Antenatal surveillance

The new approach to fetal survaillance is to integrate the information obtained from biometry, amniotic fluid volume, biophysical profile and Doppler assessment of the placental and fetal circulations. The reason why such an integrated approach is superior to the individual tests is because the compromised fetus will demonstrate different features depending on gestation and the disease responsible for the compromise.

• Impaired placentation is manifested in asymmetric growth restriction and abnormal biophysical profile and Doppler indices
• In fetal akinesia deformation sequence, fetal biometry is normal, amniotic fluid is increased, Doppler indices are normal but fetal body and breating movements are absent 
• In red blood cell isoimmunization, fetal growth, amniotic fluid and impedance to flow in the placental and fetal circulations are normal and the main features of severe anemia are increased peak systolic velocity in the fetal middle cerebral artery and reduced fetal activity
• In maternal diabetes mellitus without vasculopathy and in gestational diabetes fetal compromise is essentialy the consequence of hyperglycemia manifested in fetal macrosomia and polyhydramnios with normal biophysical profile and Doppler indices. In contrast, in diabetes with maternal renal disease and vasculopathy the fetal deterioration may be similar to that observed in impaired placentation