However, as antepartum fetal surveillance has not been shown to definitively improve perinatal outcome in. The goal of antepartum fetal surveillance is to prevent fetal death. Fetal health is evaluated, in part, by assessment of fetal heart rate patterns. Accepted guidelines state that 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. Quality and safety activities, and support for translating evidence into practice are included in the guideline supplement. 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. Antepartum fetal monitoring through a wearable system and a mobile application maria g. 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. This guideline is intended for healthcare professionals, particularly those in training, who are working in hse. Most external monitors use a doppler device with computerized logic to interpret and count the doppler signals.
Can fetal heart rate responses to maternal exercise be. 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. Antepartum fetal surveillance aims to decrease perinatal morbidity and mortality. Fetal activity chart pdf created with pdffactory trial version. Queensland clinical guidelines endorsed for use in all queensland health facilities. 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. Advanced maternal age and the risk of antepartum stillbirth. Maternity and neonatal disciplines are well supported. A warning sign that a fetus may be at risk of compromise is maternal perception of decrease in fetal movement. Further improvement in distant fetal monitoring equipment will allow the number of inconclusive results to decrease. This topic will provide an overview of antepartum fetal assessment. 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.
Its the health care providers responsibility to understand the method of surveillance, the frequency and indication for surveillance and the ability to interpret. The cardiotocogram ctg trace forms a central piece of documentary evidence in medicolegal cases related to intrapartum hypoxia and birth asphyxia. Fetal heart rate monitoring may be performed externally or internally. 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. Functional measures of antepartum surveillance supplement structural modalities lai et al. Fetal surveillance testing may be necessary to ensure that the fetus is developing normally.
Supporting quality and safety by translating evidence into best clinical. Antepartum surveillance is used for women deemed to be at increased risk for fetal death. 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. 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. Two basic approaches are taken to intrapartum fetal surveillance lowtech and hightech approaches. Antepartum fetal assessment as defined in this document refers to ultrasonography. Purpose and scope the purpose of this guideline is to reduce adverse perinatal outcomes related to inappropriate or inadequate intrapartum fetal surveillance. Contraction stress test versus nonstress test for primary surveillance. Overview of antepartum fetal surveillance uptodate. The predominant goal of antepartum fetal testing is to lower perinatal morbidity and mortality rates.
Fetal heart monitoring journal of obstetric, gynecologic. 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. Practice bulletin number 145, july 2014 replaces practice bulletin number 9, october 1999 clinical management guidelines for obstetriciangynecologists the american college of. Unlimited viewing of the articlechapter pdf and any associated supplements and figures. Pregnancy in patients with gestational diabetes mellitus gdm is associated with increased perinatal morbidity. Further studies are needed to establish the place of frme test for antepartum fetal surveillance. 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. Internal fhr monitoring is accomplished with a fetal electrode, which is a spiral wire placed directly on the fetal scalp or other presenting part. 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. Antepartum fetal monitoring through a wearable system and. Antepartum evaluation of the fetus and fetal well being. 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. Conclusion it appears that similar to cst, positive frme has a high correlation with adverse perinatal outcome. Antepartum assessment of fetal wellbeing the obstetrician is responsible for 2 patients during pregnancy and labor, one.
The nonstress test is an antepartum surveillance test for evaluation of the fetal. 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. Practice bulletin antepartum fetal surveillances 183 recorded with an external fetal monitor. Acog practice bulletin, antepartum fetal surveillance. Antepartum fetal surveillance medical clinical policy. Fetal surveillance cannot identify every compromised fetus. Electronic fetal monitoring efm is the recommended method of intrapartum fetal surveillance for highrisk pregnancies. A prospective multiinstitutional study of antepartum fetal heart rate monitoring. Antenatal testing may include contraction stress tests, nonstress tests, biophysical profiles, and modified biophysical profiles.
Fetal testing should not begin until interventions can be undertaken. 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. Prenatal care guideline prenatal care michigan medicine. This is a learning in 10 voice annotated presentation vap on intrapartum fetal monitoring to learn more about learning in 10 lit, please visit. Are we misguided by current guidelines on intrapartum. If kick counting is used by the patient, a nonreassuring count provides the alert for further assessment. View enhanced pdf access article on wiley online library html view download pdf for offline viewing. 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. Fetal surveillance an overview sciencedirect topics. Accurate determination of gestational age is essential to accurate diagnosis and appropriate management of lateterm and postterm pregnancies. 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 nonstress test is used to evaluate a babys health before birth. Whether the perinatal mortality rate, particularly the fetal death rate, is greater in these patients remains controversial. Aetna considers antepartum fetal surveillance with nst, cst, bpp, modified bpp, and.
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. 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. Seravalli et al 2014 noted that 1st trimester screening for subsequent. Table 2 shows the common indications for antepartum fetal with surveillance, the gestational ages at which to initiate testing, and the frequency of testing. Antepartum fetal surveillance in gestational diabetes.
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. Maternity and neonatal clinical guidelines queensland. Queensland clinical guidelines qcg, queensland health. Antepartum fetal surveillance 2014 essay 8496 words.
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