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Antepartum Management
and Fetal Surveillance
Chapter 4
Jordana I. Reina-Fernandez, MD and
Andrew J. Walter, MD❍ What is the utility of antepartum fetal surveillance?
To assess the risk of fetal death in pregnancies complicated with preexisting maternal conditions as well as those
in which complications have developed. These tests do not predict stillbirths related to acute changes in
maternal-fetal status; for example, placental abruption or cord accident.
❍ What are the techniques used in antepartum fetal surveillance?
- Fetal movement assessment.
- Nonstress test (NST).
- Contraction stress test (CST).
- Biophysical profile (BPP).
- Modified BPP.
- Umbilical artery Doppler velocimetry.
❍ At what gestational age, can antepartum testing be initiated?
Initiating testing at 32 to 34 weeks is appropriate for most pregnancies at increased risk of stillbirth. In those
pregnancies with multiple or worrisome conditions, testing may be initiated as early as 26 to 28 weeks.
❍ What are the indications of antepartum fetal monitoring?
Maternal conditions:
- Chronic hypertension.
- Pregestational diabetes mellitus.
- Cyanotic heart disease.
- Chronic renal disease (ie, Lupus).
- Antiphospholipid syndrome.
- Hyperthyroidism.
- Hemoglobinopathies: Hemoglobin SS (sickle cell disease), Hemoglobin SC Disease.