Antenatal fetal surveillance

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Abstract
Antenatal fetal surveillance is a field of increasing importance in modern obstetrics, especially as results in perinatal care have recently made dramatic progress. It is an evolving field, and it is no longer acceptable just to wait and see when problems arise in pregnancy. During the past few decades many studies have shown that antenatal surveillance in unselected populations is of little value. However, high-risk patients benefit from antenatal fetal surveillance, especially women with pregnancy problems associated with intrauterine growth restriction. This review shows that modern antenatal fetal surveillance is based on fetal heart rate monitoring, ultrasound biometry and amniotic fluid assessment, Doppler blood flow studies of fetal and uteroplacental circulation, and an evaluation of biophysical fetal parameters. Used in combination these methods lead to improvements in fetal morbidity and mortality. The aim of future research should be to minimize the risks of fetal morbidity and mortality further by the optimal timing of delivery. Better organization of healthcare systems may improve our ability to identify at-risk patients during pregnancy. There is potential to improve the specificity of fetal surveillance tests, e.g. better methods of biometry and amniotic volume estimation with three-dimensional ultrasound and measurements of subcutaneous tissue. Improved knowledge of fetal physiology can be gained from research on fetal circulation with Doppler studies. Computer analysis of the fetal heart rate can increase the specificity of that test, and artificial neural networks may enhance the ability to evaluate the optimal use of integrated testing.

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