Labor Admission Test Research Articles

Fetal acoustic stimulation for early intrapartum assessment of fetal well-being

Fetal heart rate monitoring is widely used to assess fetal well-being during labor. A 20-min recording of the fetal heart rate immediately after Ž . the admission of patients in labor admission test may be of value as a screening procedure for fetal w x distress 1 . In a busy labor ward without a sufficiency of monitors and personnel, the obstetrician may be greatly aided by an evaluation performed early in the course of labor that can differentiate the fetus likely to tolerate the stress of labor from one that cannot. The usefulness of fetal acoustic stimulation in the early intrapartum period was considered to be the clinical application of a w x screening technique 2]4 . The aim of this study is to evaluate the usefulness of fetal acoustic stimulation test in the early intrapartum period as a screening test to predict perinatal outcome. This prospective study was performed in the labor room of Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. Inclusion criteria

Labor Admission Test

The Labor Admission Test permits the clinician to reallocate risk patients based on their admission fetal heart rate pattern. This means that obstetric patients normally considered high risk on admission to labor and delivery can be reallocated to low risk when the initial fetal heart rate pattern is reactive.

Umbilical artery doppler velocimetry compared with fetal heart rate monitoring as a labor admission test

A total of 155 patients admitted in early labor to the delivery unit of the University of Hong Kong were recruited into a study comparing the value of umbilical artery Doppler velocimetry and fetal heart rate (FHR) monitoring in early labor as an admission test. FHR monitoring for 30 min was recorded on admission, and umbilical A B ratio was simultaneously performed. The FHR tracing was scored according to the Lyons score by a third independent observer after delivery. Outcome variables studied included small for gestational age (SGA), intrapartum FHR abnormalities, operative deliveries for fetal distress, umbilical cord pH, Apgar scores, admission into the special care baby unit, and a combination of the variables. It was found that at cut-off values of Lyons score < 7 and umbilical A B ratio > 2.6 at term, about 19% of cases were abnormal for either tests, with only a few cases of overlap. Umbilical A B ratio was found to be significantly correlated with SGA. The sensitivity and positive predictive values were, however, low. Both tests were relatively poor predictors for most of the outcome variables studied. Interestingly, FHR monitoring did not seem to have any advantage over Doppler velocimetry as a labor admission test. Further larger scale studies to evaluate their usefulness in medium and low risk populations are indicated.