Gorovitz & Borten, P.C.
Attorneys at Law

550 Cochituate Road, Suite 25
Framingham, Massachusetts
Tel: (781) 890-9095
Fetal Monitoring
Current standard of care in obstetrics considers the fetus as a patient distinct
and separate from the mother. Ethically and legally, the obstetrician or nurse
midwife must take into account the fetal well-being when making decisions
concerning a pregnancy. In particular, during the third trimester of pregnancy, the
purpose of prenatal evaluation is to determine and confirm adequate fetal growth,
lung maturity and that the fetus continues to benefit from remaining in the uterine
environment rather than timely intervention and delivery to maximize the chances
of a normal postnatal development.

Assessment of fetal well-being during the third trimester includes:

  • Clinical examination
  • Assessment of fetal movements
  • Fetal lung maturity determination
  • Assessment of placental function by means of:
   o        Nonstress test
   o        Contraction stress test
   o        Biophysical profile test
   o        Doppler fetal umbilical arterial blood flow velocity/resistance
   o        Ultrasonography

Nonstress test (NST) is a simple procedure by which the fetal heart rate is
monitored recording simultaneously the uterine activity. A reactive nonstress test

  • Heart rate of 120 to 160 beats per minute
  • Normal beat-to-beat variability
  • Two accelerations of more than 15 beats per minute lasting more than 20
    seconds each within a 15-minute time period

A nonreactive nonstress test may reflect a prior episode of intrauterine asphyxia,
a late sign of fetal asphyxia or be a nonspecific benign pattern.

Contraction stress test (CST) is used to monitor the fetal heart response to
uterine contractions (spontaneous or induced with Pitocin). For a CST to be
considered valid, the uterine contractions must:

  • Occur with a frequency of 3 in 10 minutes
  • Occur within 30 minutes
  • Last 40  to 60 seconds duration

Uterine contractions cause a diminution in the blood flow to the uterus and
placenta which is well tolerated by a fetus that is not compromised. The
appearance of late decelerations with uterine contractions may represent a
poorly tolerated transient state of hypoxia when blood flow to the placenta is
decreased. A CST is considered positive (abnormal) if late decelerations are
present in 50% or more of the uterine contractions.

Biophysical profile test (BPP) is a noninvasive test that predicts the presence
or absence of fetal asphyxia and the risk of fetal death in-utero. It combines the
nonstress test with the assessment of:

  • Amniotic fluid volume
  • Fetal breathing movements
  • Fetal activity
  • Fetal muscle tone

Each parameter is assigned a score from 0 to 2 points. The combination of a
nonstress test and an 8 out of 8 points indicates a low risk and the need for
weekly testing. The lower the score, the stronger the suggestion that immediate
delivery is in the best benefit of the fetus.

Doppler fetal umbilical blood flow study measures the velocity and resistance to
blood flow and assesses the placental function. Decreased flow velocity during
diastole indicates placental insufficiency and in severe cases, the need for
intervention. In severe cases of placental insufficiency, the diastolic flow may stop
completely and even reverse itself.

Ultrasonography is the most valuable test to detect fetal anomalies as well as
the estimation of fetal growth. Detection of intrauterine growth restriction (IUGR)
requires additional testing to confirm fetal well-being. Growth pattern is more
important than the actual estimated fetal weight at any particular point in time.
Assessment of amniotic fluid volume is also meaningful in determining the status
of the fetus. The appearance of diminished volume of amniotic fluid
(oligohydramnios) is clinically significant.

Common mistakes in monitoring fetal well-being during the third trimester include:

  • Failure to order tests
  • Failure to schedule tests at appropriate intervals
  • Failure to correctly interpret tests
  • Failure to follow-up abnormal tests results
  • Failure to intervene and promptly deliver a patient in which tests reveal
    placental insufficiency

If your child was injured as a result of intrauterine fetal hypoxia (asphyxia or
placental insufficiency) that was diagnosable, avoidable and treatable, you may
have a valid cause of action. The injury may be the result of a medical provider's
mistake in handling an obstetrical condition. Your child and you as parents of the
child are entitled to receive compensation. If your child's condition was the result
of medical negligence, allow
Dr. Borten and the Boston area medical malpractice
attorneys at Gorovitz & Borten help you assert your rights and get the
compensation you deserve.
Contact Information
For a free confidential consultation and receive a response within 24 hours
(when possible), please contact us by phone, fax or e-mail with your question or

Telephone:  781-890-9095     -     Fax:   781-890-9098               
Electronic mail:
Questions or Inquiries to: inquiry@gbmedlaw.com

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