Placental/Uterine Conditions
Other Fetal & Maternal Conditions
Maternal Diabetes
FGR
Multiples
100

Placenta Previa 

Late preterm / early term

36.0 - 37.6 

100

Cholestasis of Pregnancy (bile acids 100+) 

Late Preterm

36.0 

100

Gestational, Diet-Controlled 

Full Term 

39.0 - 40.6 

100

EFW 3rd - 10th percentile with no concurrent findings 

Early term / Full term

38.0 - 39.0 

100

Uncomplicated Di-Di Twins

Early term 

38.0 - 38.6 

200

Vasa Previa 

Late preterm / Early Term 

34.0 - 37.0 

200

Cholestasis of Pregnancy (Bile acids <100) 

Late Preterm - Full Term

36.0 - 39.0 

200

Gestational, well-controlled on meds

Full Term 

39.0 - 39.6 

200

Concurrent conditions (oligohydramnios, maternal comorbidities [eg preeclampsia, diabetes]) 

Late preterm / Early Term 

34.0 - 37.6 

200

Uncomplicated Mo-Di Twins

Late Preterm / Early Term

34.0 - 37.6

300

Placenta Accreta Spectrum 

Late preterm 

34.0 - 35.6 

300

Oligohydramnios

Late Preterm / Early Term

36.0 - 37.6 

300

Pregestational, Well-controlled 

Full Term

39.0 - 39.6

300

EFW <3rd percentile with no concurrent findings 

OR elevated UA dopplers with preserved end diastolic flow 

Early term 

37.0 

300

Uncomplicated Mo-Mo Twins

Preterm / Late Preterm 

32.0 - 34.0 

400

Prior classical cesarean section OR previous uterine rupture

Late preterm / Early Term


36.0 - 37.0 

400

HIV 

Viral Load >1000: 38.0 by cesarean 

Viral Load </= 1000 on ART: 39.0+ 

400

Pregestational, with vascular complications, poor glucose control, or prior stillbirth

Late Preterm / Early Term

36.0 - 38.6 

400

Absent end diastolic flow on UA dopplers 

Preterm / Late preterm 

33.0 - 34.0 

400

Di Di Twins with Isolated FGR 

Late Preterm / Early Term 

36.0 - 37.6

500

Prior myomectomy/uterine surgery requiring cesarean delivery

Early term 

37.0 - 38.6 

500

Alloimmunization

Not requiring fetal blood transfusion: 37.0 - 38.6 

Requiring blood transfusion: late preterm / early term **individualized 

500

Gestational, Poorly Controlled 

Late Preterm / Early Term 

**Individualized 

500

UA dopplers with reversed end diastolic flow 

Preterm  

30.0 - 32.0 

500

Mo Di Twins with Isolated FGR 

Preterm / Late Preterm 

32.0 - 34.6 

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