Fetal surveillance significantly reduces the incidence of fetal loss, perinatal morbidity and maternal distress. Obstetricians traditionally classify pregnancies as ‘low risk’ or ‘high risk’, and apply various methods of fetal surveillance in the latter group. However, the majority of stillbirths now occur in ‘low-risk’ women. This seemingly anomalous observation emphasises the need to develop more effective ways of identifying ‘at-risk’ fetuses in ‘low-risk’ women. This article describes and critically evaluates 11 currently available tools for fetal surveillance. It also reviews the criteria for ascribing risk status in pregnancy and suggests a pragmatic approach to health assessment in normally formed fetuses for each group. It does not address fetal surveillance during labour and delivery.
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