Antepartum testing

Among the methods of antepartum testing in use today, the nonprovocative tests (NST, BPP, MBPP) are safe and effective for use in ambulatory settings. Outpatient or office utilization of the CST is limited by the need for intravenous access (when oxytocin is used) and by the potential for uterine hyperstimulation and resultant acute FHR abnormalities. Regardless of the method of testing used, large studies have confirmed that the fetal death rate among patients undergoing antepartum testing is significantly lower than that in the general, untested population. This is a particularly encouraging observation in view of the fact that antepartum testing is used almost exclusively in complicated pregnancies at highest risk for poor outcome. In the future, protocols using adjunctive testing methods (fetal movement counting, fetal movement profile, Doppler velocimetry) in combination with standard methods (CST, NST, BPP, MBPP) may further reduce the incidence of fetal death in high-risk populations. At present, the beneficial effects of antepartum testing have created a situation in which the likelihood of fetal death in high-risk, tested populations is lower than that in low-risk, untested populations. This paradox will force us to consider the option of routine antepartum testing in all pregnancies.