| Well-being of a fetus is assessed by different methods. One of them is a nonstress test, in which acceleration of the fetal heart rate with fetal movements is assessed electronically over a period of 20 minutes. It is one of the oldest tests and quite reliable. Then came the biophysical profile, which assesses 4 ultrasonographic parameters in addition to a nonstress test. These are fetal movements, fetal breathing movements, fetal tone and amniotic fluid index. These are assessed over a period of about 30 minutes. It is said that a nonstress test may be omitted if the other four parameters are normal. |
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| As luck would have it, the hospital has no fetal heart rate monitor for use in the emergency hours, the monitors having been condemned long ago, and the new purchase being stuck at an unknown (to us) level for a very long time. So our smart residents send all patients who need such monitoring for a partial biophysical profile in emergency hours, which is to be done by the ultrasonographers. The most important parameter is not assessed. Why the textbook of obstetrics (Williams 23rd edition) made this recommendation of omitting a nonstress test is beyond my comprehension. Surely that posh hospital in US does not face the same deficiency of fetal monitors as we doo in a poor country? The ultrasonography residents are overworked and as smart as our residents. So the 4 parameters get assessed in 4-5 minutes and the patients come back with a score of 8/8. |
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| I know both the sides of the story. My final solution is to ask the gravida "does your child move well?" If she says yes, the fetus is well. If not, I get a nonstress test done in office hours the next day. That is going back to basics. | ||
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