[Diagnosis of biophysical status in pregnancy]

Based on 6,490 cardiotocographic examinations and numerous following diagnostic investigations a combined cardiotocographic and sonographic management during pregnancy care is recommended. The management starts with a non-stress-test (NST). Two acceleration (greater than 15 seconds, greater than 15 bpm) recorded within 10 or more minutes are a sign of fetal well-being. In order to differentiate between physiological- and pathologically suspicious heart frequency patterns a mechanical or acoustic provocation test is recommended. The dorsal transcutaneous electrical nerve stimulation (20 mA) is an effective continuous stimulus to wake up the fetus. The nipple stimulation test is the best physiological contraction stress test. The oxytocin challenge test may be replaced by the nipple stimulation. The following sonographic parameters of fetal condition are summarized to the fetal biophysical profile (FBP): body movements, breath movements, tonus and amniotic fluid volume. All these, together with the result of non-stress-testing, give the FBP-score. The predictive value of combined cardiotocographic and sonographic examination is much higher than the NST alone. An FBP-score less than or equal to 6 is an indication for the hospitalization. A score less than 4 with verified signs of maturity is an indication for the induction of labor.