Vibro-acoustic stimulation in high-risk pregnancies; maternal perception of fetal movements, fetal heart rate and fetal outcome.
Maternal perception of fetal movement in response to vibro-acoustic stimulation was compared with antenatal fetal heart rate monitoring as a test of fetal well-being in a population of gravidae with high-risk pregnancies (n = 517), admitted to the high-risk ward at Danderyd Hospital, Karolinska Institutet; a total of 2,015 tests were performed. The sensitivity and the specificity of the test compared to the fetal heart rate tracing was 81% and 89% respectively. If the test was performed within 24 hours of delivery, its predictive value for fetal asphyxia (i.e. a 5-minute Apgar score < 7) was 14% (7/49). Ten per cent of the patients felt no fetal movement in response to stimulation (irrespective of gestational age). In five cases where fetal heart rate tracings were pathological, stimulation nonetheless produced fetal movement and fetal outcome was good. Pathological heart rate tracings and no fetal movement in response to stimulation were present in 30 cases (out of 251 with no fetal movements at stimulation), in seven of which the infants had 5-minute Apgar scores < 7. Although many patients underwent repeated vibro-acoustic stimulation, there was no evidence of fetal habituation to the test. On 24 occasions (i.e. 1.2%), the patient denied vibro-acoustic stimulation, mostly because of previous discomfort due to vigorous fetal response. Where resources are limited, maternal perception of fetal movements in response to vibro-acoustic stimulation might be a useful alternative for preliminary screening of high-risk pregnancies.
Nyman
M
M
Department of Obstetrics and Gynaecology, Karolinska Institutet, Danderyd Hospital, Sweden.
Arulkumaran
S
S
Jakobsson
J
J
Westgren
M
M
D000161:Acoustic Stimulation; D000293:Adolescent; D000328:Adult; D001034:Apgar Score; D005260:Female; D005323:Fetal Monitoring / Q000379:methods*; D005324:Fetal Movement; D006340:Heart Rate, Fetal; D006801:Humans; D008875:Middle Aged; D011237:Predictive Value of Tests; D011247:Pregnancy; D012306:Risk; D012680:Sensitivity and Specificity; D014732:Vibration