The published evidence is summarized with respect to the best methods of performing fetal assessment in pregnancy. The fetal surveillance programme depends on the level of perceived fetal risk. Currently, assessment of the health of a fetus presumed to be at low-risk comprises: enquiry about fetal movements; recording fundal height growth; auscultation of the fetal heart. Reduced fetal activity is the only assessment shown to identify fetuses at risk of intrauterine death. In such cases, fetal health should be assessed in the same way as in any other high-risk pregnancies (see below). There is a need to develop better methods of identifying fetuses at risk in apparently low-risk pregnancies. For most high-risk pregnancies a comprehensive assessment of fetal health should be undertaken using:
•‘chronic measures’ (umbilical artery Doppler recordings, fetal growth measurements and amniotic fluid volume) should be recorded routinely
•‘acute measures’ (cardiotocography, CTG or biophysical profile score, BPS) should be used selectively but always if there is evidence of chronic compromise.
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