Perinatal outcome in the absence of antepartum fetal heart rate acceleration

The perinatal outcome of 27 pregnancies in which antepartum fetal activity testing revealed fetal heart rate acceleration to be either absent or less than 10 beats per minute for 80 minutes is presented. At delivery, each pregnancy was found to have one or more features consistent with uteroplacental insufficiency. These included fetal growth retardation (74%), oligohydramnios (81%), fetal acidosis (41%), meconium (30%), and placental infarction (93%). There were four fetal and seven neonatal deaths, for a perinatal mortality of 41%. Despite delivery of all live-born infants by cesarean section without labor, the infants who died during the neonatal period appeared to be in such poor condition as to preclude survival. The authors conclude that the inability of the fetus to accelerate its heart rate, when not due to maternal medications, is an ominous signal. Throughout the literature on fetal activity testing there are indications that other investigators have had similar experiences. The purpose of the present report is to direct attention to an abnormal fetal activity test result of which the significance is not widely recognized.