Comparison of Antepartum Tests and the Relationship of Multiple Test Results to Perinatal Outcome

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Abstract
Seventy-four patients with a suspected small-for-gestational age fetus or with decreased amniotic fluid had 639 tests performed with the fetus acting as its own control. These separate tests were the modified biophysical profile (BPS), a nonstress test (NST), a modified spontaneous contraction test (CST) or an oxytocin challenge test if spontaneous contractions were absent, and Doppler velocimetry. Each test was compared to the other, without reference to outcome, to determine inter- and intratest differences for this selected population. Serial testing or multiple tests at the same visit reduce the potential error in interpreting results that are due to test variability. Similar results were obtained in the second part of the study when outcomes were matched to the multiple test results. For example, by combining the NST and CST with the BPS, the sensitivity for morbidity was 91% compared to 73% for the modified BPS. The use of all four tests increased the sensitivity and improved the predictive value for perinatal morbidity when any two or more test combinations were abnormal (39% vs. 10%). The advantage of multiple testing for this highly selected group is to improve the predictive value if more than one test is abnormal, while the increased sensitivity of combined tests can be used most effectively to exclude fetal compromise when all the results are normal.

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