Acog practice bulletins 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 cardiotocogram ctg trace forms a central piece of documentary evidence in medicolegal cases related to intrapartum hypoxia and birth asphyxia. 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. Identify the purposes of fetal surveillance before birth. Acog practice bulletin, antepartum fetal surveillance. Accurate determination of gestational age is essential to accurate diagnosis and appropriate management of lateterm and postterm pregnancies. Scribd is the worlds largest social reading and publishing site.
Antenatal fetal surveillance in pregnancies complicated by diabetes should include evaluation of. The main techniques for fetal assessment are the nonstress test, biophysical profile, modified biophysical profile. If you continue browsing the site, you agree to the use of cookies on this website. Feb 01, 2015 balancing cost and benefit in antepartum fetal surveillance balancing cost and benefit in antepartum fetal surveillance brown, haywood l. See overview of antepartum fetal surveillance and nonstress test and contraction stress test. 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. Techniques for assessment of fetal wellbeing nonstress test, contraction stress test, biophysical profile, modified biophysical profile are described in. Antepartum fetal surveillance with the aim of detecting fetuses that are in distress or compromised by adverse obstetric factors so as to effect timely delivery is essential in preventing or. Aph occurs in 25 per cent of pregnancies and half are of unknown cause.
It was used among 45% of laboring women in 1980, 62% in 1988, 74% in 1992, and 85% in 2002 1. Consideration has been given to all methods of fetal surveillance currently available in canada. Jul 12, 2015 the goal of antepartum fetal surveillance is to prevent fetal death. 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. Antepartum fetal surveillance jason zachariah 1 slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Identify the advantages and limitations of each method of fetal surveillance. The fetal brain modulates the fetal heart rate through an interplay of sympathetic and parasympathetic forces. Antepartum fetal testing is indicated in pregnancies in which the risk of antepartum fetal demise is increased. Intrapartum fetal surveillance ifs publication date. Antepartum fetal surveillance 2014 essay 8496 words. Functional measures of antepartum surveillance supplement structural modalities lai et al.
The goal of antepartum fetal surveillance is to prevent fetal death. Sep 01, 2000 the american college of obstetricians and gynecologists acog has developed guidelines on antepartum fetal surveillance. The ultimate goal of antepartum surveillance program is to improve perinatal outcome and to decrease intrauterine fetal demise besides prevention of maternal morbidity and mortal ity 1, 2. Fetal heart monitoring includes initial and ongoing assessments of the woman and fetus. Further information on the fetal surveillance education program can be found at.
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. Although the bpp is typically used for antepartum fetal assessment, it can also be. Acog guidelines on antepartum fetal surveillance practice. Antenatal testing may include contraction stress tests, nonstress tests, biophysical profiles, and modified biophysical profiles. Two basic approaches are taken to intrapartum fetal surveillancelowtech and hightech approaches. The american college of obstetricians and gynecologists recommends antepartum fetal surveillance with tests such as the bpp for pregnancies at increased risk of antepartum fetal demise.
This chapter discusses the role of antepartum fetal surveillance in the management of diabetic pregnancy. A prospective multiinstitutional study of antepartum fetal heart rate monitoring. 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. The historical challenges in improving neonatal outcomes are discussed. Intrapartum fetal surveillance test bank multiple choice 1. Ctg reporting intrapartum fetal surveillance documentation for continuous monitoring.
This guideline is intended for use by all health professionals who provide antepartum and intrapartum care in canada. Antepartum haemorrhage aph is bleeding from the genital tract after 20 weeks gestation and before labour. A case report leon maria do and faustin daniel md wyckoff heights medical center, usa introduction the zika virus is a flavivirus first identified in monkeys in uganda in 1947 and later found in humans in 1952. Antepartum fetal surveillance medical clinical policy. Medicallyindicated latepreterm and earlyterm deliveries. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Acog fetal heart rate monitoring information minnesota hospital. Balancing cost and benefit in antepartum fetal surveillance. Obstetric ultrasound for the generalist obstetrician. Specific conditions and clinical settings that may be indications for antenatal fetal assessment are discussed separately, but the decision is ultimately based. Electronic fetal monitoring efm is the recommended method of intrapartum fetal surveillance for highrisk pregnancies. Antepartum fetal surveillance acog bulletin 20141 fetus.
Obstetric ultrasound for the generalist obstetrician chapter. Advanced maternal age is defined as age 35 years or above at delivery. Sep 12, 2017 antepartum fetal surveillance aims to decrease perinatal morbidity and mortality. 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. Thus, fetal heart rate fhr monitoring can be used to determine if a fetus is well oxygenated. 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. 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. This guideline is intended for healthcare professionals, particularly those in training, who are working in hse.
Fetal surveillance cannot identify every compromised fetus. Biophysical profile test for antepartum fetal assessment uptodate. The problem of stillbirth in diabetic pregnancy, causes, and timing is. Most retrospective studies of antepartum fetal surveillance in pregnancies that extended beyond the estimated date of delivery initiated testing between 41 weeks and 42 weeks of gestation 43, 44. A complex interplay of antepartum complications, suboptimal uterine perfu sion, placental. Report to be written in the medical record within 1 hour of commencement, then 2 hourly for a normal ctg, more frequently if abnormal. Blood loss is often underestimated, so it is vital to observe for maternal shock and fetal compromise. Antepartum fetal surveillance aims to decrease perinatal morbidity and mortality. Fetal heart monitoring journal of obstetric, gynecologic. 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. Which nursing action indicates the proper evaluation of this situation. 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. Practice bulletin antepartum fetal surveillances 183 recorded with an external fetal monitor. Explain the normal and pathologic mechanisms that influence fetal heart rate fhr.
Prenatal screening and diagnostic testing for fetal chromosomal and genetic conditions cobs59 prenatal screening for fetal genetic or structural conditions cobs 35 prepregnancy and pregnancy vaccinations cobs 44 progesterone support of the luteal phase and early pregnancy cobs 29a progesterone. Intrapartum fetal surveillance ifs refer to online version, destroy printed copies after use page 2 of 29 document title. The most recent outbreak zika infection occurred in 2015 in brazil and. Stillbirth is defined as fetal death at 20 weeks or more.
Antepartum fetal surveillance when should it start. Antepartum fetal surveillance acog bulletin 20141 free download as pdf file. Purpose and scope the purpose of this guideline is to reduce adverse perinatal outcomes related to inappropriate or inadequate intrapartum fetal surveillance. American college of obstetricians and gynecologists acog committee on obstetric practice. Jan 10, 2014 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. 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.
Chapter 17 intrapartum fetal surveillance learning objectives after studying this chapter, you should be able to. This oer repository is a collection of free resources provided by equella. Checklist for antepartum care of pregestational type 1. Advanced maternal age and the risk of antepartum stillbirth diagnosisdefinition. Checklist for antepartum care of pregestational type 1 or. Initial measures to evaluate and treat fetal hypoperfusion include a change in maternal position to left lateral position which increases perfusion to the uterus, maternal supplemental oxygenation, treatment of maternal hypotension, discontinue oxytocin, consider intrauterine resuscitation with tocolytics and intravenous fluids, fetal acidbase. Postterm pregnancy refers to a pregnancy that has reached or extended beyond 42 07 weeks of gestation from the last menstrual period lmp, whereas a lateterm pregnancy is defined as one that has reached between 41 07 weeks and 41 67 weeks of gestation 1. In 2011, the overall incidence of postterm pregnancy in the united states was 5. Overview of antepartum fetal surveillance uptodate. Full text of acog practice bulletins is available to acog members at.
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