Intrapartum assessment of fetal well-being: any role for a fetal admission test?
OBJECTIVE
To determine whether the fetal admission test is predictive of intrapartum complications.


METHODS
We studied the fetal heart rate tracings of women in spontaneous labor at 37-42 weeks' gestation from 1 November 2001 to 31 March 2002. The study population was subdivided based on reactivity defined as > or = 15 beats/min for > or = 15 s, reactivity redefined as > or = 10 beats/min for > or = 10 s, variability, presence of late and/or variable decelerations, and reassuring fetal admission test; and compared for various labor outcome variables. Student's t test, the chi2 test and Fisher's exact test were used for analysis.


RESULTS
A total of 426 women met our inclusion criteria. There were no differences between groups when compared for maternal age, parity, gestational age, birth weight, labor analgesia and length of labor. Irrespective of the definition of reactivity, women with a non-reactive fetal admission test were more likely to be delivered by Cesarean section, to have fetal distress resulting in Cesarean section and to have a longer neonatal hospital stay. In addition, redefining reactivity improved the specificity, positive and negative predictive values, accuracy, relative risk and likelihood ratio with regard to development of fetal distress. Similar results were obtained when variability and decelerations were used as criteria for comparisons.


CONCLUSIONS
The fetal admission test is useful in predicting the absence of intrapartum fetal distress irrespective of the criterion used for evaluation. Redefined reactivity appears to be most predictive of intrapartum fetal distress.
Elimian
A
A
Department of Obstetrics, Gynecology and Reproductive Medicine, State University of New York at Stony Brook, Stony Brook, New York 11794-8091, USA.
Lawlor
P
P
Figueroa
R
R
Wiencek
V
V
Garry
D
D
Quirk
J G
JG
D000328:Adult; D015148:Cardiotocography; D002585:Cesarean Section / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D005316:Fetal Distress / Q000175:diagnosis* / Q000628:therapy; D005328:Fetal Viability; D006801:Humans; D007743:Labor, Obstetric; D007902:Length of Stay / Q000706:statistics & numerical data; D016013:Likelihood Functions; D011237:Predictive Value of Tests; D011247:Pregnancy; D012189:Retrospective Studies; D012680:Sensitivity and Specificity