Fetal surveillance cannot identify every compromised fetus. Objective this guideline provides a consistent approach to fetal surveillance and utilization of various methods of antenatal testing and surveillance. 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. Prenatal nonstress test, popularly known as nst, is a method used to test fetal wellbeing before the onset of labor.
Antepartum fetal surveillance jason zachariah 1 slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Fetal surveillance an overview sciencedirect topics. The goal of antepartum fetal surveillance is to prevent fetal death. Polyhydramnios is definedby a mvp of equal to or greater than 8 cm figure 9. The lowrisk mother will be seen largely by the midwife in community antenatal clinics. Fetal surveillance testing may be necessary to ensure that the fetus is developing normally. Higherrisk mothers will be seen in hospital antenatal clinics often. Antepartum fetal surveillance 2000 international journal of. Whether the perinatal mortality rate, particularly the fetal death rate, is greater in these patients remains controversial. The primary outcome was the need for prolonged efm greater than 2 hours or decision to proceed with. Limitations of the existing evidence also prevent a comprehensive understanding of. Fetal surveillance in multifetal pregnancy journal of. Prenatal care guideline prenatal care michigan medicine.
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. Current inpatient antenatal fetal surveillance paradigms. Start studying 17 intrapartum fetal surveillance 9. Intrapartum fetal surveillance ifs refer to online version, destroy printed copies after use page 2 of 29. Background a complex interplay of antepartum complications, suboptimal uterine perfusion, placental dysfunction, and intrapartum events can result in adverse neonatal outcome. Avoiding the pitfalls of obstetric triage mdedge obgyn. The predominant goal of antepartum fetal testing is to lower perinatal morbidity and mortality rates. Unlimited viewing of the articlechapter pdf and any associated. Although this followup examination is intended to support the working gestational age, interval fetal growth assessment potentially may detect cases of fetal growth restriction. Antepartum fetal surveillance techniques are routinely used to assess the risk.
The purpose of intrapartum surveillance, in general, is a timely detection of babies who may be hypoxic, so. 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. Polyhydramnios the term polyhydramnios refers to increased amniotic fluid volume relative to gestational age. Antenatal testing may include contraction stress tests, nonstress tests, biophysical profiles, and modified biophysical profiles. Table 2 shows the common indications for antepartum fetal with surveillance, the gestational ages at which to initiate testing, and the frequency of testing. Eugene bailey, md, suny upstate medical university, syracuse, new york i. What is appropriate fetal surveillance for women with diet. Antepartum fetal death is much more common than intrapartum fetal death, and unexplained fetal death occurs far more commonly than unexplainedmore commonly than unexplained infant death this justifies for the use of some form of antepartum fetal health assessment. Assessments and care recommended in this guideline must be reevaluated and adjusted if required, in the event of a change in maternal or fetal condition. Pdf antenatal fetal surveillance is a field of increasing importance in modern obstetrics, especially as results in perinatal care have recently.
Antepartum fetal surveillance aims to decrease perinatal morbidity and mortality. The first edition was published in 2007 under the same title. 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. It has been developed by the editorial board based on the experience gained from maternity units where a reduction in the. Fetal heart rate monitoring may be performed externally or internally. 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. Common tests include fetal movement assessment, nonstress tests nst, contraction. Even so, the evidence supporting antepartum surveillance is weak with respect to the ideal type and frequency of testing or even whether such testing significantly alters outcome. 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. A warning sign that a fetus may be at risk of compromise is maternal perception of decrease in fetal movement. This guideline is intended for healthcare professionals, particularly those in training, who are working in hsefunded obstetric and gynaecological services.
It pertains to care of women who have had an aph and are no longer actively bleeding. Antepartum fetal surveillance medical clinical policy. Advanced maternal age and the risk of antepartum stillbirth. 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. Intrapartum fetal surveillance for healthy term women in spontaneous labour in the absence of risk factors for adverse perinatal outcome. Antepartum fetal surveillance techniques based on assessment of. Antenatal care should be appropriate and effective. Learn vocabulary, terms, and more with flashcards, games, and other study tools.
A prospective multiinstitutional study of antepartum fetal heart rate monitoring. A prenatal nonstress test functions in overall antepartum surveillance with ultrasound as a part or component of the biophysical profile. Two basic approaches are taken to intrapartum fetal surveillancelowtech and hightech approaches. Functional measures of antepartum surveillance supplement structural modalities lai et al.
Find powerpoint presentations and slides using the power of, find free presentations research about antepartal fetal surveillance ppt. This guideline is intended for use by all health professionals who provide antepartum and intrapartum care in canada. 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. 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. If you continue browsing the site, you agree to the use of cookies on this website. Thus, although no method of intrapartum fetal surveillance clearly is superior to all others, a substantial body of literature confirms that intrapartum fetal monitoring intermittent or continuous, although a relatively poor diagnostic test, is a reliable screening test for the confirmation of fetal wellbeing. Registered users can save articles, searches, and manage email alerts. Women who receive prenatal care during the first trimester have better pregnancy outcomes than. Most external monitors use a doppler device with computerized logic to interpret and count the doppler signals. Consideration has been given to all methods of fetal surveillance currently available in canada.
If kick counting is used by the patient, a nonreassuring count provides the alert for further assessment. The american college of obstetricians and gynecologists acog has developed guidelines on antepartum fetal surveillance. Antepartum fetal surveillance techniques based on assessment of fetal heart rate patterns have been in clinical use for almost three decades. Abstract the goal of antepartum fetal surveillance is to prevent fetal death. Antenatal fetal assessment or surveillance is used to improve outcomes and decrease perinatal mortality. Although few practitioners have much experience with these complicated pregnancies, knowledge is growing with the increasing incidence of multifetal pregnancy. Multiple methods of tocolysis and fetal surveillance provide unprecedented ways to improve multifetal outcomes through meticulous antepartum care. Its the health care providers responsibility to understand the method of surveillance, the frequency and indication for surveillance and the ability to interpret. Contraction stress test versus nonstress test for primary surveillance. Antepartum surveillance for fetal wellbeing is amongst one of the most common interventions done in developing world prenatal care for complicated pregnancies. Intrapartum fetal monitoring guideline published february 2018 disclaimer this guideline describes fetal monitoring using physiologybased ctg interpretation. Although nonphysician personnel provide the majority of obstetric triage services, close supervision by a doctor is required because of the considerable risks involved. Antepartum fetal surveillance is used to assess the risk of adverse perinatal outcome associated with uteroplacental insufficiency, and is recommended for pregnancies that are at risk for hypoxia and stillbirth.
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. Document and report any change to the medical team. Aph antepartum haemorrhage bpm beats per minute cefm continuous electronic fetal monitoring. The gaps in the evidence regarding the efficacy of antepartum testing in preventing fetal death or injury make it difficult to assess the largescale benefits of antepartum testing in general. The only antenatal surveillance technique recommended for all pregnant women. Results of antepartum surveillance did not significantly differ among the different diabetic classes.
Several antepartum fetal surveillance techniques tests are in clinical use. Accepted guidelines state that fetal testing should not begin until interventions can be undertaken. Intrapartum fetal monitoring guideline published february 2018. View and download powerpoint presentations on antepartal fetal surveillance ppt.
Fetal testing should not begin until interventions can be undertaken. These include maternal perception of fetal movement, contraction stress test cst. Pregnancy in patients with gestational diabetes mellitus gdm is associated with increased perinatal morbidity. The antepartum fetal surveillance protocols noted below should be used as a guideline for management. Women were divided into two groups bpps 88 or 68 or less and their outcomes compared. Antepartum surveillance is used for women deemed to be at increased risk for fetal death. In univariate and multivariate analyses, the greatest indicator for cesarean section due to fetal distress was a nonreactive nonstress test with decelerations odds ratio. The presence of fetal movements and fetal heart rate acceleration is the most critical feature of the nonstress test. Antepartum fetal surveillance in gestational diabetes. O stepwise approach for assessment of the fetal condition should be undertaken o antepartum fetal surveillance tests have high falsepositive rates and low positive predictive values o minimizes the potential for unnecessary delivery based on a single falsepositive test result o response to abnormal test result should be tailored to the. Acog practice bulletin, antepartum 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.