Sequential nonstress testing with use of each fetus as its own control

American Journal of Obstetrics and Gynecology
L D DevoeH Davis

Abstract

The sequential nonstress tests of 126 high-risk fetuses were assessed for baseline fetal heart rate, acceleration frequency, amplitude, and duration and the observance of fetal heart rate decelerations. In 108 fetuses (563 tests) with normal perinatal outcomes, no significant trends in these parameters were found. In 18 fetuses (104 tests) with perinatal compromise, 16 had significantly declining acceleration frequencies, 15 had decreasing acceleration duration, four had rising mean baseline rates, and seven, in their last test before delivery, had repetitive late or severe variable decelerations. The last tests of 11 of these 18 fetuses met institutional criteria for reactivity. When the nonstress tests of compromised fetuses were viewed sequentially, acceleration frequency declined by an average of 59% and acceleration duration by an average of 40%. Sequential assessment of the nonstress test, when compared with the use of standard reactivity criteria, improved test sensitivity from 39% to 89% and negative predictive value from 91% to 98%. We conclude that sequential nonstress test assessment in individual fetuses may improve the diagnostic value of this modality and lead to earlier recognition of fetal compromise.

References


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Citations

Jan 23, 1999·Obstetrics and Gynecology·C C Lin, J Santolaya-Forgas
Nov 20, 2002·Clinical Obstetrics and Gynecology·Lawrence D Devoe, Chandra R Jones
Feb 28, 2016·European Journal of Obstetrics, Gynecology, and Reproductive Biology·Célia Amorim-CostaJoão Bernardes
Sep 1, 1989·American Journal of Obstetrics and Gynecology·R GagnonA D Bocking
Mar 1, 1993·American Journal of Obstetrics and Gynecology·R GagnonC Hunse
May 1, 1994·International Journal of Gynaecology and Obstetrics : the Official Organ of the International Federation of Gynaecology and Obstetrics·E SalamalekisP A Zourlas
May 31, 2016·Acta Obstetricia Et Gynecologica Scandinavica·Célia Amorim-CostaJoão Bernardes
Dec 10, 1999·Obstetrics and Gynecology Clinics of North America·L D Devoe

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