Antenatal fetal surveillance (AFS) aims at reducing intrauterine fetal demise however not all antenatal fetal surveillance has shown to improve perinatal outcomes. ACOG’s Committee Opinion addresses indications for AFS and aims to suggest surveillance specifically for conditions where stillbirth occurs more frequently than the false-negative rate of BPP (0.8 per 1,000) and conditions where stillbirth is >2 times more likely than pregnancies without the condition. Individualization, patient-centered discussion, and shared decision making should be utilized. In addition, ACOG has also released an update on different AFS modalities.
Note: Negative predictive value (based on incidence of stillbirth occurring within 1 week of a normal test) is high for NST (99.8%) and >99.9% for CST, BPP and modified BPP
Fetal Growth Restriction (FGR)
Complicated Twin Pregnancies (including Monoamniotic) or Higher Order Multiples
Decreased Fetal Movements
Hypertension and Diabetes
Systemic Lupus Erythematous, Antiphospholipid Syndrome, Sickle Cell Disease, Renal Disease or Thyroid Disorders
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
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