Assessment of fetal wellbeing

1. Big picture

Assessment of fetal wellbeing means checking whether the fetus is adequately oxygenated, growing appropriately, and not showing signs of acute or chronic compromise.

The examiner wants you to think in two different clinical situations:

Situation	Main question	Main tools
Antepartum assessment	Is the fetus well before labour?	Fetal movements, ultrasound growth, amniotic fluid, Doppler, non-stress CTG, biophysical profile
Intrapartum assessment	Is the fetus tolerating labour?	Intermittent auscultation, continuous CTG, fetal scalp stimulation/blood sampling where available

Core logic:

Maternal disease / placental disease / fetal disease
        ↓
Reduced uteroplacental oxygen transfer
        ↓
Fetal compensation: redistribution to brain, heart, adrenals
        ↓
Abnormal Doppler / reduced movements / abnormal CTG
        ↓
Acidosis, fetal distress, stillbirth if untreated

The purpose is not to “make the CTG look nice”; it is to prevent fetal hypoxic injury and stillbirth while avoiding unnecessary intervention.

1. Big picture

Unlock the rest of this topic