Antepartum cardiotocography

Antepartum cardiotocography remains a valuable adjunct in the management of the high-risk gravida. Twice weekly use of NST coupled with real-time ultrasound assessment of amniotic fluid volume appear reasonable approaches to testing. More controversial is the use of testing in all pregnancies. Clearly, if one could reduce the perinatal mortality to 1-2/1000, such universal application of testing could be justified. However, more pragmatic concerns, such as personnel and cost constraints have all but prohibited the adoption of this policy. Secondly, in an attempt to improve the predictive reliability of antenatal testing additional evaluation of patients demonstrating diminished AFV or variable decelerations should be considered. More frequent testing or consideration for delivery are reasonable management plans. Finally, the use of acoustic stimulation to reduce the frequency of persistently non-reactive NSTs offers considerable promise. Investigations in this and other techniques of surveillance are ongoing. The best single method remains to be discovered, but utilization of current techniques offers the obstetrician a reliable technique by which to assess fetal well-being.