Antepartum electronic fetal monitoring interpretation: multicenter observational study.
4 affiliations
- 1Complejo Hospitalario Dr. AAM (CSS), Hospital Materno Infantil, Ciudad de la Salud (CSS), Panama City, Panama. [email protected].
- 2Complejo Hospitalario Dr. AAM (CSS), Hospital Materno Infantil, Ciudad de la Salud (CSS), Panama City, Panama.
- 3Hospital Regional Dr. Rafael Estévez (CSS), Aguadulce city, Panama.
- 4Department of Obstetrics and Gynecology, Complejo Hospitalario Dr. Manuel Amador Guerrero , Colón city, Panama.
Abstract
Background
Antepartum EFM is the most widely used method worldwide to evaluate fetal well-being. However, neither NST nor other surveillance techniques can precisely determine the onset or degree of fetal hypoxemia and acidemia. The presence of accelerations seems to reflect fetal well-being; however, their absence does not predict fetal compromise. Evidence regarding the perinatal prognosis of normal NSTs with one or no accelerations compared with those classified as reactive remains insufficient.Objective
To compare perinatal outcomes of the non-stress test (NST) interpreted by the usual reactive/non-reactive criterion versus the NST reported as "fetal well-being preserved" when there is one or no fetal heart rate (FHR) acceleration with moderate variability.Methods
Multicenter, non-randomized, observational, comparative non-inferiority study evaluating two different NST interpretation criteria, conducted in Panama among high-risk pregnant patients with ≥ 34 weeks' gestation. A reactive NST was defined as a tracing with baseline FHR 110-160 beats per minute, variability 6-25 [beats/min], no bradycardia, and at least two accelerations within 20 min. When one or no acceleration was present while the other criteria were maintained, the NST was defined as showing "fetal well-being preserved" (normal/reassuring).Results
We analyzed 1,206 NSTs from 699 patients. There were no significant differences in gestational age at birth, time elapsed since the first NST, mode of delivery, 1- and 5-minute Apgar scores, or the presence of variable decelerations. No perinatal death was associated with follow-up by NST report. Twelve cases (0.99%) were reported as abnormal at the second NST performed 7 days after the initial NST. In those cases, no perinatal deaths occurred; two cases had a 5-minute Apgar < 7, one in each reporting group. Across the entire population, there were 6 deaths with no significant differences related to the initial NST reporting category.Conclusion
This observational non-inferiority study reporting the NST as reactive (≥ 2 accelerations) or as fetal well-being preserved/reassuring (normal variability with ≤ 1 acceleration) yields no large differences in fetal well-being outcomes.
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BibTeX
@article{gracia2026antepartum,
title = {{Antepartum electronic fetal monitoring interpretation: multicenter observational study.}},
author = {Paulino Vigil-De Gracia and Colisandra Robledo Paz and Cristobalina Campos Ávila and Katia González and Gioconda Sáenz and Alfonso Gómez and Ricardo Mock},
journal = {BMC pregnancy and childbirth},
year = {2026},
month = jul,
doi = {10.1186/s12884-026-09711-z},
url = {https://europepmc.org/article/MED/42907762},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Antepartum electronic fetal monitoring interpretation: multicenter observational study.
AU - Paulino Vigil-De Gracia
AU - Colisandra Robledo Paz
AU - Cristobalina Campos Ávila
AU - Katia González
AU - Gioconda Sáenz
AU - Alfonso Gómez
AU - Ricardo Mock
PY - 2026
DA - 2026/07/01
JO - BMC pregnancy and childbirth
DO - 10.1186/s12884-026-09711-z
UR - https://europepmc.org/article/MED/42907762
AB - Background Antepartum EFM is the most widely used method worldwide to evaluate fetal well-being. However, neither NST nor other surveillance techniques can precisely determine the onset or degree of fetal hypoxemia and acidemia. The presence of accelerations seems to reflect fetal well-being; however, their absence does not predict fetal compromise. Evidence regarding the perinatal prognosis of normal NSTs with one or no accelerations compared with those classified as reactive remains insufficient.Objective To compare perinatal outcomes of the non-stress test (NST) interpreted by the usual reactive/non-reactive criterion versus the NST reported as "fetal well-being preserved" when there is one or no fetal heart rate (FHR) acceleration with moderate variability.Methods Multicenter, non-randomized, observational, comparative non-inferiority study evaluating two different NST interpretation criteria, conducted in Panama among high-risk pregnant patients with ≥ 34 weeks' gestation. A reactive NST was defined as a tracing with baseline FHR 110-160 beats per minute, variability 6-25 [beats/min], no bradycardia, and at least two accelerations within 20 min. When one or no acceleration was present while the other criteria were maintained, the NST was defined as showing "fetal well-being preserved" (normal/reassuring).Results We analyzed 1,206 NSTs from 699 patients. There were no significant differences in gestational age at birth, time elapsed since the first NST, mode of delivery, 1- and 5-minute Apgar scores, or the presence of variable decelerations. No perinatal death was associated with follow-up by NST report. Twelve cases (0.99%) were reported as abnormal at the second NST performed 7 days after the initial NST. In those cases, no perinatal deaths occurred; two cases had a 5-minute Apgar < 7, one in each reporting group. Across the entire population, there were 6 deaths with no significant differences related to the initial NST reporting category.Conclusion This observational non-inferiority study reporting the NST as reactive (≥ 2 accelerations) or as fetal well-being preserved/reassuring (normal variability with ≤ 1 acceleration) yields no large differences in fetal well-being outcomes.
SN - 1471-2393
ER -