While ama has clearly been shown to be a significant risk factor for stillbirth at term, in the absence of other coindications eg, maternal or fetal complications, it has not routinely served as an indication for antepartum testing. Seravalli et al 2014 noted that 1st trimester screening for subsequent. Accurate determination of gestational age is essential to accurate diagnosis and appropriate management of lateterm and postterm pregnancies. Maternity and neonatal clinical guidelines queensland. Fetal activity chart pdf created with pdffactory trial version. Antepartum fetal surveillance and induction of labor have been evaluated as strategies to decrease the risks of perinatal morbidity and mortality associated with lateterm and postterm pregnancies. Antepartum fetal surveillance techniques are routinely used to assess the risk. Antepartum fetal assessment as defined in this document refers to ultrasonography.
Fetal surveillance cannot identify every compromised fetus. Functional measures of antepartum surveillance supplement structural modalities lai et al. Antepartum assessment of fetal wellbeing the obstetrician is responsible for 2 patients during pregnancy and labor, one. A nonstress test is used to evaluate a babys health before birth. Accepted guidelines state that fetal testing should not begin until interventions can be undertaken. This guideline provides new recommendations pertaining to the application and documentation of fetal surveillance in the antepartum and intrapartum period that will decrease the incidence of birth. Antepartum fetal surveillance in gestational diabetes. Antepartum fetal surveillance aims to decrease perinatal morbidity and mortality. Fetal heart rate monitoring may be performed externally or internally. A prospective multiinstitutional study of antepartum fetal heart rate monitoring. The nonstress test is an antepartum surveillance test for evaluation of the fetal. Two basic approaches are taken to intrapartum fetal surveillance lowtech and hightech approaches. Further improvement in distant fetal monitoring equipment will allow the number of inconclusive results to decrease.
Queensland clinical guidelines qcg, queensland health. Electronic fetal heart rate monitoring efm was introduced into clinical practice during an era in which intrapartum fetal hypoxia was thought to be the primary cause of cerebral palsy cp. The purpose of intrapartum surveillance, in general, is a timely detection of babies who may be hypoxic, so that additional assessments of fetal wellbeing may be used or the baby be delivered by caesarean or instrumental vaginal birth, to prevent perinatalneonatal morbidity or mortality. Common indications for fetal surveillance with nonstress test and amniotic fluid index. This is a learning in 10 voice annotated presentation vap on intrapartum fetal monitoring to learn more about learning in 10 lit, please visit. Queensland clinical guidelines endorsed for use in all queensland health facilities. As the recognized leader in fetal heart monitoring education, awhonns inperson and online formats are convenient, evidencebased and the essential tools for educating the entire team. Most external monitors use a doppler device with computerized logic to interpret and count the doppler signals. Antepartum fetal surveillance using nst, cst, bpp, or modified bpp is considered medically necessary for women with risk factors for stillbirth due to uteroplacental insufficiency.
Table 2 shows the common indications for antepartum fetal with surveillance, the gestational ages at which to initiate testing, and the frequency of testing. Quality and safety activities, and support for translating evidence into practice are included in the guideline supplement. Antepartum fetal surveillance medical clinical policy. Aetna considers antepartum fetal surveillance with nst, cst, bpp, modified bpp, and.
Acog practice bulletin, antepartum fetal surveillance. Further studies are needed to establish the place of frme test for antepartum fetal surveillance. Pregnancy in patients with gestational diabetes mellitus gdm is associated with increased perinatal morbidity. Antepartum fetal monitoring through a wearable system and. Practice bulletins authored by the american college of obstetricians and gynecologists acog are evidencebased documents that summarize current information on techniques and clinical management issues for the practice of obstetrics and gynecology the official list of current bulletins is published monthly and includes reaffirmed dates for older bulletins. Antepartum fetal surveillance 2014 essay 8496 words. Antepartum surveillance is used for women deemed to be at increased risk for fetal death. Practice bulletin number 145, july 2014 replaces practice bulletin number 9, october 1999 clinical management guidelines for obstetriciangynecologists the american college of.
Fetal health is evaluated, in part, by assessment of fetal heart rate patterns. Unlimited viewing of the articlechapter pdf and any associated supplements and figures. The cardiotocogram ctg trace forms a central piece of documentary evidence in medicolegal cases related to intrapartum hypoxia and birth asphyxia. Are we misguided by current guidelines on intrapartum. Antepartum fetal surveillance is the assessment of fetal well being in utero before the onset of labor early detection of fetus at risk so that timely management to prevent further deterioration. View enhanced pdf access article on wiley online library html view download pdf for offline viewing.
If kick counting is used by the patient, a nonreassuring count provides the alert for further assessment. This topic will provide an overview of antepartum fetal assessment. The simplest technique of perceived fetal movements kick counts by the mother provides a broad indication of normal maturational change quickening at 1820 weeks of gestation, diurnal effect more movements when the mother is resting or sleeping, or fewer movements at older gestational ages. This guideline is intended for healthcare professionals, particularly those in training, who are working in hse. The predominant goal of antepartum fetal testing is to lower perinatal morbidity and mortality rates. Fetal testing should not begin until interventions can be undertaken. Antepartum fetal surveillance techniques based on assessment of fetal heart rate patterns have been in clinical use for almost three decades. Maternity and neonatal disciplines are well supported. Fetal surveillance the availability of fetal surveillance has transformed the pregnancy experience from a miracle of nature to a riskdominated and technologyguided event shifts the focus of the pregnancy to what could go wrong, not what. Whether the perinatal mortality rate, particularly the fetal death rate, is greater in these patients remains controversial.
The primary goal of antepartum fetal surveillance antepartum testing with the nonstress test nst and the contraction stress test cst is to identify fetuses at risk of hypoxic injury or death and intervene to prevent these adverse outcomes, if possible. Antepartum evaluation of the fetus and fetal well being. Antenatal testing may include contraction stress tests, nonstress tests, biophysical profiles, and modified biophysical profiles. The goal of antepartum fetal surveillance is to prevent fetal death. Intrapartum electronic fetal heart rate fhr monitoring is widely practiced in the uk, the usa and in many other developed countries. The goal of a nonstress test is to provide useful information about your babys oxygen supply by checking his or her heart rate and how it responds to your babys movement. Fetal surveillance an overview sciencedirect topics. Prenatal care guideline prenatal care michigan medicine. Contraction stress test versus nonstress test for primary surveillance.
The american congress of obstetricians and gynecologists practice bulletin on antepartum fetal surveillance suggests that antepartum testing may be appropriate for any pregnancy in which there is an increased risk of fetal demise. Antenatal fetal assessment or surveillance is used to improve outcomes and decrease perinatal mortality. Overview of antepartum fetal surveillance uptodate. The argument in favor of antepartum surveillance starting at 37 weeks is that the risk of stillbirth at this gestational age is similar in frequency to other highrisk condition for which testing is routinely performed chronic hypertension, diabetes, cholestasis, etc. Fetal assessment or surveillance may be provided by various means based on individual history and case presentation. Although this chapter focuses on fetal surveillance of the woman during labor, many of these techniques and guidelines may be used in the care of a woman with an antepartum complication. Purpose and scope the purpose of this guideline is to reduce adverse perinatal outcomes related to inappropriate or inadequate intrapartum fetal surveillance. Internal fhr monitoring is accomplished with a fetal electrode, which is a spiral wire placed directly on the fetal scalp or other presenting part. Antepartum fetal surveillance techniques based on assessment of fetal heart rate fhr patterns have been in clinical use for almost four decades and are used along with realtime ultrasonography and umbilical artery doppler velocimetry to evaluate fetal wellbeing. Fetal heart monitoring requires advanced assessment and clinical judgment skills and should not be delegated to unlicensed assistive personnel or others who do not possess the appropriate licensure, education, and skills validation. Signorini 1, giordano lanzola 2,3, emanuele torti 2,3 id, andrea fanelli 1,4 and giovanni magenes 2,3, id 1 department of electronics, information and bioengineeringdeib, politecnico di milano. Fetal surveillance testing may be necessary to ensure that the fetus is developing normally. Fetal heart monitoring journal of obstetric, gynecologic. Can fetal heart rate responses to maternal exercise be.
Practice bulletin antepartum fetal surveillances 183 recorded with an external fetal monitor. Antepartum fetal monitoring through a wearable system and a mobile application maria g. A warning sign that a fetus may be at risk of compromise is maternal perception of decrease in fetal movement. Electronic fetal monitoring efm is the recommended method of intrapartum fetal surveillance for highrisk pregnancies. Advanced maternal age and the risk of antepartum stillbirth. The association of womens health, obstetric and neonatal nurses awhonn asserts that the availability of registered nurses rns and other health care professionals who are skilled in fetal heart monitoring fhm techniques, including auscultation and electronic fetal monitoring efm, is essential to maternal and fetal wellbeing during antepartum care, labor, and birth. Conclusion it appears that similar to cst, positive frme has a high correlation with adverse perinatal outcome. Intrapartum fetal surveillance in the presence of, or with the emergence of, fetal andor maternal risk factors management of fetal heart rate patterns considered suggestive of fetal. The american college of obstetricians and gynecologists acog has developed guidelines on antepartum fetal surveillance. Supporting quality and safety by translating evidence into best clinical.
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