Antenatal assessment for the detection of fetal asphyxia. An evidence-based approach using indication-specific testing.
One of the most important advances in perinatal health care is the use of antepartum fetal testing. Antepartum fetal testing methods may include inexpensive tests such as fetal kick counts or tests that can be quite expensive such as non-stress tests, fetal biophysical profiles, and Doppler assessments as well as invasive tests such as amniocentesis or cordocentesis. Clinical experience, combined with recent literature, suggest that there is no ideal test for all high-risk fetuses and that some antepartum fetal tests may be more appropriate than others, depending on the underlying pathophysiology or the indication for testing. Because many different pathophysiological processes lead to fetal acidemia and in-utero death, indication-specific testing may be not only logical, but also cost-effective. In this article, specific guidelines of antepartum fetal testing are presented. These indication-specific guidelines are based on the underlying pathophysiological processes that place the fetus at risk and also on the need to use the fewest number of tests without compromising safety.
Vintzileos
A M
AM
Department of Obstetrics, Gynecology and Reproductive Sciences, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School/St. Peter's University Hospital, New Brunswick 08903, USA. vintziam@umdnj.edu
D002985:Clinical Protocols; D019317:Evidence-Based Medicine; D005260:Female; D005311:Fetal Hypoxia / Q000175:diagnosis*; D005323:Fetal Monitoring; D005865:Gestational Age; D006801:Humans; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis; D011296:Prenatal Diagnosis; D012307:Risk Factors