Consideration has been given to all methods of fetal surveillance currently available in canada. Intrapartum fetal surveillance ifs refer to online version, destroy printed copies after use page 2 of 29 document title. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Antepartum fetal surveillance aims to decrease perinatal morbidity and mortality. Two basic approaches are taken to intrapartum fetal surveillancelowtech and hightech approaches. Acog fetal heart rate monitoring information minnesota hospital. Identify the purposes of fetal surveillance before birth. A prospective multiinstitutional study of antepartum fetal heart rate monitoring. Checklist for antepartum care of pregestational type 1. Jan 10, 2014 antepartum fetal surveillance jason zachariah 1 slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. This guideline is intended for healthcare professionals, particularly those in training, who are working in hse. 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. Accurate determination of gestational age is essential to accurate diagnosis and appropriate management of lateterm and postterm pregnancies. Electronic fetal monitoring efm is the recommended method of intrapartum fetal surveillance for highrisk pregnancies.
Fetal surveillance cannot identify every compromised fetus. Antepartum fetal surveillance acog bulletin 20141 free download as pdf file. Intrapartum fetal surveillance ifs publication date. This guideline is intended for use by all health professionals who provide antepartum and intrapartum care in canada. Intrapartum fetal surveillance test bank multiple choice 1. Full text of acog practice bulletins is available to acog members at. Sep 12, 2017 antepartum fetal surveillance aims to decrease perinatal morbidity and mortality. 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. Purpose and scope the purpose of this guideline is to reduce adverse perinatal outcomes related to inappropriate or inadequate intrapartum fetal surveillance. 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. It was used among 45% of laboring women in 1980, 62% in 1988, 74% in 1992, and 85% in 2002 1.
Fetal surveillance an overview sciencedirect topics. Antepartum fetal surveillance 2014 essay 8496 words. Ctg reporting intrapartum fetal surveillance documentation for continuous monitoring. This chapter discusses the role of antepartum fetal surveillance in the management of diabetic pregnancy. Further information on the fetal surveillance education program can be found at. 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. Feb 01, 2015 balancing cost and benefit in antepartum fetal surveillance balancing cost and benefit in antepartum fetal surveillance brown, haywood l. Antepartum haemorrhage aph is bleeding from the genital tract after 20 weeks gestation and before labour. The problem of stillbirth in diabetic pregnancy, causes, and timing is. The goal of antepartum fetal surveillance is to prevent fetal death. Report to be written in the medical record within 1 hour of commencement, then 2 hourly for a normal ctg, more frequently if abnormal. Jul 12, 2015 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 realtime ultrasonography and umbilical artery doppler velocimetry to evaluate fetal wellbeing.
Sep 01, 2000 the american college of obstetricians and gynecologists acog has developed guidelines on antepartum fetal surveillance. Balancing cost and benefit in antepartum fetal surveillance balancing cost and benefit in antepartum fetal surveillance brown, haywood l. Aph occurs in 25 per cent of pregnancies and half are of unknown cause. Fetal heart monitoring journal of obstetric, gynecologic. 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. Blood loss is often underestimated, so it is vital to observe for maternal shock and fetal compromise. 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.
Overview of antepartum fetal surveillance uptodate. This oer repository is a collection of free resources provided by equella. Antepartum fetal testing is indicated in pregnancies in which the risk of antepartum fetal demise is increased. Advanced maternal age and the risk of antepartum stillbirth diagnosisdefinition. Antepartum fetal surveillance jason zachariah 1 slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. 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. Acog guidelines on antepartum fetal surveillance practice. Antepartum fetal surveillance when should it start. Antepartum fetal surveillance and induction of labor have been.
The cardiotocogram ctg trace forms a central piece of documentary evidence in medicolegal cases related to intrapartum hypoxia and birth asphyxia. In 2011, the overall incidence of postterm pregnancy in the united states was 5. Thus, fetal heart rate fhr monitoring can be used to determine if a fetus is well oxygenated. Antenatal fetal surveillance in pregnancies complicated by diabetes should include evaluation of. Antepartum fetal surveillance medical clinical policy. Practice bulletin antepartum fetal surveillances 183 recorded with an external fetal monitor. 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. 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. Explain the normal and pathologic mechanisms that influence fetal heart rate fhr. 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 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. 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.
The main techniques for fetal assessment are the nonstress test, biophysical profile, modified biophysical profile. Specific conditions and clinical settings that may be indications for antenatal fetal assessment are discussed separately, but the decision is ultimately based. 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. Obstetric ultrasound for the generalist obstetrician. See overview of antepartum fetal surveillance and nonstress test and contraction stress test. Contraction stress test versus nonstress test for primary surveillance. Fetal heart monitoring includes initial and ongoing assessments of the woman and fetus. Advanced maternal age is defined as age 35 years or above at delivery. Which nursing action indicates the proper evaluation of this situation.
Obstetric ultrasound for the generalist obstetrician chapter. Scribd is the worlds largest social reading and publishing site. The most recent outbreak zika infection occurred in 2015 in brazil and. American college of obstetricians and gynecologists acog committee on obstetric practice. Acog practice bulletin, antepartum fetal surveillance. 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. If you continue browsing the site, you agree to the use of cookies on this website.
Checklist for antepartum care of pregestational type 1 or. Biophysical profile test for antepartum fetal assessment uptodate. 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. Stillbirth is defined as fetal death at 20 weeks or more. The historical challenges in improving neonatal outcomes are discussed. 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. 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. Although the bpp is typically used for antepartum fetal assessment, it can also be. Functional measures of antepartum surveillance supplement structural modalities lai et al. A complex interplay of antepartum complications, suboptimal uterine perfu sion, placental. 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. Antepartum fetal surveillance acog bulletin 20141 fetus.