ACOG recommends antepartum testing in the following situations

(a) Women with high-risk factors for fetal asphyxia should undergo antepartum fetal surveillance with tests (eg, BPS, nonstress test)

(b) Testing may be initiated as early as 26 weeks of gestation when clinical conditions suggest early fetal compromise is likely. Initiating testing at 32 to 34 weeks of gestation is appropriate for most pregnancies at increased risk of stillbirth.

(c) A reassuring test (eg, BPS of 8 to 10) should be repeated periodically (weekly or twice weekly) until delivery when the high-risk condition persists.

(d) Any significant deterioration in the clinical status (eg, worsening preeclampsia, decreased fetal activity) requires fetal reevaluation.

(e) Severe oligohydramnios (no vertical pocket >2 cm or amniotic fluid index <5) requires either delivery or close maternal and fetal surveillance.

(f) Induction of labor may be attempted with abnormal antepartum testing as long as the fetal heart rate and contractions are monitored continuously and are reassuring. Cesarean delivery is indicated if there are repetitive late decelerations.

(2) The minimum gestational age for testing should reflect the lower limit that intervention with delivery would be considered. This age is now 24 to 25 weeks.

(3) Modified biophysical profile. Assessment of amniotic fluid volume and nonstress testing appear to be as reliable a predictor of long-term fetal well-being as the full BPS. The rate of stillbirth within one week of a normal modified BPS is the same as with the full BPS, 0.8 per 1000 women tested.

Guidelines for Antepartum Testing

Indication

Initiation

Frequency

Post-term pregnancy

41 weeks

Twice a week

Preterm rupture of membranes

At onset

Daily

Bleeding

26 weeks or at onset

Twice a week

Oligohydramnios

26 weeks or at onset

Twice a week

Polyhydramnios

32 weeks

Weekly

Diabetes

32 weeks

Twice a week

Chronic or pregnancy-induced hypertension

28 weeks

Weekly. Increase to twice-weekly at 32 weeks.

Steroid-dependent or poorly controlled asthma

28 weeks

Weekly

Sickle cell disease

32 weeks (earlier if symptoms)

Weekly (more often if severe)

Impaired renal function

28 weeks

Weekly

Substance abuse

32 weeks

Weekly

Prior stillbirth

At 2 weeks before prior fetal death

Weekly

Multiple gestation

32 weeks

Weekly

Congenital anomaly

32 weeks

Weekly

Fetal growth restriction

26 weeks

Twice a week or at onset

Decreased fetal movement

At time of complaint

Once

F. Perinatal outcome. An abnormal NST result should be interpreted with caution. Further assessment of fetal condition using the NST, OCT, or BPP should usually be performed to help determine whether the fetus is in immediate jeopardy.

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