Intrapartum Fetal Heart Rate Monitoring: Nomenclature, Interpretation, and General Management Principles This Practice Bulletin was developed by the ACOG. Obstet Gynecol. Jul;(1) doi: /AOG.0beaef . ACOG Practice Bulletin No. Intrapartum fetal heart rate monitoring. This Practice Bulletin was devel- oped by the ACOG Committee on. Practice Bulletins—Obstetrics with the assistance of George A. Macones,. MD.
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Fetal Heart Rate Monitoring
In this setting, the decision to deliver should be made with consideration of whether the benefits outweigh the potential risks of expectant management. In the absence of obstetric contraindications, deliv- ery of the fetus with an abnormal test result often may be attempted by induction of labor, with con- tinuous intrapartum monitoring of the FHR and uterine contractions.
Determining when to intervene for oligohydram- nios depends on several factors, including gestational age, maternal condition, and fetal clinical condition as determined by other indices of fetal well-being. Dan Med Bull ; Choosing the appropriate point in gestation to begin antepartum fetal testing depends on several consider- ations, including the prognosis for neonatal survival, the risk of fetal death, the severity of maternal disease, and the potential for iatrogenic prematurity complications resulting from false-positive test results.
What is the recommended management of an abnormal antepartum fetal test result? Fetal monitoring may be done at set times throughout your labor and delivery or throughout active labor. Fetal health surveil- lance: Should all women perform daily fetal move- ment assessment? Uterine stimulation is not necessary if the patient is having spontaneous uterine contractions of adequate frequency. 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.
Fetal biophysical profile scoring: Association of spontaneous fetal heart rate decelerations vetal antepartum nonstress testing and intrauterine growth retardation. Certain acute maternal conditions eg, diabetic ketoacidosis or pneumonia with hypoxemia can result in abnormal test results, which generally will normalize as monittoria maternal condition improves. If vibroacoustic stimulation fails to elicit a response, it may be repeated up to three times for progressively longer durations of up to 3 seconds.
Duplex Doppler ultrasonographic evaluation of the fetal renal artery in normal and abnormal fetuses.
Fetal Heart Rate Monitoring | Memorial Bariatrics
Average ER Wait Time. Acute effects of maternal cigarette smoking on fetal heart rate and fetal body movements felt by the mother. Relative contraindications to the CST generally include conditions that also are contraindications to labor or vaginal delivery This gives your doctor information about how well your baby is handling the stress of labor.
Internal monitoring may increase the risk of infection. Correlation with antepartum umbilical venous fetal pH.
The risks confronting twins: An added risk factor. There are no lasting effects that your doctor will need to monitor. Identification of suspected fetal compromise provides the opportunity to intervene before progressive metabolic acidosis results in fetal death.
In growth-restricted fetuses, umbilical artery Doppler velocimetry used in conjunction with standard fetal surveillance, such as NSTs, or BPPs, or both, is associated with improved outcomes. However, in pregnancies with multiple or particularly worrisome high-risk conditions eg, chronic hypertension with suspected fetal growth restrictiontesting might begin at a gestational age when delivery would be considered for perinatal benefit 64 — When during gestation should antepartum fetal surveillance be initiated?
Call Memorial Bariatric Surgery Center at In one small randomized study, it took less time to obtain a reactive Mpnitoria when patients were placed in the semi-Fowler ,onitoria tion The effect of fetal age upon normal fetal laboratory values and venous pressure. The average fetal heart rate is beats per minute.
Omnitoria use of the oxytocin challenge test for antepartum clinical evaluation of uteroplacental respira- tory function. The goal of antepartum fetal surveillance is to prevent fetal death.
In pregnancies complicated by fetal growth restric- tion, the optimal interval for fetal growth assessment and the optimal surveillance regimen have not been estab. In most circumstances, a BPP score of less than 4 should result in delivery. This content is reviewed regularly and is updated when new and relevant evidence is made available.
If the maternal medical condition is stable and test results are reassuring, tests of fetal well-being NST, BPP, modified BPP, or CST are typically repeated at weekly moniyoria however, in the presence of cer- tain high-risk conditions, some investigators have performed more frequent testing, although the opti- mal regimen has not been established.
Routine formal fetal movement counting and risk of antepartum late death in normally formed singletons. Based on these data, feta, negative predictive value is In some cases of severe fetal growth restric- tion, diastolic flow is absent or even reversed.
Women’s Health Care Physicians
There are no large clinical trials to guide scog frequency of testing, and thus, the optimal frequency remains unknown; it depends on several factors and should be fetwl and based on clinical judgment.
Reference ranges for serial measurements of umbilical artery Doppler indices in the second half of pregnancy. The procedure is completed with labor. Level A—Recommendations are based on good and con- sistent scientific evidence. Biophysical profile with amniotic fluid volume assessments. Fetal movements as an indicator of fetal well- being. In cases in which an abnormal test result is not associated with any clinical evidence of acute and potentially reversible worsening in the maternal status, a stepwise approach to the investigation of the fetal con- dition should be undertaken.
American College of Obstetricians and Gynecologists. Although the degree of hypoxemia and acidemia at which various indices of fetal well-being become abnor- mal is not known with precision, it can be estimated based on data from published studies. Measurement of fetal forelimb movements in the lamb in utero.