## Assessment of Fetal Well-Being Before Induction ### Clinical Context In a post-term pregnancy (>40 weeks) with an unfavourable cervix, assessment of fetal well-being is critical before committing to cervical ripening agents (which carry risks of hyperstimulation and uterine rupture). ### Why Biophysical Profile (BPP) is the Investigation of Choice **Key Point:** The BPP combines real-time ultrasound assessment of fetal behaviour with NST and is the **gold standard** for comprehensive fetal well-being evaluation in the context of labour induction decisions. The BPP includes: 1. Fetal breathing movements 2. Fetal body movements 3. Fetal tone 4. Amniotic fluid volume 5. Reactive NST **High-Yield:** A BPP score of 8–10 (with normal AFI) indicates low risk of intrauterine fetal death and supports safe induction. A score ≤6 may warrant delivery regardless of cervical favourability. ### Comparison of Investigations | Investigation | Use Case | Limitation in This Scenario | |---|---|---| | **NST + AFI** | Routine screening; does not assess fetal tone/breathing | Incomplete assessment; AFI alone insufficient for induction decision | | **CST** | Detects placental insufficiency via labour stress | Contraindicated in post-term pregnancy with unfavourable cervix; risk of precipitating labour | | **BPP** | Comprehensive assessment of fetal status and reserves | **Most appropriate**; combines NST + ultrasound parameters | | **Doppler (UA)** | Assesses placental perfusion in growth restriction | Not indicated for post-term pregnancy without IUGR suspicion | **Clinical Pearl:** In post-term pregnancy, a normal BPP (8–10) reassures that the fetus can tolerate cervical ripening and labour induction safely. An abnormal BPP (≤6) may prompt expedited delivery by caesarean section. [cite:Williams Obstetrics 26e Ch 42]
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