Antenatal Fetal Surveillance: Indications and Timing
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.
Initiate once or twice weekly testing at time of diagnosis
Polyhydramnios (DVP ≥12cm or AFI ≥30cm)
32w0d to 34w0d: Initiate once or twice weekly testing
Other Potential Indications
Genetic: Fetal anomalies and aneuploidy
Associated increased risk for stillbirth
Requires individualized care and consultation with specialists
Evidence does not support routine AFS for other congenital infections
Parvovirus infection is an exception based on evidence that there is a role for serial ultrasonography and middle cerebral artery Doppler assessment
Studies show increased risk for stillbirth with advancing age
In isolation, age remains a poor predictor for stillbirth
Without other risk factors “there is insufficient evidence to recommend routine antenatal fetal surveillance” for pregnant women ≥35 years
Individualize initiation and surveillance if there is cumulative risk based on other factors
Evidence That AFS Improves Perinatal Outcomes
High-quality evidence remains limited
The ACOG Practice Bulletin states
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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