Fetal+monitoring

Contra Costa Regional Medical Center Fetal Monitoring Recommendations
**CCRMC Antepartum Testing Phone #925-370-5609** **Updated October 2009** 

These are recommendations and not the absolute rule--a consultant may recommend more or less monitoring in a particular case. Please be careful that your patients are not being scheduled early for testing as the schedules are very full. Sometimes if you order monitoring to begin in two weeks, nurses do not understand that sooner is not indicated so they take the first available appointment even if it is 2 weeks before monitoring is actually needed. NST/optional AFI x 1 || Consider kick count counseling for all patients in 3 rd trimester and especially high risk || Low risk patient || Biweekly NST/Weekly AFI Begin early 41 st week || Usually induce by 42 weeks Induce early 41 st week for certain dates and favorable cervix Delay induction if uncertain dates, VTOL, or unfavorable cervix || Adequate control on diet only || Biweekly NST/Weekly AFI Begin by early 41 st week. May begin 40-41 weeks. || Induce at 41 weeks || (Medication Indicated—on meds or poor control on diet) || Biweekly NST/Weekly AFI Begin 32 weeks. Consider delay to 34-35 weeks if good control on low dose medication. || Deliver by 40 week EGA (after 39 weeks) Consider 38 week sono for EFW if clinically suspected macrosomia. Offer cesarean if EFW>4500 gm. Consult >4200 gm. || (vasculopathy, etc) || May begin as early as 28 weeks. Consult. ||  || (possible IUGR) || Biweekly NST/Weekly AFI Begin at diagnosis or pending formal ultrasound for EFW || Continue monitoring if EFW < 15 th percentile by Hadlock chart. Stop if >15 th percentile Consult for delivery plan EFW < 10 th percentile || or on BP medication || Biweekly NST/Weekly AFI Begin 32 weeks. Consider delay to 36 weeks if mild or good control and normal fetal growth || Deliver by 40 weeks. Consult for earlier delivery if severe. Monitor closely for superimposed preeclampsia and fetal growth || Gestational Hypertension usually deliver by 40 weeks || Begin in the 37 th week || *new recommendation || Begin at diagnosis or pending diagnosis after 32 weeks || Check LFTs and serum bile acids Treat with Actigall 300mg bid-tid Induce at 37 weeks || Begin 2 weeks before prior demise after 28 weeks || Consider induction after 39 weeks || Begin 34-36 weeks for concordant dichorionic twins Begin 32 weeks for monochorionic or discordant || Deliver by 38-39 weeks, or earlier if discordant (>20% difference EFW) Consider umbilical artery dopplers if one or both <10 th percentile Transfer monoamniotic to Perinatology || Begin at 32 weeks or diagnosis || Consider level II ultrasound for anomaly Confirm no GDM || Thrombophilia Renal Disease Hyperthyroidism Lupus Anemia Hb < 8 Active Substance Abuse Elevated AFP on State Screen Two vessel umbilical cord Other significant maternal medical condition || Biweekly NST/weekly AFI Begin at 32 weeks or when identified after 32 weeks || Generally deliver by 40 weeks ||
 * **DIAGNOSIS** || **MONITORING** || **RECOMMENDATIONS** ||
 * **DECREASED FETAL**
 * MOVEMENT** || Immediately at diagnosis
 * **POSTDATES**
 * **GDMA1**
 * **GDMA2**
 * **SEVERE DIABETES**
 * **FETAL SIZE LESS**
 * THAN DATES**
 * **CHRONIC**
 * HYPERTENSION** BP>140/90
 * **GESTATIONAL HYPERTENSION OR MILD PREECLAMPSIA** || After initial evaluation usually done on Perinatal Unit, begin biweekly NST/weekly AFI. || Mild Preeclampsia deliver by 38 weeks
 * **MATERNAL AGE >35** || Biweekly NST/Weekly AFI
 * **CHOLESTASIS OF PREGNANCY** || Biweekly NST/weekly AFI
 * **HISTORY OF PRIOR**
 * FETAL DEMISE** || Biweekly NST/weekly AFI
 * **TWIN GESTATION** || Biweekly NST
 * **POLYHYDRAMNIOS**
 * AFI > 24** || Biweekly NST
 * **OLIGOHYDRAMNIOS** || Consult. Immediate Fetal Monitoring/AFI if over 24 weeks. || Evaluate for SROM; consider anomaly such as absent kidneys if no prior sono with normal AFI. ||
 * **OTHER**