Antepartum and Intrapartum Fetal Assessment and Management

Antenatal surveillance and intrapartum fetal monitoring are routine components of obstetric care, particularly in the high-risk patient. The goal of antenatal testing is to reduce stillbirths in pregnancies with heightened risk. The goal of intrapartum monitoring is to reduce fetal acidemia, which can lead to asphyxia and long-term neurologic sequelae. Both antepartum and intrapartum monitoring of the fetal heart rate and its variability are sensitive to acidemia. Standard nomenclature exists for describing the features of fetal heart rate tracing. Ultrasonography is a useful adjunct to fetal heart rate monitoring, particularly for antenatal testing. The decision to initiate antenatal testing or intrapartum monitoring depends on many factors, particularly gestational age and maternal status. All forms of surveillance have high false-positive rates and poor positive predictive value. If the results of abnormal testing will not affect clinical management, testing should not be performed. This review contains 9 figures, 7 tables, and 50 references. Keywords: acidemia, antenatal testing, assessment, biophysical profile, electronic fetal monitoring, labor and delivery, nonstress test, stillbirth