Abstract
Objective This study was conducted to determine the difference in the number of pregnancies
that would qualify for outpatient fetal testing between our current academic practice
and that of the 2021 American College of Obstetricians and Gynecologists (ACOG) antepartum
recommendations.
Study Design We performed a retrospective study of all pregnancies that delivered and received
prenatal care at our institution between January 1, 2019, and May 31, 2021. The timing
and amount of outpatient antepartum testing was determined for each patient. Our current
antepartum testing guidelines (clinic protocol) were compared with the 2021 ACOG recommendations
(ACOG protocol). Statistical analysis was performed with descriptive statistics and
z scoring to compare the total amount of antepartum testing utilized with each protocol.
Results A total of 1,335 pregnancies were included in the study. With the ACOG protocol,
an additional 310 (23.2%) of pregnancies would qualify for antepartum testing (57.8%
with ACOG protocol vs. 34.6% with clinic protocol). Most of the increased testing
was due to maternal age with additional risk factors, hypertensive disorders, diabetes,
prepregnancy body mass index ≥ 35, and complex fetal anomalies or aneuploidies. Overall,
the ACOG protocol would require an additional 570 antepartum tests (z-score = 4.04, p = 0.000005) over the study period, which is equivalent to 19 additional tests per
month and 5 per week. Only nine stillbirths occurred during this time, of which two
would have had antepartum testing with both protocols, one would have only had testing
per ACOG, and two would have had testing individualized per ACOG.
Conclusion More pregnancies would require outpatient antenatal testing with adoption of the
ACOG protocol. A 23% increase in testing would equate to five additional antepartum
tests per week. Although this study cannot assess the clinical impact of additional
testing, minimal scheduling resources are needed to accommodate this increase.
Key Points
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Most pregnancies have risk factors for stillbirth.
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Most pregnancies qualify for fetal testing per ACOG.
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More resources are needed for this increased testing.
Keywords
pregnancy - fetal monitoring - stillbirth - resources - protocols - high risk
