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Indications for Outpatient Antenatal Fetal Surveillance

ACOG Committee Opinion Summary, Number 828

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doi: 10.1097/AOG.0000000000004408
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Abstract

Recommendations and Conclusions

The American College of Obstetricians and Gynecologists makes the following recommendations and conclusions regarding indications for antenatal fetal surveillance:

  • This Committee Opinion provides guidance on and suggests surveillance for conditions for which stillbirth is reported to occur more frequently than 0.8 per 1,000 (the false-negative rate of a biophysical profile or modified biophysical profile) and which are associated with a relative risk (RR) or odds ratio for stillbirth of more than 2.0 compared with pregnancies without the condition.
  • When data on gestational age-adjusted risk of occurrence of stillbirth were not available, the Committee’s suggestions regarding when to begin antenatal fetal surveillance are based on the reported risk of stillbirth, generally falling into three major categories of when to begin: (1) at or by 32 0/7 weeks, (2) at or by 36 0/7 weeks, or (3) at or beyond 39 0/7 weeks of gestation (if undelivered). However, individualization about if and when to begin antenatal fetal surveillance is advised.
  • Initiating antenatal fetal surveillance at 32 0/7 weeks of gestation or later is appropriate for most at-risk patients. However, for pregnant individuals with multiple or particularly worrisome high-risk conditions (eg, chronic hypertension with suspected fetal growth restriction), antenatal fetal surveillance might begin at a gestational age when delivery would be considered for perinatal benefit.
  • As with all testing and interventions, shared decision making between the pregnant individual and the clinician is critically important when considering or offering antenatal fetal surveillance for individuals with pregnancies at high risk for stillbirth or with multiple comorbidities that increase the risk of stillbirth. This can be particularly important in situations that involve fetal structural or genetic anomalies or when initiating antenatal fetal surveillance around the threshold of viability, where the pregnant individual’s goals for pregnancy care are critical in decision making.
  • Table 1 presents suggestions for the timing and frequency of antenatal fetal surveillance for specific conditions.
  • It is important to emphasize that the guidance offered in this Committee Opinion should be construed only as suggestions; this guidance should not be construed as mandates or as all encompassing. There is a paucity of evidence for the efficacy of antenatal fetal surveillance and for evidence-based recommendations on the timing and frequency of antenatal fetal surveillance; consequently, for most conditions, recommendations for antenatal fetal surveillance are largely based on expert consensus and relevant observational studies.

[Table 1]
[Table 1]:
Factors Associated With an Increased Risk of Stillbirth and Suggested Strategies for Antenatal Fetal Surveillance After ViabilityThe guidance offered in this table should be construed only as suggestions, not mandates. Ultimately, individualization about if and when to offer antenatal fetal surveillance is advised.
[Table 1]-A
[Table 1]-A:
Factors Associated With an Increased Risk of Stillbirth and Suggested Strategies for Antenatal Fetal Surveillance After ViabilityThe guidance offered in this table should be construed only as suggestions, not mandates. Ultimately, individualization about if and when to offer antenatal fetal surveillance is advised.

Number 828

For a comprehensive overview of these recommendations, the full-text version of this Committee Opinion is available athttp://dx.doi.org/10.1097/AOG.0000000000004407.

Scan this QR code with your smartphone to view the full-text version of this Committee Opinion.

Committee on Obstetric Practice Society for Maternal-Fetal Medicine

Society for Maternal–Fetal Medicine,

This Committee Opinion was developed by the Committee on Obstetric Practice in collaboration with committee members Rita Wesley Driggers, MD and Allison S. Bryant, MD, MPH and the Society for Maternal–Fetal Medicine in collaboration with Alessandro Ghidini, MD.

Full-text document published online on May 20, 2021.

Copyright 2021 by the American College of Obstetricians and Gynecologists. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, posted on the internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.

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Official Citation

Indications for outpatient antenatal fetal surveillance. ACOG Committee Opinion No. 828. American College of Obstetricians and Gynecologists. Obstet Gynecol 2021;137:e177–97.

© 2021 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.