Role of Admission test in predicting foetal outcome in low and high risk pregnancies

Introduction: Unfortunately, risk assessment profiles used at present are insufficient. Intrapartum mortality and morbidity are not uncommon in the low risk pregnancies also. FHR and fetal acidosis can occur with the same frequency as in a High risk group. Hence, there is a need for a simple, effective screening test to identify the pregnancies requiring continuous EFM. Materials and Methods: This study is a prospective study comprising of 200 singleton pregnancies with cephalic presentation in early labour admitted to the labour room. Following Admission, the Admission test was done and the results were classified based on the three tier Heart interpretation system recommended by the 2008 NICHD Workshop on EFM as Reassuring, Nonreassuring and Ominous. The patients were then followed up and the mode of delivery and the different variables of perinatal outcome noted and correlated with the Admission test results. Results: The Low risk group had 88% Reassuring, 8% Nonreassuring and 4% Ominous Admission Test patterns. The High risk group had 80% Reassuring, 11% Nonreassuring and 9% Ominous Admission Test patterns. The study showed that operative deliveries were more significantly associated with Non reassuring and Ominous Admission test patterns especially in the High risk group. Admission test showed Sensitivity of 60%, Specificity of 90.86%, PPV 48.39% and NPV of 94.08%. Conclusion: Admission test can be used as an important non-invasive method to diagnose fetal compromise present at the time of admission in both high as well as low risk patients in labour.