Antenatal Fetal Surveillance Recommendations Based on ACOG Guidelines June 2021

These cheat sheets outline the indications and recommendations for outpatient antenatal fetal surveillance, including the reasons and frequency for non-stress tests (NST) and biophysical profile (BPP) based on various maternal conditions and fetal considerations. Guidelines are provided for different scenarios such as maternal medical history, obstetric conditions, and specific fetal concerns to optimize antenatal monitoring and management.

• Antenatal
• Fetal surveillance
• ACOG guidelines
• NST
• BPP

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1. NST cheat sheets Based on ACOG CO June 2021 Indications for Outpatient Antenatal Fetal Surveillance

2. Recommend Reason for NST Number per week BPP EGA to start IDDM 2 weekly 32 GDM- insulin or any poor control 2 weekly 32 GDM-orals 2 Prn NR-NST 32 GDM- diet 1 Prn NR-NST 40 FGR EFW 11th-20th 1 (regardless of UAD) Prn NR-NST or with UAD At dx FGR EFW 3rd-10th 1 if NL UAD, 2 if ABNL UAD weekly At dx FGR <3rd 2 (regardless of UAD) weekly At dx CHTN stable (meds) 1 Prn NR-NST 32(*36 no meds) gHTN/preE 2 weekly At dx oligohydramnios 1-2 weekly At dx Twins 1 (inc or add BPP for complications) Prn NR-NST 36 DC 32 MC

3. Recommend Indication for NST Number per week BPP EGA to start BMI 35-39.9 pre-preg 1 Prn NR NST 37 BMI 40 or greater 1 Prn NR NST 34 AMA 40 or greater (isolated) 1 Prn NR-NST 32-36 h/o IUFD 1-2 weekly 32 (individualize if loss <32) Polyhydramnios (AFI 30 or more, MVP 12 or more) 1-2 weekly 32-34 Decreased fetal mvmt 1 at dx Prn NST At dx (need not rpt if resolves) Sickle cell dz 1-2 weekly 32 Suspected abruption 2 Prn NR-NST At dx Late term (41 wks) 1-2 1 41 wks SLE At least 1 weekly By 32 APAS 2 weekly By 32 ICP 1-2 1 BPP at dx, NST by 32 wks IVF (SMFM recs MAR 2022) 1 Prn NR NST 36

4. Consider Reason Number per week EGA to start BPP Prior FGR w/PTB 1 32 Prior preE with PTB 1 32 Inhibin 2 MoM or greater 1 36 Velamentous PCI or SUA 1 36 Renal dz Cr> 1.4 mg/dl 1-2 32 5 or more alcoholic drinks per wk 1 36 SUA (SMFM recs on markers 2022) 1 36 prn