Am J Perinatol
DOI: 10.1055/a-2184-1294
Original Article

Urgent Follow-up after Outpatient Nonstress Tests and the Potential for Fetal Monitoring at Home

Alissa Dangel
1   Mother Infant Research Institute, Tufts Medical Center, Boston, Massachusetts
,
Priyanka Shindgikar
2   Tufts University School of Medicine, Boston, Massachusetts
,
Andrew Polio
3   Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, Massachusetts
,
Janis L. Breeze
4   Tufts Clinical and Translational Science Institute, Tufts University, and Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
,
1   Mother Infant Research Institute, Tufts Medical Center, Boston, Massachusetts
› Author Affiliations
Funding This study was supported by the Tufts Medical Center COVID-19 Rapid Response Seed Funding Program. The project described was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, Award Number UL1TR002544 (U.S. Department of Health and Human Services, National Institutes of Health, National Center for Advancing Translational Sciences, Award no.: UL1TR002544; Tufts Medical Center COVID-19 Rapid Response Seed Funding Program).

Abstract

Objective This study aimed to measure the proportion of patients needing urgent clinical follow-up after an abnormal outpatient nonstress test (NST). We further sought to capture the patient perspective on the acceptability of performing NSTs at home.

Study Design A retrospective cohort study was performed over a 2-year period to determine the frequency of abnormal NSTs in a hospital-based, antepartum testing unit in patients greater than or equal to 32 weeks' gestation. The proportion of patients who delivered within 24 hours of an abnormal NST was also determined. A cross-sectional, web-based patient survey was conducted to obtain insight into the patient's comfort level with potentially performing NSTs at home.

Results The chart review yielded 665 patients who underwent 2,122 NSTs at greater than or equal to 32 weeks. Of the 2,122 NSTs, 111 were categorized as abnormal and required urgent clinical follow-up, or 5.2% (95% confidence interval [CI] 4.3, 6.3%). Of the 665 patients, 13 delivered within 24 hours of an abnormal NST, or 2.0% (95% CI 1.0, 3.3%). In the web-based survey, the proportion of respondents who would feel comfortable or very comfortable conducting NSTs at home was 87/125, or 69.6% (95% CI 60.9, 77.1%).

Conclusion This study revealed that 5.2% of NSTs performed in a hospital-based antepartum testing unit were abnormal and required urgent clinical follow-up. Of the patients being followed in the antepartum testing unit, 2.0% delivered within 24 hours of an abnormal NST. The majority of the survey respondents indicated they would feel comfortable performing NSTs at home. The present study adds important information regarding the risks and benefits of NSTs at home.

Key Points

  • Telehealth for NSTs offers advantages over in-person NSTs.

  • The proportion of NSTs that need urgent follow-up was 5.2%.

  • A majority of patients are interested in telehealth for NSTs.

  • Guidelines are needed before adoption of telehealth for NSTs.



Publication History

Received: 12 June 2022

Accepted: 26 September 2023

Accepted Manuscript online:
29 September 2023

Article published online:
01 November 2023

© 2023. Thieme. All rights reserved.

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  • References

  • 1 Antepartum Fetal Surveillance. Antepartum Fetal Surveillance: ACOG Practice Bulletin, Number 229. Obstet Gynecol 2021; 137 (06) e116-e127
  • 2 Boddy K, Dawes GS, Fisher R, Pinter S, Robinson JS. Foetal respiratory movements, electrocortical and cardiovascular responses to hypoxaemia and hypercapnia in sheep. J Physiol 1974; 243 (03) 599-618
  • 3 Manning FA, Platt LD. Maternal hypoxemia and fetal breathing movements. Obstet Gynecol 1979; 53 (06) 758-760
  • 4 Wosik J, Fudim M, Cameron B. et al. Telehealth transformation: COVID-19 and the rise of virtual care. J Am Med Inform Assoc 2020; 27 (06) 957-962
  • 5 Tamaru S, Jwa SC, Ono Y. et al. Feasibility of a mobile cardiotocogram device for fetal heart rate self-monitoring in low-risk singleton pregnant women. J Obstet Gynaecol Res 2021
  • 6 Zizzo AR, Hvidman L, Salvig JD, Holst L, Kyng M, Petersen OB. Home management by remote self-monitoring in intermediate- and high-risk pregnancies: a retrospective study of 400 consecutive women. Acta Obstet Gynecol Scand 2022; 101 (01) 135-144
  • 7 Jørgensen IL, Vestgaard M, Àsbjörnsdóttir B, Mathiesen ER, Damm P. An audit on a routine antenatal nonstress testing program in pregnant women with preexisting diabetes. Acta Obstet Gynecol Scand 2019; 98 (09) 1148-1156
  • 8 Ostlund E, Hanson U. Antenatal nonstress test in complicated and uncomplicated pregnancies in type-1-diabetic women. Eur J Obstet Gynecol Reprod Biol 1991; 39 (01) 13-18
  • 9 Landon MB, Langer O, Gabbe SG, Schick C, Brustman L. Fetal surveillance in pregnancies complicated by insulin-dependent diabetes mellitus. Am J Obstet Gynecol 1992; 167 (03) 617-621
  • 10 Figueroa R, Carroll L, Trymbulak KM, Wakefield D. Antenatal fetal surveillance of women with severe obesity. J Matern Fetal Neonatal Med 2022; 35 (25) 9288-9293
  • 11 Madden N, Emeruwa UN, Friedman AM. et al. Telehealth uptake into prenatal care and provider attitudes during the COVID-19 pandemic in New York City: a quantitative and qualitative analysis. Am J Perinatol 2020; 37 (10) 1005-1014
  • 12 Peahl AF, Smith RD, Moniz MH. Prenatal care redesign: creating flexible maternity care models through virtual care. Am J Obstet Gynecol 2020; 223 (03) 389.e1-389.e10
  • 13 Turrentine M, Ramirez M, Monga M. et al. Rapid deployment of a drive-through prenatal care model in response to the coronavirus disease 2019 (COVID-19) pandemic. Obstet Gynecol 2020; 136 (01) 29-32
  • 14 DeNicola N, Grossman D, Marko K. et al. Telehealth interventions to improve obstetric and gynecologic health outcomes: a systematic review. Obstet Gynecol 2020; 135 (02) 371-382
  • 15 Sense4baby® wireless maternal fetal monitoring, Advanced Maternity Innovations, Accessed March 15, 2022 at: https://www.advancedmaternityinnovations.com/products/sense4baby/
  • 16 Pushing the Boundaries of Care, Nuvo Inc, Accessed August 1, 2022 at: https://www.nuvocares.com/solutions