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    ACOG Guidelines at a Glance: Antepartum fetal surveillance

     

    Committee on Practice Bulletins—Obstetrics

    ACOG Practice Bulletin Number 145: Antepartum Fetal Surveillance, July 2014. Obstet Gynecol. 2014; 124:182–92. Full text of ACOG Practice Bulletins is available to ACOG members at http://www.acog.org/Resources-And-Publications/Practice-Bulletins/Committee-on-Practice-Bulletins-Obstetrics/Antepartum-Fetal-Surveillance

    Antepartum Fetal Surveillance

    The goal of antepartum fetal surveillance is to prevent fetal death. 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 real-time ultrasonography and umbilical artery Doppler velocimetry to evaluate fetal well-being. 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 restriction). The purpose of this document is to provide a review of the current indications for and techniques of antepartum fetal surveillance and outline management guidelines for antepartum fetal surveillance that are consistent with the best scientific evidence.

     

    Used with permission. Copyright the American College of Obstetricians and Gynecologists.

     

    Commentary: Balancing cost and benefit in antepartum fetal surveillance

     

     

     

    For nearly 4 decades, fetal heart monitoring (FHR) has been used to assess antenatal and intrapartum fetal well-being. While both antenatal and intrapartum monitoring have come under criticism, antepartum fetal heart rate surveillance to assess the risk of fetal death and stillbirth is less controversial for the purpose for which it was intended when it was introduced in the 1970s.

    This Practice Bulletin provides a review of the indications and techniques for antepartum fetal surveillance with FHR being the consistent parameter used in the assessment of fetal well-being.

    Abnormal fetal surveillance is based on physiologic changes that alter fetal heart rate and fetal activity. Fetal heart rate, fetal movement, and tone in particular are impacted by uteroplacental fetal blood flow alterations and are thereby sensitive to fetal hypoxemia and acidemia. While nonreassuring fetal surveillance is associated with fetal hypoxemia and acidemia based on these physiologic adjustments, these indicators can neither predict the degree or duration of the fetal acid base disturbance nor precisely predict neonatal outcome.

     

    Haywood L. Brown, MD
    Dr. Brown is the F. Bayard Carter Professor and Chair, Division of Maternal Fetal Medicine, Duke University Medical Center, Durham, ...

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