Current Inpatient Antenatal Fetal Surveillance Paradigms and the Effect on Clinical Decision Making
ACOG ePoster. Racusin D. 04/27/18; 211981; 23B
Diana Racusin
Diana Racusin
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Abstract
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Introduction: While outpatient biophysical profiles (BPPS) are routinely used to prevent intrauterine fetal demise, the clinical utility of BPPs performed inpatient with scheduled electronic fetal monitoring (EFM) is uncertain. Our objective was to determine whether BPPs performed in the hospital on the antepartum unit result in prolonged duration of EFM or in delivery.

Methods: A retrospective cohort review was performed among women who had a BPP during their antepartum hospital admission. Women were divided into two groups (BPPs 8/8 or 6/8 or less) and their outcomes compared. The primary outcome was the need for prolonged EFM greater than 2 hours or decision to proceed with delivery. Maternal demographics, pregnancy characteristics, and neonatal outcomes were compared. Indications for hospitalization and delivery were collected. Student-t test and chi-square test were used for statistical analysis.

Results: Among our high-risk cohort (n=325), delivery management was altered in one case (0.3%) by the BPP findings. There were no BPPs that resulted in need for prolonged monitoring. Need for delivery or prolonged monitoring was primarily dictated by either change in clinical scenario or EFM abnormalities. Compared to women with BPP 8/8, women with BPP 6/8 or less were admitted and delivered at significantly earlier gestational ages, had higher corticosteroid rates, lower birthweight neonates and required more frequent NICU admissions.

Conclusion/Implications: In our analysis, hospital BPPs alter clinical decision making in less than 1% of cases. An intervention trial is warranted to assess the potential benefits of BPPs in an inpatient antepartum setting.
Introduction: While outpatient biophysical profiles (BPPS) are routinely used to prevent intrauterine fetal demise, the clinical utility of BPPs performed inpatient with scheduled electronic fetal monitoring (EFM) is uncertain. Our objective was to determine whether BPPs performed in the hospital on the antepartum unit result in prolonged duration of EFM or in delivery.

Methods: A retrospective cohort review was performed among women who had a BPP during their antepartum hospital admission. Women were divided into two groups (BPPs 8/8 or 6/8 or less) and their outcomes compared. The primary outcome was the need for prolonged EFM greater than 2 hours or decision to proceed with delivery. Maternal demographics, pregnancy characteristics, and neonatal outcomes were compared. Indications for hospitalization and delivery were collected. Student-t test and chi-square test were used for statistical analysis.

Results: Among our high-risk cohort (n=325), delivery management was altered in one case (0.3%) by the BPP findings. There were no BPPs that resulted in need for prolonged monitoring. Need for delivery or prolonged monitoring was primarily dictated by either change in clinical scenario or EFM abnormalities. Compared to women with BPP 8/8, women with BPP 6/8 or less were admitted and delivered at significantly earlier gestational ages, had higher corticosteroid rates, lower birthweight neonates and required more frequent NICU admissions.

Conclusion/Implications: In our analysis, hospital BPPs alter clinical decision making in less than 1% of cases. An intervention trial is warranted to assess the potential benefits of BPPs in an inpatient antepartum setting.
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