Version May 2024
| Factor | Suggested gestational age to begin antenatal fetal surveillance | Suggested frequency of antenatal fetal surveillance |
| Fetal | ||
| Growth restriction* | ||
| UAD: normal or with elevated impedance to flow in umbilical artery with diastolic flow present; with normal AFI and no other concurrent maternal or fetal conditions | At diagnosis¶ | Once or twice weekly |
| UAD: AEDV or concurrent conditions (oligohydramnios, maternal comorbidity [eg, preeclampsia, chronic hypertension]) | At diagnosis¶ | Twice weeklyΔ or consider inpatient management |
| UAD: REDV | At diagnosis¶ | Inpatient managementΔ |
| Multiple gestation | ||
| Twins, uncomplicated dichorionic | 36 0/7 weeks | Weekly |
| Twins, dichorionic, complicated by maternal or fetal disorders, such as fetal growth restriction | At diagnosis¶ | Individualized |
| Twins, uncomplicated monochorionic-diamniotic | 32 0/7 weeks◊ | Weekly |
| Twins, complicated monochorionic-diamniotic (ie, TTTS) | Individualized | Individualized |
| Twins, monoamniotic | Individualized | Individualized |
| Triplets and higher order multiples | Individualized | Individualized |
| Decreased fetal movement | At diagnosisΔ | Once§ |
| Fetal anomalies and aneuploidy | Individualized | Individualized |
| Maternal | ||
| Hypertension, chronic | ||
| Controlled with medications | 32 0/7 weeks | Weekly |
| Poorly controlled or with associated medical conditions | At diagnosis¶ | Individualized |
| Gestational hypertension/preeclampsia | ||
| Without severe features | At diagnosis¶Δ | Twice weekly |
| With severe features | At diagnosis¶Δ | Daily |
| Diabetes | ||
| Gestational, controlled on medications without other comorbidities | 32 0/7 weeks | Once or twice weekly |
| Gestational, poorly controlled | 32 0/7 weeks | Twice weekly |
| Pregestational | 32 0/7 weeks¥ | Twice weekly |
| Systemic lupus erythematosus | ||
| Uncomplicated | By 32 0/7 weeks | Weekly |
| Complicated‡ | At diagnosis¶ | Individualized |
| Antiphospholipid syndrome | By 32 0/7 weeks† | Twice weekly |
| Sickle cell disease | ||
| Uncomplicated | 32 0/7 weeks | Once or twice weekly |
| Complicated** | At diagnosis¶ | Individualized |
| Hemoglobinopathies other than Hb SS disease | Individualized | Individualized |
| Renal disease (Cr greater than 1.4 mg/dL) | 32 0/7 weeks | Once or twice weekly |
| Thyroid disorders, poorly controlled | Individualized | Individualized |
| In vitro fertilization | 36 0/7 weeks | Weekly |
| Substance use | ||
| Alcohol, 5 or more drinks per week | 36 0/7 weeks | Weekly |
| Polysubstance use | Individualize | Individualized |
| Prepregnancy BMI | ||
| Prepregnancy BMI 35.0 to 39.9 kg/m2 | 37 0/7 weeks | Weekly |
| Prepregnancy BMI 40 kg/m2 or above | 34 0/7 weeks | Weekly |
| Maternal age older than 35 years | Individualized¶¶ | Individualized |
| Obstetric | ||
| Previous stillbirth | ||
| At or after 32 0/7 weeks | 32 0/7 weeksΔΔ | Once or twice weekly |
| Before 32 0/7 weeks of gestation | Individualized | Individualized |
| History of other adverse pregnancy outcomes in immediately preceding pregnancy | ||
| Previous fetal growth restriction requiring preterm delivery | 32 0/7 weeks | Weekly |
| Previous preeclampsia requiring preterm delivery | 32 0/7 weeks | Weekly |
| Cholestasis | At diagnosis¶ | Once or twice weekly |
| Late term | 41 0/7 weeks | Once or twice weekly |
| Abnormal serum markers◊◊ | ||
| PAPP-A less than or equal to the fifth percentile (0.4 MoM) | 36 0/7 weeks | Weekly |
| Second-trimester Inhibin A equal to or greater than 2.0 MoM | 36 0/7 weeks | Weekly |
| Placental | ||
| Chronic placental abruption§§ | At diagnosis¶ | Once or twice weekly |
| Vasa previa | Individualized | Individualized |
| Velamentous cord insertion | 36 0/7 weeks | Weekly |
| Single umbilical artery | 36 0/7 weeks | Weekly |
| Isolated oligohydramnios (single deepest vertical pocket less than 2 cm) | At diagnosis¶Δ | Once or twice weekly |
| Polyhydramnios, moderate to severe (deepest vertical pocket equal to or greater than 12 cm or AFI equal to or greater than 30 cm) | 32 0/7 to 34 0/7 weeks¥¥ | Once or twice weekly |
AEDV: absent end-diastolic velocity; AFI: amniotic fluid index; BMI: body mass index; Cr; creatinine; MoM: multiples of the median; PAPP-A: pregnancy-associated plasma protein A; REDV: reversed end-diastolic flow; TTTS: twin to twin transfusion syndrome; UAD: umbilical artery Doppler.
* Estimated fetal weight or abdominal circumference less than the 10th percentile.
¶ Or at a gestational age when delivery would be considered because of abnormal test results.
Δ If not delivered.
◊ In addition to routine surveillance for twin–twin transfusion syndrome and other monochorionic twin complications.
§ Repeat if decreased fetal movement recurs.
¥ Or earlier for poor glycemic control or end organ damage.
‡ Such as active lupus nephritis, recent lupus flare, antiphospholipid antibodies with prior fetal loss, anti-RO/SSA or anti-La/SSB antibodies, or thrombosis.
† Individualize, take into consideration obstetric history, number of positive antibodies, and current pregnancy complications.
** Such as maternal hypertension, vaso-occlusive crisis, placental insufficiency, fetal growth restriction.
¶¶ Based on cumulative risk when present with other factors.
ΔΔ Or starting 1 to 2 weeks before the gestational age of the previous stillbirth.
◊◊ If serum screening for aneuploidy is performed, the results may be considered in determining whether antenatal fetal surveillance should be performed.
§§ In individuals who are candidates for outpatient management.
¥¥ Or at diagnosis if diagnosed after 32 0/7 to 34 0/7 weeks.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
