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

Abstract

Objective: The objective of this study was to measure the proportion of patients needing urgent clinical follow-up after an abnormal outpatient non-stress test. We further sought to capture the patient perspective on the acceptability of performing non-stress tests at home. Study Design: A retrospective cohort study was performed over a two-year period to determine the frequency of abnormal non-stress tests 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 non-stress test was also determined. A cross-sectional, web-based patient survey was conducted to obtain insight into the patient’s comfort level with potentially performing non-stress tests at home. Results: The chart review yielded 665 patients who underwent 2,122 non-stress tests at greater than or equal to 32 weeks. Of the 2,122 non-stress tests, 111 were categorized as abnormal and required urgent clinical follow-up, or 5.2% (95% confidence interval 4.3%, 6.3%). Of the 665 patients, 13 delivered within 24 hours of an abnormal non-stress test, or 2.0% (95% confidence interval 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 5.2% of non-stress tests 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 non-stress test. The majority of the survey respondents indicated they would feel comfortable performing non-stress tests at home. The present study adds important information regarding the risks and benefits of non-stress tests at home.