The goal of antepartum fetal surveillance is to prevent fetal death. Chapter 10antepartum fetal assessment flashcards quizlet. Contraction stress test versus nonstress test for primary surveillance. Fetal surveillance cannot identify every compromised fetus. A prospective multiinstitutional study of antepartum fetal heart rate monitoring. Fetal surveillance is a broad term that refers to a variety of noninvasive tests that may be administered during a pregnancy in order to evaluate whether or not a baby is thriving in utero. Antepartum fetal surveillance using nst, cst, bpp, or modified bpp is considered medically necessary for women with risk factors for stillbirth due to utero. Antepartum fetal surveillance techniques based on assessment of fetal heart rate patterns have been in clinical use for almost three decades. Ultrasound is used to assess four discrete biophysical parameters. No authors listed the goal of antepartum fetal surveillance is to prevent fetal death. Start studying chapter 10antepartum fetal assessment. Higherrisk mothers will be seen in hospital antenatal clinics often.
Intrapartum fetal monitoring guideline published february 2018. Thus, fetal heart rate fhr monitoring can be used to determine if a fetus is well oxygenated. This checklist is a general guide for antepartum care for patients with pregestational. Antepartum fetal surveillance aims to decrease perinatal morbidity and mortality. Fetal surveillance testing may be necessary to ensure that the fetus is developing normally.
Acog hypertension in pregnancy executive summary available at. 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. Advanced maternal age and the risk of antepartum stillbirth. It is associated with significant maternal and fetal morbidity and mortality. Obstetricians and gynecologists acog clinical guideline on antepartum fetal surveillance. Which nursing action indicates the proper evaluation of this situation. What is appropriate fetal surveillance for women with diet. Antepartum fetal surveillance medical clinical policy. Antepartum surveillance is also indicated for other conditions affecting or suspected to affect the maternalfetal unit see table 41. Purpose and scope the purpose of this guideline is to reduce adverse perinatal outcomes related to inappropriate or inadequate intrapartum fetal surveillance. Antepartum fetal surveillance retrieved april 17,20 from 1. In univariate and multivariate analyses, the greatest indicator for cesarean section due to fetal distress was a nonreactive nonstress test with decelerations odds ratio. This guideline is intended for healthcare professionals, particularly those in training, who are working in hse.
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. Common causes of antepartum hemorrhage are bloody show associated with labor, placental previa, and placental abruption. Nonstress test nst by definition, an nst is a fetal assessment without the stress of labour. Links to html for online reading and pdf for printing versions of each bulletin are included when available. These include maternal perception of fetal movement, contraction stress test cst. Intrapartum fetal heart rate monitoring obstetricsgynecology. 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. Aph antepartum haemorrhage bpm beats per minute cefm continuous electronic fetal monitoring. Disclaimer this information is intended to provide general advice to practitioners, and should not be relied on as a substitute for proper assessment. Aetna considers inoffice and inhospital antepartum fetal surveillance with nonstress tests nst, contraction stress tests cst, biophysical profile bpp, modified bpp, and umbilical artery doppler velocimetry medically necessary according to the american college of obstetricians and gynecologists acog clinical guideline on antepartum fetal surveillance. It was used among 45% of laboring women in 1980, 62% in 1988, 74% in 1992, and 85% in 2002 1. Acog members log in here lippincott journals subscribers, use your username or email along with your password to log in. Antepartum fetal surveillance techniques are routinely used to assess the risk.
Two basic approaches are taken to intrapartum fetal surveillancelowtech and hightech approaches. The primary indication for fetal surveillance may be a maternal condition or a pregnancyrelated condition american college of obstetricians and gynecology compendium acog, 2004a x american college of obstetricians and gynecology compendium, 2004a american college of obstetricians and gynecology compendium. The lowrisk mother will be seen largely by the midwife in community antenatal clinics. Intrapartum fetal surveillance clinical guideline fourth edition 2019 the royal australian and new zealand college of obstetricians and gynaecologists. Checklist for antepartum care of pregestational type 1. The american academy of pediatrics aap and american college of obstetricians and gynecologists acog have issued researchbased guidelines that delineate testing criteria and procedures. Antenatal testing may include contraction stress tests, nonstress tests, biophysical profiles, and modified biophysical profiles. Several antepartum fetal surveillance techniques tests are in clinical use. It must also be remembered that uterine artery doppler assessment is a screening test for risk and not an assessment of antepartum fetal health, so has no role in the management of fetuses with established fgr. 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. Rare causes include vasa previa and uterine rupture. A warning sign that a fetus may be at risk of compromise is maternal perception of decrease in fetal movement.
Fetal testing should not begin until interventions can be undertaken. 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. 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. Table 2 shows the common indications for antepartum fetal with surveillance, the gestational ages at which to initiate testing, and the frequency of testing. Clinical management guidelines for obstetriciangynecologists. Acog practice bulletin, antepartum fetal surveillance. Prenatal care guideline prenatal care michigan medicine.
The predominant goal of antepartum fetal testing is to lower perinatal morbidity and mortality rates. A nonstress test nst is a noninvasive test performed to determine the fetal heart rate. The american college of obstetricians and gynecologists acog has developed guidelines on antepartum fetal surveillance. Acog monitoria fetal pdf intrapartum fetal heart rate monitoring. 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. Antepartum fetal surveillance techniques are routinely used to assess the risk of fetal death in pregnancies complicated by preexisting maternal conditions eg, diabetes mellitus as well as those in which complications have developed eg, fetal growth. Checklist for antepartum care of pregestational type 1 or type 2 diabetes. What are the indications for antepartum fetal surveillance. The nurse sees a pattern on the fetal monitor that looks similar to early decelerations, but the deceleration begins near the acme of the contraction and continues well beyond the end of the contraction.
An efm tracing of fhr and uterine activity is obtained for. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Antepartum fetal surveillance jason zachariah 1 slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Internal monitoring may increase the risk of infection. The fetal brain modulates the fetal heart rate through an interplay of sympathetic and parasympathetic forces. The antepartum fetal surveillance protocols noted below should be used. The nonstress test is an antepartum surveillance test. The fetal biophysical profile bpp is a noninvasive, easily learned and performed antepartum test for evaluating the fetus for signs of compromise. Nomenclature, interpretation, and general management principles this practice bulletin was developed by the acog.
There is no value to repeating the uterine artery doppler results in later pregnancy. Antepartum surveillance is used for women deemed to be at increased risk for fetal death. Results of antepartum surveillance did not significantly differ among the different diabetic classes. Antepartum hemorrhage knowledge for medical students and. Intrapartum fetal surveillance test bank multiple choice 1. If you continue browsing the site, you agree to the use of cookies on this website. If kick counting is used by the patient, a nonreassuring count provides the alert for further assessment. The purpose of intrapartum surveillance, in general, is a timely detection of babies who may be hypoxic, so. Number 9, october 1999 replaces technical bulletin number 188, january 1994. If the gestational age is monitoring is appropriate but such management should be individualized, especially in cases of fgr. Antepartum fetal surveillance using nst, cst, bpp, or modified bpp is considered medically necessary for women with risk factors for stillbirth due to utero placental. Antenatal care should be appropriate and effective. If you wish to search for a bulletin on a specific topic.
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