title: ACR Appropriateness Criteria Assessment of Fetal Well-Being.
abstract: Although there is limited evidence that antepartum testing decreases the risk for fetal death in low-risk pregnancies, women with high-risk factors for stillbirth should undergo antenatal fetal surveillance. The strongest evidence supporting antepartum testing pertains to pregnancies complicated by intrauterine fetal growth restriction secondary to uteroplacental insufficiency. The main ultrasound-based modalities to determine fetal health are the biophysical profile, modified biophysical profile, and duplex Doppler velocimetry. In patients at risk for cardiovascular compromise, fetal echocardiography may also be indicated to ensure fetal well-being. Although no single antenatal test has been shown to be superior, all have high negative predictive values. Weekly or twice-weekly fetal testing has become the standard practice in high-risk pregnancies. The timing for the initiation of assessments of fetal well-being should be tailored on the basis of the risk for stillbirth and the likelihood of survival with intervention. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (the RAND/UCLA Appropriateness Method and the Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
authors.affiliation: Columbia University Medical Center, New York, New York, American Congress of Obstetricians and Gynecologists. Electronic address: ls731@mail.cumc.columbia.edu.
authors.forename: Lynn
authors.initials: L
authors.lastname: Simpson
authors.affiliation: George Washington University Hospital, Washington, District of Columbia.
authors.forename: Nadia J
authors.initials: NJ
authors.lastname: Khati
authors.affiliation: Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: Sandeep P
authors.initials: SP
authors.lastname: Deshmukh
authors.affiliation: Mayo Clinic, Rochester, Minnesota.
authors.forename: Kika M
authors.initials: KM
authors.lastname: Dudiak
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Mukesh G
authors.initials: MG
authors.lastname: Harisinghani
authors.affiliation: Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: Tara L
authors.initials: TL
authors.lastname: Henrichsen
authors.affiliation: Northwestern University Prentice Hospital, Chicago, Illinois.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Meyer
authors.affiliation: The Old Vicarage, Worcester Park, United Kingdom.
authors.forename: David A
authors.initials: DA
authors.lastname: Nyberg
authors.affiliation: University of California San Francisco, San Francisco, California.
authors.forename: Liina
authors.initials: L
authors.lastname: Poder
authors.affiliation: Brigham & Women's Hospital, Boston, Massachusetts, American Congress of Obstetricians and Gynecologists.
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Shipp
authors.affiliation: Valley Hospital, Ridgewood, New Jersey, and NYU School of Medicine, New York, American Congress of Obstetricians and Gynecologists.
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Zelop
authors.affiliation: Sunnybrook Health Sciences Centre, Bayview Campus, Toronto, Ontario, Canada.
authors.forename: Phyllis
authors.initials: P
authors.lastname: Glanc
mesh_terms: D004452:Echocardiography; D005260:Female; D005313:Fetal Death / Q000517:prevention & control*; D006801:Humans; D011247:Pregnancy; D018566:Pregnancy, High-Risk; D012307:Risk Factors; D016216:Ultrasonography, Prenatal / Q000592:standards*
keywords: Appropriateness Criteria; Fetal well-being; antenatal testing