Fetal Wellbeing (Assessment)
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Population Covered By The Guidance
This pathway provides guidance on the imaging assessment of pregnant patients for fetal well-being in the third trimester.
Date reviewed: October 2013
Date of next review: June 2023
Published: November 2013
Quick User Guide
Move the mouse cursor over the PINK text boxes inside the flow chart to bring up a pop up box with salient points.
Clicking on the PINK text box will bring up the full text.
The relative radiation level (RRL) of each imaging investigation is displayed in the pop up box.
| SYMBOL | RRL | EFFECTIVE DOSE RANGE |
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None | 0 |
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Minimal | < 1 millisieverts |
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Low | 1-5 mSv |
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Medium | 5-10 mSv |
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High | >10 mSv |
Images
Image GalleryNote: These images open in a new page |
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| 1a |  |
Intrauterine Growth Restriction Image 1a,b,c (Ultrasound, 33 weeks gestation): The fetus is in a cephalic presentation. The placenta is situated on the posterior uterine wall, clear of the cervix. Measurements: Biparietal diameter 78mm, Head circumference 283mm, Abdominal circumference 266mm, Femur length 58mm. Estimated fetal weight 1625g +/- 237g. Amniotic fluid volume is normal (Amniotic Fluid Index = 12cm).
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| 1b |  |
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| 1c |  |
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| 1d |  |
Image 1d (Fetal Biometry Chart, 33 weeks gestation): The above measurements are all below the 3rd percentile. |
Teaching Points
Teaching Points
- Routine ultrasound in the third trimester is not indicated. However, there are a number of maternal, fetal and pregnancy related indications for an ultrasound examination at this time. These include 4
- Pregnancy induced hypertension/pre-eclampsia
- Chronic renal disease and hypertension
- Maternal diabetes mellitus, pregnancy induced diabetes mellitus
- Maternal vascular disorders
- Suspected or previous history of IUGR
- Previous history of intrauterine fetal death
- Previous history of abruption
- Multiple pregnancy
- Clinical polyhydramnios or oligohydramnios
- Review of fetal anomaly
- Malpresentation
- Planned vaginal delivery of breech presentation
- Palpates small for dates
- Advanced maternal age (>35 years)
- Umbilical artery Doppler studies in high risk populations can help reduce perinatal mortality. Consider results in conjunction with ultrasound and other Doppler studies of the MCA, uterine artery and ductus venosus
References
References
Date of literature search: July 2013
The search methodology is available on request. Email
References are graded from Level I to V according to the Oxford Centre for Evidence-Based Medicine, Levels of Evidence. Download the document
- Rossi AC, Prefumo F. Perinatal outcomes of isolated oligohydramnios at term and post-term pregnancy: a systematic review of literature with meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2013;169(2):149-54. (Level III evidence)
- Zhang J, Troendle J, Meikle S, Klebanoff MA, Rayburn WF. Isolated oligohydramnios is not associated with adverse perinatal outcomes. BJOG. 2004;111(3):220-5. (Level II evidence)
- Lausman A, McCarthy FP, Walker M, Kingdom J. Screening, diagnosis and management of intrauterine growth restriction. J Obstet Gynaecol Can. 2012;34(1):17-28. (Review article)
- Nyberg D, Abuhamad A, Ville Y. Ultrasound assessment of abnormal fetal growth. Semin Perinatol. 2004;28(1):3-22. (Review article)
- Sylvan K, Ryding EL, Rydhstroem H. Routine ultrasound screening in the third trimester: a population-based study. Acta Obstet Gynecol Scand. 2005;84(12):1154-8. (Level II evidence)
- Bricker L, Neilson JP, Dowswell T. Routine ultrasound in late pregnancy (after 24 weeks' gestation). Cochrane Database Syst Rev. 2008(4):CD001451. (Level I evidence)
- Alfirevic Z, Stampalija T, Gyte GM. Fetal and umbilical Doppler ultrasound in normal pregnancy. Cochrane Database Syst Rev. 2010 (8):CD001450. (Level I/II evidence)
- Royal College of Obstetricians and Gynaecologists. Green-top guideline No. 31: The investigation and management of the small-for-gestational-age fetus. 2013 [cited 2013 July 1]. (Evidence based guideline). View the reference
- Harman C, Baschat A. Comprehensive assessment of fetal wellbeing: which Doppler tests should be performed? Curr Opin Obstet Gynecol. 2003;15(2):147-57. (Review article)
- Australasian Society for Ultrasound in Medicine. Guidelines for the performance of third trimester ultrasound. ASUM guidelines; 1999. (Position statement)
- Harman CR, Baschat AA. Arterial and venous Dopplers in IUGR. Clin Obstet Gynecol. 2003;46(4):931-46. (Review article)
- Alfirevic Z, Stampalija T, Gyte GM. Fetal and umbilical Doppler ultrasound in high-risk pregnancies. Cochrane Database Syst Rev. 2010 (1):CD007529. (Level I evidence)
- Cosmi E, Ambrosini G, D'Antona D, Saccardi C, Mari G. Doppler, cardiotocography, and biophysical profile changes in growth-restricted fetuses. Obstet Gynecol. 2005;106(6):1240-5. (Level III evidence)
- Morris RK, Say R, Robson SC, Kleijnen J, Khan KS. Systematic review and meta-analysis of middle cerebral artery Doppler to predict perinatal wellbeing. Eur J Obstet Gynecol Reprod Biol. 2012;165(2):141-55. (Level II evidence)
- Morris RK, Malin G, Robson SC, Kleijnen J, Zamora J, Khan KS. Fetal umbilical artery Doppler to predict compromise of fetal/neonatal wellbeing in a high-risk population: systematic review and bivariate meta-analysis. Ultrasound Obstet Gynecol. 2011;37(2):135-42. (Level I/II evidence)
- Alfirevic Z, Neilson JP. Doppler ultrasonography in high-risk pregnancies: systematic review with meta-analysis. Am J Obstet Gynecol. 1995;172(5):1379-87. (Level II evidence)
- Severi FM, Bocchi C, Visentin A, Falco P, Cobellis L, Florio P, et al. Uterine and fetal cerebral Doppler predict the outcome of third-trimester small-for-gestational age fetuses with normal umbilical artery Doppler. Ultrasound Obstet Gynecol. 2002;19(3):225-8. (Level III evidence)
- Morris RK, Selman TJ, Verma M, Robson SC, Kleijnen J, Khan KS. Systematic review and meta-analysis of the test accuracy of ductus venosus Doppler to predict compromise of fetal/neonatal wellbeing in high risk pregnancies with placental insufficiency. Eur J Obstet Gynecol Reprod Biol. 2010;152(1):3-12. (Level I/II evidence)
- Thornton JG, Hornbuckle J, Vail A, Spiegelhalter DJ, Levene M. Infant wellbeing at 2 years of age in the Growth Restriction Intervention Trial (GRIT): multicentred randomised controlled trial. Lancet. 2004;364(9433):513-20. (Level II evidence)
- Walker DM, Marlow N, Upstone L, Gross H, Hornbuckle J, Vail A, et al. The growth restriction intervention trial: long-term outcomes in a randomized trial of timing of delivery in fetal growth restriction. Am J Obstet Gynecol. 2011;204(1):34 e1-9. (Level II evidence)
- Williams KP, Farquharson DF, Bebbington M, Danscreau J, Galerneau F, Wilson RD, et al. Screening for fetal well-being in a high-risk pregnant population comparing the nonstress test with umbilical artery Doppler velocimetry: a randomized controlled clinical trial. Am J Obstet Gynecol. 2003;188(5):1366-71. (Level II evidence)
Information for Consumers
Information for Consumers
Information from this website |
Information from the Royal Australian and New Zealand College of Radiologists’ website |
Consent to Procedure or Treatment Radiation Risks of X-rays and Scans |
Radiation Risk of Medical Imaging During Pregnancy Radiation Risk of Medical Imaging for Adults and Children |
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