Evaluation of current antepartum fetal tests

Three hundred high-risk pregnancies of at least 28 weeks' gestation were included in this prospective descriptive study. Fetal movement count was performed daily. Maternal perception of sound provoked fetal movement (MPSPFM), fetal acoustic stimulation test (FAST), amniotic fluid index (AFI) and doppler umbilical artery pulsatility index were tested weekly until delivery. All fetal testing performed within a week of delivery was compared with fetal outcome. Fetal outcome was considered poor when there was perinatal death, intrapartum fetal distress, a five minute Apgar score of less than 7, thick meconium-stained amniotic fluid or admission to the neonatal intensive care unit. Seventeen pregnancies were considered poor outcome (prevalence of 5.7%). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and Kappa index (KI) of each test to predict poor fetal outcome were evaluated. A combination of FAST and AFI is the most reliable antepartum fetal test. The sensitivity, specificity, positive predictive value, negative predictive value, accuracy and Kappa index of the combination of FAST and AFI were 70.0%, 99.6% 87.5%, 98.8%, 98.5% and 0.77%, respectively.