Indications for Outpatient Antenatal Fetal Surveillance ACOG Committee Opinion, Number 828
Indications for Outpatient Antenatal Fetal Surveillance ACOG Committee Opinion, Number 828
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DOI：
10.1097/aog.0000000000004407
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发表时间：
2021-06-01
影响因子：
7.2
通讯作者：
Ghidini, Alessandro
中科院分区：
文献类型：
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作者：
Driggers, Rita Wesley;Bryant, Allison S.;Ghidini, Alessandro
本委员会意见的目的是就门诊环境下产前胎儿监护的适应症、时间和频率提供指导。进行产前胎儿监测，以降低死产风险。然而，由于在特定情况下导致死产风险增加的途径可能未知，而且产前胎儿监测并未显示出在所有与死产相关的情况下改善围产期结局，因此创建一份应考虑产前胎儿监测的所有适应症的处方清单是具有挑战性的。委员会的这一意见提供了指导，并建议对据报告死产发生率高于每1,000人0.8人(生物物理资料的假阴性率)的情况进行监测，这些情况与死产的相对风险或优势比大于2.0与没有这种情况的妊娠有关。表1对特定条件下的测试时间和频率提出了建议。与所有检测和干预一样，在考虑或提供产前胎儿监测时，孕妇和临床医生之间的共同决策至关重要，因为这些人怀孕时死产风险很高，或者合并多种疾病会增加死产风险。必须强调的是，本委员会意见中提出的指导意见应仅解释为建议；这一指导意见不应解释为授权或包罗万象。最终，建议对是否以及何时提供产前胎儿监护进行个性化。
The purpose of this Committee Opinion is to offer guidance about indications for and timing and frequency of antenatal fetal surveillance in the outpatient setting. Antenatal fetal surveillance is performed to reduce the risk of stillbirth. However, because the pathway that results in increased risk of stillbirth for a given condition may not be known and antenatal fetal surveillance has not been shown to improve perinatal outcomes for all conditions associated with stillbirth, it is challenging to create a prescriptive list of all indications for which antenatal fetal surveillance should be considered. This Committee Opinion provides guidance on and suggests surveillance for conditions for which stillbirth is reported to occur more frequently than 0.8 per 1,000 (the false-negative rate of a biophysical profile) and which are associated with a relative risk or odds ratio for stillbirth of more than 2.0 compared with pregnancies without the condition. Table 1 presents suggestions for the timing and frequency of testing for specific conditions. As with all testing and interventions, shared decision making between the pregnant individual and the clinician is critically important when considering or offering antenatal fetal surveillance for individuals with pregnancies at high risk for stillbirth or with multiple comorbidities that increase the risk of stillbirth. It is important to emphasize that the guidance offered in this Committee Opinion should be construed only as suggestions; this guidance should not be construed as mandates or as all encompassing. Ultimately, individualization about if and when to offer antenatal fetal surveillance is advised.