Fetal Monitoring

Aka: Fetal Monitoring, Fetal Assessment, Prenatal Testing

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II. Efficacy: Accuracy of Testing

  1. Tests with high sensitivity and Specificity
    1. Biophysical Profile (BPP)
  2. Tests with high sensitivity (but high False Positives)
    1. Nonstress Test (NST)
    2. Contraction Stress Test (CST or OCT)

III. Types: Birth Defect Screening

  1. See Antenatal Screening

IV. Types: Antepartum Fetal Assessment

  1. Fetal Movement Counts (Fetal Kick Counts)
  2. Non-Stress Test
  3. Contraction Stress Test
  4. Biophysical Profile

V. Types: Intrapartum Fetal Assessment

  1. Fetal Heart Tracing
    1. Continuous Electronic Fetal Monitoring (CEFM)
    2. Structured Intermittent Auscultation (SIA)
  2. Manual Fetal Scalp Stimulation
  3. Fetal Acoustic Stimulation
  4. Other measures that are not often performed
    1. Fetal Scalp pH Sampling
      1. Prolonged sample to result time (approaches 18 minutes)
      2. Inadequate sample rate as high as 10%
    2. Fetal lactate scalp sampling
      1. Rapid turn around (2 minutes), but does not alter newborn outcomes
      2. East (2015) Cochrane Database Syst Rev (5):CD006174 [PubMed]
    3. Fetal Pulse Oximetry
      1. Decreases second stage operative Vaginal Delivery rates
      2. Does not alter newborn outcomes
      3. East (2006) Am J Obstet Gynecol 194(3): 606.e1-606.e16 [PubMed]
    4. Fetal Electrocardiograms
      1. Does not alter newborn outcomes
      2. No change in Cesarean Section or operative Vaginal Delivery rates
      3. Belfort (2015) N Engl J Med 373(7): 632-41 [PubMed]
      4. Neilson (2015) Cochrane Database Syst Rev (12): CD000116 [PubMed]
  5. References
    1. Visser (2015) Int J Gynecol Obstet 131(1): 25-9 [PubMed]

VI. References

  1. Arnold (2020) Am Fam Physician 102(3): 158-67 [PubMed]
  2. Smith-Levitin (1997) Am Fam Physician 56(8):1981-8 [PubMed]

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