconds (after 34 weeks)

Pregnancy management. There is a good relation between the total score and perinatal mortality rate in the following week.

• If the score is 0 or 2 it is recommended that immediate delivery is undertaken. If the score is 4 or 6 with oligohydramnios testing is repeated immediately for an hour and if there is no improvement it is recommended that immediate delivery is undertaken
• If the score is equivocal retesting within 24 hours is recommended
• If the score is normal retesting is usually in one week