The modified BPP is considered abnormal if either the NST is nonreactive or the deepest vertical pocket of amniotic fluid is 2 cm or less . The Society of Obstetricians and Gynaecologists of Canada SOGC suggests antenatal fetal surveillance may also be beneficial in pregnancies complicated by preterm premature rupture of membranes, chronic stable abruptionvaginal bleeding, abnormal maternal serum screening in the absence of confirmed fetal anomaly, motor vehicle accident during pregnancy, morbid obesity, advanced maternal age, assisted reproductive technologiesmultiple pregnancy, polyhydramnios, and preterm labor . However, in pregnancies with multiple or particularly worrisome high-risk conditions e.
Once levels of maternal care are established, analysis of data collected from all facilities and regional systems will inform future updates to the levels of maternal care. Consistent with the levels of neonatal care published by the AAP 7each level reflects required minimal capabilities, physical facilities, and medical and support personnel.
Note that each higher level of care includes and builds on the capabilities of the lower levels. As with the AAP-defined levels of neonatal care, the system will be modified as analysis is completed.
The goal of regionalized maternal care is for pregnant women at high risk to receive care in facilities that are prepared to provide the required level of specialized care. Each facility should have a clear understanding of its capability to handle increasingly complex levels of maternal care, and should Antepartum fetal surveillance 2014 a well-defined threshold for transferring women to health care facilities that offer a higher level of care.
These proposed categories of maternal care are meant to facilitate this process. These guidelines also are intended to foster the development of equitably distributed resources throughout the country. These are guidelines, not mandates, and geographic and local issues will affect systems of implementation for regionalized perinatal care.
In fact, levels of maternal and neonatal care may not match within facilities. Because all facilities cannot maintain the breadth of resources available at subspecialty centers, interfacility transport of pregnant women or women in the postpartum period is an essential component of a regionalized perinatal Antepartum fetal surveillance 2014 care system.
To ensure optimal care of all pregnant women, all birth centers, hospitals, and higher-level facilities should collaborate to develop and maintain maternal and neonatal transport plans and cooperative agreements capable of managing the health care needs of women who develop complications; receiving hospitals should openly accept transfers.
The appropriate care level for patients should be driven by their medical need for that care and not limited by financial constraint. Because of the importance of accurate data for the assessment of outcomes, all facilities should have requirements for data collection, storage, and retrieval.
An important goal of regionalized maternal care is for higher-level facilities to provide training for quality improvement initiatives, educational support, and severe morbidity and mortality case review for lower-level hospitals. In those regions that do not have a facility that qualifies as a level IV center, any level III facilities in the region should provide the educational and consultation function see Table 3.
Birth centers provide family-centered care for healthy women before, during and after normal pregnancy, labor and birth. Birth centers provide peripartum care to low-risk women with uncomplicated singleton term pregnancies with a vertex presentation who are expected to have an uncomplicated birth.
Cesarean delivery or operative vaginal delivery are not offered at birth centers. In a freestanding birth center, every birth should be attended by at least two professionals. The primary maternity care provider that attends each birth is educated and licensed to provide birthing services.
Primary maternity care providers include certified nurse—midwives CNMscertified midwives, certified professional midwives, and licensed midwives who are legally recognized to practice within the jurisdiction of the birth center; family physicians; and obstetrician—gynecologists.
In addition, there should be adequate numbers of qualified professionals available who have completed orientation and demonstrated competence in the care of obstetric patients women and fetuses consistent with level I care criteria and are able to stabilize and transfer high-risk women and newborns.
Medical consultation should be available at all times. These facilities should be ready to initiate emergency procedures including cardiopulmonary and newborn resuscitation and stabilization at all times 7to meet unexpected needs of the woman and newborn within the center, and to facilitate transport to an acute care setting when necessary.
To ensure optimal care of all women, a birth center should have a clear understanding of its capability to provide maternal and neonatal care and the threshold at which it should transfer women to a facility with a higher level of care. A birth center should have an established agreement with a receiving hospital and have policies and procedures in place for timely transport.
These transfer plans should include risk identification; determination of conditions necessitating consultation; referral and transfer; and a reliable, accurate, and comprehensive communication system between participating facilities and transport teams.
All facilities should have quality improvement programs that include efforts to maximize patient safety. The Commission for the Accreditation of Birth Centers is the only accrediting agency that chooses to use the national American Association of Birth Centers Standards for Birth Centers in its accreditation process.
In those regions that do not have a facility that qualifies as a level IV center, any level III facilities in the region should provide the educational and consultation function.
Level I facilities have the capability to perform routine intrapartum and postpartum care that is anticipated to be uncomplicated 6. As in birth centers, maternity care providers, midwives, family physicians, or obstetrician—gynecologists should be available to attend all births.
Adequate numbers of registered nurses RNs are available who have completed orientation, demonstrated competence in the care of obstetric patients women and fetuses consistent with level I care criteria, and are able to stabilize and transfer high-risk women and newborns.
Nursing leadership should have expertise in perinatal nursing care. An obstetric provider with privileges to perform an emergency cesarean delivery should be available to attend deliveries.Obstetrics and Gynecology Beckmann 7th Edition.
Established as the standard resource of the obstetrics and gynecology clerkship, Obstetrics and Gynecology is now in its revised Seventh Edition. Evaluate intrapartum and antepartum fetal status with this portable, practical guide!
Mosby's Pocket Guide to Fetal Monitoring, 7th Edition provides a multidisciplinary, evidence-based approach model that's ideal for use in the clinical environment. It offers a single definitive source on fetal heart rate monitoring, with the description, characteristics, etiology, clinical significance, and.
Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases The material in this report originated in the National Center for Immunization and Respiratory Diseases, Anne Schuchat, MD, Director, and the Division of Bacterial Diseases, Rana Hajjeh, MD, Director.
Provincial Health Services Authority (PHSA) improves the health of British Columbians by seeking province-wide solutions to specialized health care needs in . antepartum fetal surveillance and outline management guidelines for antepartum fetal surveillance that are consistent with the best scientific evidence.
Background In humans, the . For fetuses > 32 weeks gestational age the peak heart rate must be > 15 beats per minute (BPM) above the baseline and must last for > 15 seconds but less than 2 minutes from the initial change in heart rate to the time of return of the fetal heart rate to the baseline.
For fetuses 10 beat and a duration of > 10 seconds but.