Nonstress Test Research Articles

Umbilical Artery Systolic/Diastolic Ratio and Amniotic Fluid Index in Prediction of Adverse Perinatal Outcome in Term Pregnancies.

Background:Antenatal fetal surveillance is a field of increasing importance in modern obstetrics. It is based on fetal heart rate monitoring using nonstress test and contraction stress test, ultrasound biometry and amniotic fluid assessment, Doppler blood flow studies of fetal and uteroplacental circulation, and an evaluation of biophysical fetal parameters. The combination of these methods leads to improvements in fetal morbidity and mortality.Aim:The present study aimed to assess the sensitivity, specificity, and positive and negative predictive values of umbilical artery (UA) systolic/diastolic (S/D) ratio, and amniotic fluid index (AFI) in term pregnancies for the prediction of perinatal outcome and their relation with perinatal outcome.Methods:This study was conducted at a tertiary care hospital on 100 pregnant women where all the term singleton pregnancies (37–42 weeks) admitted in maternity were subjected to color Doppler for UA S/D ratio assessment and AFI estimation. Further, management of patients was done according to color Doppler findings and their relation with perinatal outcome.Results:Out of 100 pregnant women, 68% had AFI >8 (normal), while 32% of women had AFI <8 (abnormal), with the mean AFI being 9.39 ± 2.55 cm, whereas70% had S/D ratio <3 (normal) and 30% of women had S/D ratio >3 (abnormal), with the mean S/D ratio of 2.61 ± 0.450. UA S/D ratio had better performance values (i.e., sensitivity, specificity, and positive and negative predictive value) than AFI in predicting adverse perinatal outcomes.Conclusion:AFI and UA S/D ratio are important for predicting low appearance, pulse, grimace, activity, and respiration score, meconium, respiratory complications, and perinatal mortality in high as well as low-risk pregnancy cases. However, UA S/D ratio is a better predictor of perinatal outcome in high-risk pregnancies.

Predictive value of doppler cerebroplacental ratio for adverse perinatal outcomes in postdate pregnancies in Northwestern Nigeria.

Postdate pregnancy is a very common obstetric condition, increasing the risk of perinatal morbidity and mortality from uteroplacental insufficiency. To determine the predictive values of Doppler cerebroplacental ratio (CPR), that is, the ratio between middle cerebral artery (MCA) and UA pulsatility indices (UA PI), and other potential velocimetric predictors of adverse perinatal outcomes in women with postdated pregnancies. A prospective cohort study was conducted on consenting 212 low-risk pregnant women beyond 40 weeks' gestational age. The pulsatility indices of MCA, UA, and CPR as well as non-stress tests (NST) and amniotic fluid index (AFI) were measured and recorded. The women were divided into two groups based on the presence or absence of adverse perinatal outcome defined as: meconium stained liquor, meconium aspiration syndrome, perinatal asphyxia, cesarean section for suspected fetal distress, and perinatal death. : Of the 200 women whose data were available for analysis, 40 (20%) of them had adverse perinatal outcome and 160 (80%) had normal perinatal outcome. The CPR showed statistically significant difference in predicting adverse perinatal outcome (P < 0.001). CPR had a better predictive value than UA-PI and outperformed MCA-PI and NST for adverse perinatal outcomes. The sensitivity, specificity, negative predictive value (NPV), and accuracy of prediction of adverse perinatal outcomes by CPR were 90%, 81.25%, 97.01%, and 83%, respectively. The Doppler CPR shows the highest diagnostic accuracy in prediction of adverse perinatal outcome in pregnant women after 40 weeks' gestation than UA PI and velocimetric indices when used as stand-alone test.

Prenatal diagnosis of Galen vein aneurysm: when to deliver?

Objective: Prenatal diagnosis of Galen vein aneurysm using color Doppler has become relatively easy. Management and timing of delivery is however challenging because of cardiac function deterioration. Ultrasound follow-up is essential to detect signs of fetal cardiac failure which must be weighed against risks of prematurity. Postnatal deterioration of the vital signs can follow a short period of improvement after birth. This report illustrates the many pitfalls that could affect the final outcome, raising the issue of the proper timing for delivery. Case(s): A 23-year-old G1P0 spontaneous pregnancy was referred at 28 WA for a Galen Vein aneurysm. The ultrasound finding included a 35 by 14 mm vascular structure with a turbulent flow, occupying the central part of the head. After 48 hours in-hospital surveillance through non-stress tests twice daily, she had a cesarean section due to a persistent non-reactive fetal heart rate, with absent variability. Unfortunately, despite a stable state for the first ten days, the baby’s cardiac function deteriorated abruptly on day 11, and the baby died of heart failure despite medical management. Conclusion: The timing of delivery in cases with Galen vein aneurysm is challenging mainly in the case of premature babies, as the prognosis is globally bad. Postnatal deterioration of the vital signs can follow a short period of improvement after delivery.

Evaluation of the Active Nursing Management on the Nonreactive Nonstress Test of Antenatal Mothers Above 32 Weeks of Gestation

Introduction: Nonstress test (NST) is a part of routine monitoring of pregnant women before delivery. It is the most common and significant test performed for assessing the well-being of the fetus by observing the fetal heart rate and its acceleration in response to fetal movement. Objective: To evaluate the active nursing management on the nonreactive NST of antenatal mothers above 32 weeks of gestation. Material and Methodology: A descriptive study was conducted at an obstetrics and gynecology OPD of a tertiary care teaching hospital in Chandigarh, India, for a period from October to December 2020. Ethical approval was obtained from the Institute Ethics Committee, PGIMER, Chandigarh. The total sample for the study includes 60 antenatal mothers above 32 weeks of gestation, who were enrolled by enumeration sampling technique. The tools used for collecting the data were as follows: (1) interview schedule that comprised of (a) sociodemographic profile and (b) obstetric profile, and (2) NST graph and pro forma to record the result of NST. The NST was performed in the left lateral position for 20 min and extended to 40 min if desired results were not obtained. Antenatal mothers with nonreactive NST were given active nursing management, such as having breakfast/juice and ambulation/walking around. Again, a half-hour later, NST was repeated. A Philips Avalon FM 30 fetal monitor was used to record all the NST tracings. The results obtained were evaluated by the same obstetrician and gynecologist. Data were analyzed using IBM SPSS version 20. Result: Findings revealed that the majority (85%) of the antenatal mothers had a reactive NST, whereas 10% of antenatal mothers had a nonreactive NST. Out of the 6 (10%) antenatal mothers who were nonreactive, five antenatal mothers were changed into reactive NST after the active nursing management, i.e., maternal ambulation, having breakfast/juice for hydration after half-hour elapsed, whereas one antenatal mother who remained nonreactive NST was referred to a clean labor room after an abnormal ultrasound biophysical profile result by the obstetrician and gynecologist for induction of labor. Conclusion: It is concluded that NST is a significant test to prevent stillbirth. Active nursing management, such as maternal ambulation, well-fed, and well hydration, of the antenatal mothers can change the nonreactive NST to a reactive NST result.

Nonstress test and maximal vertical pocket vs the biophysical profile: Equivocal or equivalent?

Nonstress test and maximal vertical pocket vs the biophysical profile: Equivocal or equivalent?

Effect of Left Lateral Position combined with Zhiyin Point Acupressure on Maternofetal Physiological Parameters during Non-Stress Test

Effect of Left Lateral Position combined with Zhiyin Point Acupressure on Maternofetal Physiological Parameters during Non-Stress Test

Evaluation of the Effect of Acupressure, LV3 Point on Maternal Physiological Parameters and Non-Stress Testing of the Fetus

Evaluation of the Effect of Acupressure, LV3 Point on Maternal Physiological Parameters and Non-Stress Testing of the Fetus

Umbilical Cord Entanglement.

Umbilical Cord Entanglement.

The effect of motivational video and nutrition on the non-stress test: a randomised controlled clinical trial

This study aimed to determine the effect of motivational video stimulation and nutrition on the non-stress test (NST). The sample of the study consisted of 360 pregnant women in total, including two experimental groups and one control group (120 pregnant women in each group). After the pregnant women in the study were divided into three groups at a 1:1:1 ratio with the computer-assisted random sampling method, the draw method was used to determine the experimental and control groups. The pregnant women in the first experimental group were allowed to consume cake and juice 30 min before the NST procedure. The pregnant women in the second experimental group were also allowed to consume cake and juice, while they were also shown a video with the content of development and changes in the mother and the foetus during pregnancy, with relaxing music, for about 15–20 min. There was no intervention made in the control group. The data were collected using a Participant Information Form and an NST Findings Registry Form which were created by the researchers based on their review of the relevant literature. The data were analysed using arithmetic means, percentage distributions, ANOVA, Bonferroni and chi-squared tests. It was found that the mean number of foetal movements and the mean number of accelerations in the cake + juice and motivational video groups were higher than those in the control group (p < 0.001). Besides, the pregnant women in the experimental groups were found to have more reactive NST results. As a result, it was determined that the motivational video and cake + juice interventions improved the movement of the foetus, the number of accelerations and the ratio of reactivity in NST, but the two interventions did not have any superiority over each other. It is recommended to offer cake and juice to pregnant women before NST or have them watch a motivational video during NST, for having good NST results. Impact statement What is already known about the topic? The false-positive rates of the NST, which enables monitoring foetal movements and foetal heart rates, are high. These false-positive rates of the NST lead to many obstetric complications, in addition to increasing the rates of cesarean-section deliveries. Recent studies showed that there are methods and factors that increase foetal movements and shorten the application period of the NST. It was identified that food intake, music therapy, foetal vibroacoustic and halogen light stimulation before the NST increases foetal movements and shortens the application period of the NST. What this paper adds? In the study, it was found that watching motivational videos and consuming cake and juice increased the number of foetal movements, the number of accelerations and the rate of reactive NST results, but the two interventions did not have superiority over each other. What are the implications of these findings for clinical practice and/or further research? In order to increase reactive NST rates, it is recommended that pregnant women consume cake and fruit juice before the procedure and watch a motivational video during the NST procedure.

Results of expectant management in singleton and twin pregnancies complicated by preterm premature rupture of membranes.

This study aimed to examine whether expectant management in twin pregnancies with preterm premature rupture of membranes (pPROM) is as safe as in singleton pregnancies. It was a retrospective cohort study comparing pregnancy course and outcome in singleton (n = 299) and twin pregnancies (n = 49) complicated by preterm premature rupture of membranes. Analysed factors included maternal diseases, gestational age at premature rupture of membranes (PROM), management during hospitalization, latency periods between PROM and delivery, gestational age at delivery, neonatal management and outcome. The difference in the proportion of patients with latency up to 72 hours, latency between 72 hours and seven days, and latency exceeding seven days were insignificant. The percentage of patients who received intravenous tocolysis and antenatal corticosteroids were similar; however, patients in twin pregnancies more often received incomplete steroids dose (p = 0.01). The occurrence of the positive non-stress test result and signs of intrauterine infection were similar between the groups. No statistically significant differences in the prevalence of neonatal complications except transient tachypnoea of the newborn were identified (24% in the singleton vs 13% in the twin group, p = 0.03). Expectant management of pPROM in singleton and twin pregnancies results in similar perinatal and neonatal outcome. Consequently, in case of no evident contraindications, expectant management of twin pregnancies seems to be equally as safe as in singleton pregnancies. Patients in twin pregnancies may be at higher risk of delivery before administration of full antenatal corticosteroids dose, therefore require immediate management initiation and transfer to a tertiary referral centre.

Betamethasone versus dexamethasone on the fetal movement index in the women with preterm labor: A cross-sectional study

Background and aims: Biophysical evaluation of fetal profile and movements is a useful tool for assessing fetal health, which even has significant effects on neonatal health. This study aimed to compare the biophysical parameters of the profile – fetal movement index, in particular – before and after corticosteroid administration in two groups receiving dexamethasone and betamethasone. Methods: In this descriptive/analytical study, 200 patients diagnosed with preterm delivery and admitted to the gynecology section of Hajar Hospital in Shahrekord in 2016 were investigated. Their demographic findings and medical histories were collected using a checklist form. Then their biophysical profiles 24 to 48 hours after corticosteroid administration were assessed. Finally, the data were analyzed by SPSS v. 18 software using t test, chi-square and Fisher exact test. Results: According to our study results, there was a significant difference in fetal movements before and after receiving corticosteroids, and the decrease in the percentage of movements was greater in the betamethasone group (P&lt;0.001). Also, the biophysical profile was significantly different in the dexamethasone group compared to the betamethasone group (P&lt;0.001). No significant difference was found between two groups in terms of fetal respiration and non-stress test (NST) before and after receiving corticosteroids (P=0.47 and P=0.65, respectively). Conclusion: Dexamethasone administration had less effect on reducing fetal movement index than betamethasone administration. As the result, the biophysical profile was significantly different in the dexamethasone group compared to the betamethasone one.

Antenatal fetal surveillance of women with severe obesity

Objective To estimate the impact of body mass index (BMI) categories on duration of the nonstress test (NST), and the need for additional tests of fetal wellbeing or interventions. Methods We conducted a retrospective cohort study of women with singleton pregnancies who had an NST for the indications of severe obesity (BMI ≥40 kg/m2), diabetes (pre-gestational or gestational), hypertensive disorders (chronic, gestational, and preeclampsia), and others between 1 January 2015 until 31 December 2016. NST durations (<30 and ≥30 min) were compared between groups first based on BMI (kg/m2) categories (<30, 30–39, 40–49, and ≥50) and then based on BMI and comorbidities: (1) severe obesity alone, (2) severe obesity and comorbidities, and (3) comorbidities alone. We compared the results of the NSTs, any subsequent fetal testing or interventions, and pregnancy outcomes among groups. Demographic information was compared using t-tests for continuous data and χ 2 analyses or Fisher’s exact test, if the cells sizes were small, for categorical data. NST durations based on BMI groups, as well as BMI and comorbidities groups, were compared using linear mixed models and ANOVA. Results Three hundred and fifty-one women underwent 1665 NSTs during the study period. After excluding women <18 and >50 years, gestational age <30 weeks, fetal anomalies, and NSTs lasting longer than 60 min, the study population included 313 women and 1471 NSTs. The mean NST duration in minutes of the BMI ≥50 (32.2 ± 9.6) category was significantly longer than the NST duration of the other BMI categories (BMI <30: 29.4 ± 8.3; BMI 30–39: 29.7 ± 8.9; BMI 40–49: 29.9 ± 8.3) (p=.05). Additionally, there was an increased percentage of NSTs lasting ≥30 min as the BMI category increased (p=.005). Women in the severe obesity and comorbidities group (n = 79) were less likely to have a reactive NST than women with severe obesity alone (n = 56) or comorbidities alone (n = 178) (92% vs. 97% vs. 98%, p<.0001). They were also more likely to need a biophysical profile (BPP) (8% vs. 3% vs. 2%, p<.0001). Of the 25 women that were sent to the labor and delivery unit for evaluation, 20 (80%) were admitted and delivered. The reasons for delivery were hypertension (n = 9, 45%), an abnormal NST (n = 5, 25%), oligohydramnios (n = 4, 20%), and labor (n = 2, 10%). Conclusions We found an increase in NST duration as the BMI increased. Women with severe obesity and a comorbidity were more likely to have a nonreactive NST and require a subsequent BPP. Of the 20 patients delivered due to NST surveillance, the most common indication for delivery was hypertension.

Do different positions during a non-stress test affect the maternofetal physiological parameters and comfort in pregnant women?

A non-stress test (NST) is an essential diagnostic test performed during pregnancy to assess fetal well-being. It is a recording of fetal movements besides fetal heart rate, indicating fetal biophysiological well-being. As maternal physiology is altered in various positions, apt positioning during the NST is essential for accurate results while ensuring maternal comfort. This study aims to evaluate the effect of different maternal positions, left lateral and semi-fowler's, on NST reactivity, maternal blood pressure, heart rate, and comfort in pregnant women while performing the NST. This crossover study evaluated 50 healthy pregnant women between 32 and 40 weeks of gestation with no obstetric complications for the effect of maternal positions on maternofetal physiological parameters and comfort. The NST was performed for 20 min in each position with a washout period of 10 min. The maternofetal physiological parameters were recorded by a calibrated sphygmomanometer and the electrocardiograph interpretations. The maternal comfort was assessed using a maternal comfort rating scale (MCRS) for each position after the NST. Relevant descriptive and inferential statistics are applied to compute the results. Statistically, there was a significant difference in the mean maternal blood pressure and heart rate between the left lateral and semi-fowler's positions at 0 and 20 min (P = 0.001), whereas within the groups, in the same position at 0 and 20 min, no significant difference was found. There was no significant difference in NST reactivity (P = 0.79) in different positions. There was no significant difference between the MCR scores of women in either of the positions (Z = -1.64, df = 49, P = 0.100). Semi-fowler's position demonstrated favorable maternal blood pressure and heart rate during the NST in the third trimester of pregnancy, though it was clinically not significant. There was no significant difference in the comfort of women in both positions. Hence, either of the positions can be implemented in practice as an alternative position while performing the NST, based on the women's preference.

Effect of different maternal positions on comfort of antenatal mothers and fetal parameters during nonstress test.

Providing comfort to an antenatal mother is one of the critical components of the nonstress test (NST). An experimental study was conducted on 450 antenatal mothers beyond 34 weeks, who were randomly allocated into three groups - supine, left lateral, and semi-fowler's position, to explore the association of selected maternal positions on NST results and to find the impact of these positions on the comfort level of antenatal mothers. The fetal parameters were assessed by observing and recording biophysiological measurements from the NST and the maternal comfort of different positions by the Verbal Numerical Rating Scale. The data analyzed reveal a significant association between maternal positions and fetal parameters at P < 0.05 level. Antenatal women who were in semi-fowler's position exhibited more comfort and fetal NST reactivity as noted by significant variation in the baseline fetal heart rate, beat-to-beat variability, acceleration, deceleration, and fetal movements.

Maternal risk factors and perinatal outcomes inantenatally diagnosed oligohydramnios

Objective: Our study aims to study the maternal risk factors and perinatal outcomes in antenatally diagnosed oligohydramnios” Study design: Hospital based prospective observational study Methods and materials: The present study was a prospective observational study conducted at Dr L. H. Hiranandani Hospital from 01/09/16 to 30/03/18.This study was carried out after obtaining clearance from the institutional ethical committee. Antenatal women with singleton pregnancy registered / referred to our hospital at or beyond 28 weeks of gestation with clinically suspected oligohydramnios were screened. Thorough history taking, complete examination and baseline investigations were done for all the cases. Ultrasound examination was done for these women and AFI was calculated by four quadrant amniotic fluid volume measurement technique as described by Phelan, et al.1 A curvilinear transducer was used. By marking, the uterus was divided into four quadrants using the maternal sagittal midline vertically and an arbitrary transverse line approximately half way between the symphysis pubis and upper edge of uterine fundus. The transducer was kept parallel to the maternal sagittal plane and perpendicular to the maternal coronal plane throughout. The deepest, unobstructed and clear pocket of amniotic fluid was visualized and the image was frozen. The ultrasound calipers were manipulated in such a way that it measured the pocket in a strictly vertical direction. The process was repeated in each of the four quadrants. AFI was then calculated. Thus, antenatal women with singleton pregnancy at or beyond 28 weeks of gestation with decreased AFI (AFI < / = 8 cm) on ultrasonography were included in the study. Written informed consent was taken after explaining the purpose of the study. The study did not compromise with any treatment/care given routinely to them. Results: It was observed that a higher incidence of antenatal high risk factors and adverse perinatal outcome was seen in higher percentage of patients having severe oligohydramnios than that of borderline oligohydramnios. We observed that decreased AFI (AFI < / = 5 cm) was associated with increased incidence of induction of labour, atypical / abnormal NST, meconium staining of liquor, incidence of LSCS, low APGAR score at 5 minutes and NICU admissions. Amniotic fluid volume measured in terms of AFI is a good predictor of adverse perinatal outcome. Conclusion: Oligohydramnios is as an indicator of the possible presence of maternal factors e.g. gestational hypertension, fetal growth restriction (FGR), abruptio placentae. It is an indicator of poor perinatal outcome. Estimation of amniotic fluid volume should be a part of antenatal fetal surveillance. Amniotic fluid volume measured in terms of amniotic fluid index (AFI) is a helpful tool in determining patients at risk. Severe oligohydramnios, as compared to borderline oligohydramnios is significantly associated with pregnancy complications and perinatal morbidity and mortality such as increased incidence of induction of labour, atypical / abnormal non stress test (NST), Meconium staining of liquor, increased incidence of LSCS, Low APGAR score at 5 minutes, Increased NICU admissions. This highly significant statistical correlation between oligohydramnios and poor perinatal outcome suggests that AFI in adjunct with other methods of fetal surveillance can be used to identify patients at risk. Detailed history taking, experienced clinical judgment, strict antepartum and intrapartum surveillance can reduce perinatal complications.

Perinatal Outcome with Isolated Oligohydramnios in Term Pregnancies: A Case-control Study from a District Hospital of Southern India

Introduction: Oligohydramnios is an abnormality of amniotic fluid which is one of the common complications during pregnancy and a threat to foetal development. Often it is associated with maternal risk factors like uteroplacental insufficiency, hypertension and preeclampsia which by themselves can affect perinatal outcome. Aim: To determine the perinatal outcome in isolated oligohydramnios with Amniotic Fluid Index (AFI) ≤5cm at term pregnancies. Materials and Methods: This was a hospital-based prospective case-control study done in Department of Obstetrics and Gynaecology at District Hospital Tumakuru, Karnataka, India, from January 2019 to July 2020. The study included two groups i.e, case group included 150 pregnant females with Amniotic Fluid Index (AFI) ≤5 cm and control group included 150 pregnant females with AFI range between 6-24 cm. After interview of all participants, all the information was entered in the proforma. All newborn babies birth weight, APGAR scores (Appearance, Pulse, Grimace, Activity, and Respiration) at 1st and 5th minute was recorded. Categorical outcomes were compared between the groups using Chi-square test. A p-value &lt;0.05 was considered statistically significant. Results: The mean age was 23.16±3.09 years in case group and it was 23.42±2.99 years in control group, the difference of age between study group was statistically not significant (p-value=0.460). Abnormal doppler in 19.33% of cases versus 6% of controls (p-value&lt;0.001). Non reactive Non Stress Test (NST) was seen in 46.67% versus 10.67% in control group (p-value&lt;0.001). The foetal distress as a cause for caesarean section was seen in 64.8% cases group in comparison with 23.9% of control group. Low birth weight was found in 58.67% of cases versus 30% in control groups (p-value&lt;0.001). Low APGAR scores (&lt;7) were seen in 24.67% of case group versus 5.33% in control groups. The difference in the proportion of APGAR score at 5 minutes between study group was statistically significant (p-value&lt;0.001) Neonatal intensive care unit admissions were seen in 42.67% of cases versus 12.67% in controls (p-value&lt;0.001). Perinatal deaths was in 5.33% in cases versus 0.67% in controls (p-value=0.017). Conclusion: Isolated oligohydramnios was a significant risk factor during term pregnancies. Incidence of operative deliveries (instrumental vaginal delivery and caesarean section) is significantly increased in these patients with significant increase in perinatal morbidity and mortality.

Maternal Facial Nerve Palsy and a Perinatal Infection.

Maternal Facial Nerve Palsy and a Perinatal Infection.

Fetal outcome in pathological cardiotocography (CTG), omdurman maternity hospital

Objective: To determine the role of pathological cardiotocography in evaluating the fetal well-being. Methods: This is cross sectional hospital-based study. Results Our study included 100 with abnormal CTG, 72 (72%) of them were intrapartum and classified as pathological CTG, and 28 patients had their CTG during antenatal periods (Non-stress test), all of these 28 patients, were delivered by C/S (100%), with 25 (89.2%) babies cried immediately and 3(10.7%) cried after resuscitation, their Apgar scores at 1minute was &gt;8 in 25(89.2%) babies. Out of 72 intrapartum pathological CTG, 59(81.9) were delivered by C/S, 8 (11.1%) by Instrumental delivery and 5 (6.9%) through NVD, 21 (29.1%) of babies cried immediately, 46(63.8%) cried after resuscitation and 5(6.9%) their outcome was early neonatal deaths. Conclusion: CTG found to be important in evaluating the fetal well-being. Adjunctive methods are required to improve the sensitivity and specificity of fetal monitoring.

Experience with home-based, remote non-stress tests, including automatic decision support for interpretation of reactivity

The fetal non-stress test (NST) for antepartum surveillance involves frequent, burdensome in-office visits. INVUTM is a wireless, remote, FDA-cleared monitoring device, designed to perform self-administered NST from home. Here, we present (1) our initial experience with INVUTM home NST monitoring, and (2) a novel machine learning decision support system (DSS) to detect fetal heart rate (FHR) accelerations, with the potential to alert clinicians on NST reactivity. A single-center, prospective, open label study was conducted, in which women with ≥32 week high-risk singleton gestations performed self-administered NST using the INVUTM device at home, replacing in-clinic NSTs. NSTs were reviewed by clinicians via the INVUTM web application who determined clinically interpretability and reactivity. Interpretable sessions were retrospectively analyzed by the DSS for reactivity and compared to clinician assessment (Figure). The time to reactivity as analyzed by the DSS was compared to the session length until reactivity was determined by clinicians. Of the first 30 INVUTM sessions (across 9 subjects), clinicians deemed 27 (90%) interpretable, and 27/27 as reactive (100%). The DSS correctly classified 92.6% (25/27) of the interpretable NSTs compared with clinicians. In the 2 cases where DSS did not match the clinician decision, DSS did not rule the NST reactive, whereas the clinician did. On review, these cases may have been due to clinician averaging the FHR baseline from which accelerations are measured, compared to the conservative nature of the DSS. In the cases deemed reactive by DSS, time to reactivity was reduced by 14.72±13.79 min as compared to clinician determination. Early clinical experience conducting self-administered, remote NSTs at home using the INVUTM device supports the feasibility of bringing this telehealth solution to high risk pregnancy care. In addition, a novel DSS tool accurately identifies reactivity, which could reduce the length of NST sessions and improve clinician workflow.

Single sporadic deceleration during reactive nonstress test – clinical significance and risk for cesarean delivery

The nonstress test (NST) is a widely applied technique for antepartum fetal assessment despite a high false-positive rate. The evidence regarding the clinical significance of a single sporadic variable deceleration (SSD) in fetal heart rate (FHR) during reactive NST is scarce, and therefore, the optimal management of SSD in a term pregnancy without other signs of fetal compromise has not been established. Thus, we aim to evaluate whether SSD during a reactive NST at term is associated with a higher risk for FHR decelerations during labor and need for intervention.