II. Background: Abbreviations

  1. NST: Nonstress Test
  2. AFI: Amniotic fluid index

III. Protocol: Gestational Diabetes

  1. Class A1 (diet controlled, no complications)
    1. NST/AFI: bi-weekly starting at 40 weeks
  2. Class A2 and B (Insulin controlled, no complications)
    1. NST/AFI: Weekly starting at 32 weeks
    2. Ultrasound: Monthly starting at 36 weeks for EFW
  3. Class A or B with poor control, or Classes B-D
    1. NST/AFI: bi-weekly starting at 32 weeks
    2. Obstetric Ultrasound: Monthly starting at 32 weeks
  4. Classes F, H, R, T
    1. NST/AFI: bi-weekly starting at 28 weeks
    2. Obstetric Ultrasound: Monthly starting at 28 weeks

IV. Background: Hypertension

  1. Chronic Hypertension Low Risk
    1. NST/AFI: Weekly starting at 34 weeks
    2. Obstetric Ultrasound: Monthly starting at 32 weeks
  2. Chronic Hypertension High Risk
    1. NST/AFI: Bi-weekly starting at 32 weeks
    2. Obstetric Ultrasound: Monthly starting at 28 weeks
  3. Pregnancy Induced Hypertension (PIH)
    1. NST/AFI: Bi-weekly starting at time of diagnosis

V. Background: Assorted Maternal Conditions

  1. Maternal Anemia, Sickle Cell Disease (Hematocrit < 28%)
    1. NST/AFI: Weekly starting at 34 weeks
  2. Seizure Disorder
    1. NST/AFI: Weekly starting at 34 weeks
  3. Hyperthyroidism
    1. NST/AFI: Weekly starting at 34 weeks
  4. Maternal Heart Disease
    1. NST/AFI: Weekly starting at 34 weeks
    2. Obstetric Ultrasound: Monthly starting at 28 weeks
  5. Maternal Renal or Collagen Vascular disease
    1. NST/AFI: Weekly starting at 28-30 weeks
    2. Obstetric Ultrasound: Monthly starting at 28 weeks
  6. Advanced Maternal Age (>34 yo)
    1. NST/AFI: Weekly starting at 36 weeks
  7. Asthma (Symptomatic)
    1. NST/AFI: Weekly starting at 34 weeks
  8. Third Trimester abdominal surgery (e.g. Appendectomy)
    1. NST/AFI: Weekly starting at date of surgery
  9. Post-term (>41 weeks)
    1. NST/AFI: Bi-weekly starting at 41 weeks
  10. Previous fetal demise or Stillbirth
    1. NST/AFI: Weekly starting at time of IUFD or 32 weeks

VI. Background: Placenta Conditions

  1. Placenta Previa
    1. NST/AFI: Weekly starting at 34 weeks
  2. Chronic Abruption
    1. NST/AFI: Weekly starting at diagnosis
    2. Obstetric Ultrasound: Monthly starting at diagnosis

VII. Background: Fetal Conditions

  1. Intrauterine Growth Retardation (IUGR)
    1. NST/AFI: Bi-weekly from time of diagnosis (>28 weeks)
    2. Ultrasound: Bi-Monthly from time of diagnosis
  2. Multiple Gestation
    1. NST/AFI: Weekly starting at 28-32 weeks
    2. Ultrasound: Monthly starting at 28 weeks
  3. Rh Isoimmunization
    1. NST/AFI: Weekly starting at 28 weeks
    2. Ultrasound: Monthly starting at 28 weeks
  4. Polyhydramnios (Amniotic fluid index >20)
    1. NST/AFI: Weekly starting at 32 weeks
  5. Oligohydramnios (Amniotic fluid index <5)
    1. NST/AFI: bi-weekly starting at 28 weeks

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