A controlled trial of self-nonstress test versus assisted nonstress test in the evaluation of fetal well-being.
OBJECTIVE
New portable devices have become available for home monitoring of fetal heart rates; these devices have the potential to immediately transmit these tracings to a medical facility. The null hypothesis of this study is the inability of mothers to perform their own nonstress tests (self-nonstress tests) and that such tests are not comparable to those performed by professional medical personnel (assisted nonstress tests).


METHODS
The feasibility of maternal self-testing was established in 50 high-risk patients followed by a controlled clinical trial conducted in 60 patients. The latter study represents the first controlled trial in which patients performed self-nonstress tests at their homes and transmitted the tracings via telecommunication to our perinatal unit. In all cases these patients came to our hospital within 60 minutes after the self-nonstress tests to have a perinatal nurse perform a second nonstress test. The pairs of self and assisted fetal heart rate tracings were independently reviewed by two investigators.


RESULTS
The self and assisted tracing pairs were judged satisfactory for interpretation in 100% and 90%, respectively; self and assisted were interpreted by each examiner to be nonreactive in 20% and 14%, respectively. However, both examiners were unable to distinguish between tracings generated by assisted nonstress and self-nonstress tests. Furthermore, cost analysis revealed an estimated twofold savings with self-nonstress testing compared with the assisted nonstress test.


CONCLUSIONS
Self-nonstress testing is a reliable and accurate method of antepartum fetal heart rate testing. This method of fetal assessment not only introduces a new approach to fetal surveillance with added convenience to patients, but may also significantly reduce medical cost without compromising the results of fetal testing.
Reece
E A
EA
Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut.
Hagay
Z
Z
Garofalo
J
J
Hobbins
J C
JC
D003365:Costs and Cost Analysis; D005240:Feasibility Studies; D005260:Female; D005323:Fetal Monitoring / Q000191:economics / Q000379:methods; D006340:Heart Rate, Fetal; D006801:Humans; D011247:Pregnancy; D016353:Self-Examination / Q000191:economics / Q000379:methods