Antenatal Testing
Antenatal Testing
Antenatal Testing
PRINCIPAL AUTHOR
Gregory A.L. Davies, MD, FRCSC, Kingston ON
These guidelines reflect emerging clinical and scientific advances as of the date issued and are subject to change. The information should not be construed as
dictating an exclusive course of treatment or procedure to be followed. Local institutions can dictate amendments to these opinions. They should be well doc-
umented if modified at the local level. None of the contents may be reproduced in any form without prior written permission of SOGC.
TABLE IV PERINATAL MORTALITY WITHIN ONE WEEK OF BIOPHYSICAL PROILE BY BPP SCORE
Modified from Manning FA, Dynamic ultrasound-based fetal assessment: The fetal biophysical score (Ciin Obstet Gyneco1) 27
QUALITY OF EVIDENCE ASSESSMENT I. Wadhera S, Strachan J. Selected infant mortality and related statistics,
Canada, 1921-1990. Ottawa: Statistics Canada, 1993.
The quality of evidence reported in these guidelines has been 2. Alfirevic Z, Neilson JP. Biophysical profile for fetal assessment in high
described using the Evaluation of Evidence criteria outlined in the risk pregnancies (Cochrane Review). In: The Cochrane Library.Vol.
Report of the Canadian Task Force on the Periodic Health Exam. 35 Issue 3: Oxford, 1998.
3. Soothill PW,Ajayi RA, Campbell S, Nicolaides KH. Prediction of morbid-
ity in small and normally grown fetuses by fetal heart rate variability,
1: Evidence obtained from at least one properly randomized biophysical profile score and umbilical artery Doppler studies. Brit J
controlled trial. Obstet Gynaecol 1993; I00:742-5.
II-l:Evidence obtained from well-designed controlled trials 4. Sadovsky E, Polishuk WZ. Fetal movement in utero: nature, assessment,
prognostic value, timing of delivery. Obstet Gynecol 1977;50:49-55.
without randomization. 5. McClure-Browne JC. Post-maturity.Am J Obstet Gynecol 1963;85:573.
II-2:Evidence obtained from well-designed cohort or case- 6. Phelan JP, Platt LD,Yeh S,Trujillo M, Paul RH. Continuing role of the non-
control analytic studies, preferably from more than one stress test in the management of postdates pregnancy. Obstet Gynecol
1984;64:624-8.
centre or research group. 7. Torres PJ, Gratacos E,Aionso PL. Umbilical artery Doppler ultrasound
II-3:Evidence obtained from comparisons between times or predicts low birth weight and fetal death in hypertensive pregnancies.
places with or without the intervention. Dramatic results Acta Obstet Gynecol Scandinavia 1995;74:352-5.
8. von Kries R, Kimmerle R, Schmidt JE, Hachmeister A, Bohm O,Wolf
in uncontrolled experiments (such as the results of treat-
HG. Pregnancy outcomes in mothers with pregestational diabetes: a
ment with penicillin in the 1940's) could also be included population-based study in North Rhine (Germany) from 1988 to 1993.
in this category. Eur J Ped 1997; 156:963-7.
III: Opinions of respected authorities, based on clinical expe- 9. Girz BA, Divon MY, Merkatz IR. Sudden fetal death in women with
well-controlled, intensively monitored gestational diabetes.J Peri nat
rience, descriptive studies or reports of expert committees. 1992; 12:229-33.
I0. Vintzileos AM. Antepartum surveillance in preterm rupture of
membranes.) Perinat Med 1996;24:319-26.
I I. Sholl JS.Abruptio placentae: Clinical management in nonacute cases.
Am J Obstet Gynecol 1987; 156:40-51.
12. Rouse DJ, Owen J, Gogenberg RL, Cliver SP. Determinants of the
optimal time in gestation to initiate antenatal fetal testing: a decision-
analytic approach. Am J Obstet Gynecol 1995; 173:1357-63.
13. Miller DA, Rabello YA, Paul RH.The modified biophysical profile:
Antepartum testing in the 1990s.Am J Obstet Gynecol 1996; 174:812-7.
14. Platt LD,Walla CD, Paul RH,et ai.A prospective trial of the fetal
biophysical profile versus the nonstress test in the management of
high-risk pregnancies. Am J Obstet Gynecol 1985; 153:624-33.
15. Nageotte MP,Towers CV,AsratT, Freeman RK, DorchesterW.The value
of a negative antepartum test: contraction stress test and modified
biophysical profile. Obstet Gynecol 1994;84:231-4.
16. Manning FA, Lange IR, Morrison I, Harman CR. Fetal biophysical profile
score and the nonstress test: a comparative trial. Obstet Gynecol
1984;64:326-31.
17. Alfirevic Z,Walkinshaw SA. A randomised controlled trial of simple
compared with complex antenatal fetal monitoring after 42 weeks
of gestation. Brit J Obstet Gynaecol 1995; I02:638-43.
18. Neilson JP,Aifirevic Z. Doppler ultrasound in high risk pregnancies
(Cochrane Review).ln:The Cochrane Library. Vol. Issue 3: Oxford, 1998.
19. Rayburn WF. Fetal movement monitoring. Clin Obstet Gynecol
1995;38:59-67.
20. Freda MC, Mikhail M, Mazloom E, Polizzotto R, Damus K, Merkatz I.
Fetal movement counting: which method. Am J Matern Child Nursing
1993; 18:314-21.
21. Grant A, Valentin L, Elbourne D,Aiexander S. Routine formal fetal move-
ment counting and risk of antepartum late death in normally formed
singletons. Lancet 1989;2(8659):345-9.
22. Vintzileos AM, Gaffney S, Salinger LM, Kontopoulos VG, Campbell WA,
Nochimson DJ.The relationships among the fetal biophysical profile,
umbilical cord pH, and Apgar scores.Am J Obstet Gynecol
1987; 157:627-31.
23. Druzin ML, Fox A, Kogut E, Carlson C. The relationship of the nonstress
test to gestational age. Am J Obstet Gynecol 1985; 153:386-9.
24. Lagrew DC Jr. The contraction stress test. Clin Obstet Gynecol
1995;38: I 1-25.
25. Huddleston JF, Sutliff G, Robinson D. Contraction stress test by
intermittent nipple stimulation. Obstet Gynecol 1984;63:669-73.
26. Parer JT. Fetal heart rate.ln: Creasy RK, Resnik R, eds. Maternal-Fetal
Medicine. Philadelphia:W.B. Saunders, 1999: 1266.
27. Manning FA Dynamic ultrasound-based fetal assessment: The fetal
biophysical score. Clin Obstet Gynecol 1995;38:26-44.
28. Moore TR.Assessment of amniotic fluid volume in at-risk pregnancies.
Clin Obstet Gynecol 1995;38:78-90.
29. Manning FA, Boondaji N, Harman CR, et al. Fetal assessment based
on fetal biophysical profile scoring VII I. The incidence of cerebral palsy
in tested and untested perinates.Am J Obstet Gynecol 1998; 178:
696-706.
30. Viatzileos AM, Campbell WA, Nochimson DJ,Weinbaum PJ.
The use and misuse of the fetal bioprofile. Am J Obstet Gynecol
1987; 156:527-33.
3 I. Baskett TF. Gestational age and fetal biophysical assessment. Am J
Obstet Gynecol 1988; 158:332-4.
32. Karsdorp VH, van Vugt JM, van Geijn HP, et al. Clinical significance of
absent or reversed end diastolic velocity waveforms in umbilical artery.
Lancet 1994;344: 1664-8.
33. Alfirevic Z, Neilson JP. Doppler ultrasonography in high-risk
pregnancies: systematic review with meta-analysis. Am J Obstet
Gynecol 1995; 172: 1379-87.
34. Petrovic 0, Frkovic A, Matejcic N. Fetal biophysical profile and vibratory
acoustic stimulation in high-risk pregnancies.lnt J Gynaecol Obstet
1995;50: I 1-5.
35. Woolf SH, Battista RN,Angerson GM, Logan AG, EEL W. Canadian Task
Force on the Periodic Health Exam. Ottawa: Canada Communication
Group, 1994:xxxvii.