Expectant management with antenatal surveillance

1. Begin testing near the end of the 41st week of pregnancy. Antepartum testing consists of the nonstress test (NST) combined with the amniotic fluid index (AFI) twice weekly. The false-negative rate is 6.1/1000 (stillbirth within 1 week of a reassuring test) with twice weekly NSTs.

2. The AFI involves measuring the deepest vertical fluid pocket in each uterine quadrant and summing the four together. Less than 5 cm is considered oligohydramnios, 5 to 8 cm borderline, and greater than 8 cm normal.

E. Fetal movement counting (kick counts). Fetal movement has been correlated with fetal health. It consist of having the mother lie on her side and count fetal movements. Perception of 10 distinct movements in a period of up to 2 hours is considered reassuring. After 10 movements have been perceived, the count may be discontinued.

F. Delivery is indicated if the amniotic fluid index is less than 5 cm, a nonreactive non-stress test is identified, or if decelerations are identified on the nonstress test.

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