Auscultated fetal heart rate accelerations. III. Use of vibratory acoustic stimulation.
The auscultated acceleration test has been proposed as a simple, inexpensive screening test for fetal health; previous studies of the auscultated acceleration test used external stimulation to elicit fetal movement. This study was conducted to explore the ability of the auscultated acceleration test to predict nonstress test results when vibratory acoustic stimulation is used to elicit fetal reactivity. After antepartum nonstress testing on 100 gravid women between 28 and 43 weeks' gestation, a 6-minute auscultated acceleration test protocol was performed with two vibratory acoustic stimulations to the maternal abdomen if no spontaneous fetal heart rate acceleration occurred. The ability of the auscultated acceleration test to predict nonstress test results after selected variables were controlled for was as follows: sensitivity, 75%; specificity, 97.6%; false-positive results, 14.3%; and false-negative results, 4.7%. Logistic regression analysis indicated that, in addition to the auscultated acceleration test, gestational age and race contributed significantly to the prediction of nonstress test results. Although specificity and the false-positive rate were improved, the use of vibratory acoustic stimulations to elicit fetal movement did not improve the validity of the auscultated acceleration test in terms of sensitivity and false-negative results over previous studies. However, the auscultated acceleration test continues to show potential as an initial screening test for fetal assessment. In addition to recommendations for further research, methodologic issues related to sampling techniques are identified.
Paine
L L
LL
Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD.
Johnson
T R
TR
Alexander
G R
GR
D000161:Acoustic Stimulation; D000293:Adolescent; D000328:Adult; D005069:Evaluation Studies as Topic; D005260:Female; D005318:Fetal Heart; D005544:Forecasting; D006326:Heart Auscultation / Q000379:methods*; D006334:Heart Function Tests; D006339:Heart Rate; D006801:Humans; D011247:Pregnancy; D014732:Vibration