Antepartum Evaluation of the Fetus and Fetal Well Being

OʼNeill, Erica; Thorp, John M.

doi:10.1097/grf.0b013e318253b318

Cited by 34 publications

(27 citation statements)

References 19 publications

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“…Normal fetal heart rate tracings have a high predictive value for fetal wellness, with a false-negative rate of <1% 402 ; however, the positive predictive value for an abnormal test is fairly low. 401,402 Cardiotocography and nonstress testing are unlikely to be useful in fetuses with arrhythmias, particularly bradycardia and CHB, but may be considered as an adjunct to other monitoring in high-risk pregnancies with at-risk structural, functional, or rhythm-related fetal heart disease beginning in the third trimester and continuing periodically until delivery, although their usefulness has not been established.…”

Section: Cardiotocography and Nonstress Testingmentioning

confidence: 99%

“…This study showed no benefit, with an antepartum fetal death rate of 2.9 in 1000 in the intervention group versus 2.7 in 1000 in the control group. 400,401 Unfortunately, there are no such trials in high-risk pregnancies with fetal anomalies such as CHD or cardiac conditions that might put the fetus at risk as a result of hemodynamically unfavorable circumstances such as severe AV or semilunar valve regurgitation or arrhythmias. In populations with structural, functional, or rhythm-related CHD that put the fetus at risk for developing acidosis, it may be reasonable to encourage daily maternal movement assessments beginning at 26 to 28 weeks of gestation when movement can be reliably felt; however, the usefulness is not well established.…”

Section: Fetal Movement Assessment By Mother ("Kick Counts")mentioning

confidence: 99%

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Diagnosis and Treatment of Fetal Cardiac Disease

Donofrio¹,

Moon-Grady²,

Hornberger³

et al. 2014

Circulation

976

543

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Background— The goal of this statement is to review available literature and to put forth a scientific statement on the current practice of fetal cardiac medicine, including the diagnosis and management of fetal cardiovascular disease. Methods and Results— A writing group appointed by the American Heart Association reviewed the available literature pertaining to topics relevant to fetal cardiac medicine, including the diagnosis of congenital heart disease and arrhythmias, assessment of cardiac function and the cardiovascular system, and available treatment options. The American College of Cardiology/American Heart Association classification of recommendations and level of evidence for practice guidelines were applied to the current practice of fetal cardiac medicine. Recommendations relating to the specifics of fetal diagnosis, including the timing of referral for study, indications for referral, and experience suggested for performance and interpretation of studies, are presented. The components of a fetal echocardiogram are described in detail, including descriptions of the assessment of cardiac anatomy, cardiac function, and rhythm. Complementary modalities for fetal cardiac assessment are reviewed, including the use of advanced ultrasound techniques, fetal magnetic resonance imaging, and fetal magnetocardiography and electrocardiography for rhythm assessment. Models for parental counseling and a discussion of parental stress and depression assessments are reviewed. Available fetal therapies, including medical management for arrhythmias or heart failure and closed or open intervention for diseases affecting the cardiovascular system such as twin–twin transfusion syndrome, lung masses, and vascular tumors, are highlighted. Catheter-based intervention strategies to prevent the progression of disease in utero are also discussed. Recommendations for delivery planning strategies for fetuses with congenital heart disease including models based on classification of disease severity and delivery room treatment will be highlighted. Outcome assessment is reviewed to show the benefit of prenatal diagnosis and management as they affect outcome for babies with congenital heart disease. Conclusions— Fetal cardiac medicine has evolved considerably over the past 2 decades, predominantly in response to advances in imaging technology and innovations in therapies. The diagnosis of cardiac disease in the fetus is mostly made with ultrasound; however, new technologies, including 3- and 4-dimensional echocardiography, magnetic resonance imaging, and fetal electrocardiography and magnetocardiography, are available. Medical and interventional treatments for select diseases and strategies for delivery room care enable stabilization of high-risk fetuses and contribute to improved outcomes. This statement highlights what is currently known and recommended on the basis of evidence and experience in the rapidly advancing and highly specialized field of fetal cardiac care.

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Section: Cardiotocography and Nonstress Testingmentioning

confidence: 99%

Section: Fetal Movement Assessment By Mother ("Kick Counts")mentioning

confidence: 99%

Diagnosis and Treatment of Fetal Cardiac Disease

Donofrio¹,

Moon-Grady²,

Hornberger³

et al. 2014

Circulation

976

543

View full text Add to dashboard Cite

show abstract

“…However, in over 500 United States Maternal‐Fetal Medicine members surveyed, 92% would recommend induction without documented lung maturity before 39 weeks, and 35% before 37 weeks, even though only one‐third of respondents felt induction would decrease adverse outcomes 75 , 76 . If expectant management is chosen, there is no consensus on what fetal monitoring is best, or even if fetal monitoring is necessary; however, the use of Doppler monitoring in pregnancies thought to be at risk of placental insufficiency has shown benefit 77 . Consistent maternal oral hydration can be encouraged.…”

Section: Dynamicsmentioning

confidence: 99%

“…If polyhydramnios is a late presentation, all the above should be considered, excluding an anatomical evaluation as this should have already been completed. Antenatal testing should be initiated at 24 weeks gestation, although there is no consensus on what type of testing should be begun, or at what interval 77 . This can be left to the discretion of the physician.…”

Section: Dynamicsmentioning

confidence: 99%

Amniotic fluid as a vital sign for fetal wellbeing

Dubil

Magann

2013

Australas J Ultrason Med

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Introduction: Amniotic fluid, once thought to merely provide protection and room for necessary movement and growth for the fetus, is now understood to be a highly complex and dynamic system that is studied as a data point to interpret fetal wellbeing. Methods: Assessment of amniotic fluid volume is now routine when performing a sonographic evaluation of fetal status and is an important consideration in the assessment and management of perinatal morbidity and mortality. 1 , 2 In this review, we will cover the dynamics that affect amniotic fluid volume, review methods for measurement and quantification of volume, review definitions for normative data as related to neonatal outcomes, and provide evidence based guidance on the workup and management options for oligoydramnios and polyhydramnios in singleton and twin pregnancies. Conclusions: When abnormalities of fluid exist, appropriate workup to uncover the underlying etiology should be initiated as adverse fetal outcomes are sometimes associated with these variations from normalcy.

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“…The American Congress of Obstetricians and Gynecologists states that the evaluation of fetal well-being may be appropriate for pregnancies with an increased risk of fetal involvement; however, there are no comprehensive trials demonstrating the benefit of all tests and their potential indications. On the other hand, experts recommend carrying out tests of fetal wellbeing in cases of diabetes, uterine growth restriction, and hypertension [7].…”

mentioning

confidence: 99%

Clinical Trials in Pregnant Women with Preeclampsia

García-Benavides¹,

Molina²,

Vega³

et al. 2018

Clinical Trials in Vulnerable Populations

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Preeclampsia (PE) is the leading cause of preterm birth by medical indication when associated with premature detachment of placenta normoinserta, and Intrauterine growth restriction (IUGR) is associated with high perinatal morbidity and mortality and longterm sequelae. The main problem of PE is threefold: the diagnostic difficulty, the complicated interrelationship of the pathophysiological processes, and the vulnerability of the maternal-fetal binomial to the therapeutic interventions. The approach for management with PE is preventing its late occurrence in pregnancy. The key to preventing PE is knowledge of the factors that trigger the pathophysiological processes that culminate in the presentation of PE. Understanding the developmental characteristics of the placenta in pregnancy at high risk for PE is essential for understanding the pathophysiology and developing strategies for prevention. When deciding that the population of study is a group of pregnant women, the first ethical criteria that need to be reviewed are those aimed at the protection of the fetus. There are no specific guidelines on how to assess fetal well-being during pregnancy routinely in the clinic, and this deficiency is shifted to clinical research with pregnant women.

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Antepartum Evaluation of the Fetus and Fetal Well Being

Cited by 34 publications

References 19 publications

Diagnosis and Treatment of Fetal Cardiac Disease

Diagnosis and Treatment of Fetal Cardiac Disease

Amniotic fluid as a vital sign for fetal wellbeing

Clinical Trials in Pregnant Women with Preeclampsia

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