ANTEPARTUM SURVEILLANCE FOR A HISTORY OF STILLBIRTH - WHEN TO BEGIN

OBJECTIVE: A history of stillbirth is universally accepted as an indic ation for antepartum fetal heart rate testing. Our goal was to examine when fetal testing should begin in an otherwise healthy patient with a history of stillbirth.STUDY DESIGN: This is a nonconcurrent cohort s tudy of patients who were seen for antepartum surveillance from Januar y 1979 to December 1991 with a history of stillbirth as the only indic ation for testing. Subsequent pregnancies were evaluated for adverse o utcomes and abnormal antepartum test results. RESULTS: There was one c ase of recurrent stillbirth among the 300 study patients. Nineteen pat ients (6.4%) had one or more positive antepartum surveillance tests (p ositive contraction stress test or biophysical profile less than or eq ual to 4). Three patients (1%) had positive tests before 32 weeks, all of whom were subsequently delivered without incident at term. Three p atients were delivered for positive tests at <36 weeks, one by cesarea n section for fetal distress. We could not detect a relationship betwe en the gestational age of the previous stillborn and the incidence of abnormal tests or fetal distress in subsequent pregnancies. CONCLUSION : Antepartum surveillance should begin at greater than or equal to 32 weeks in the healthy pregnant woman with a history of stillbirth.