Temporal and Spatial Epidemiology of Monkeypox (Mpox) in Plateau State of Nigeria

Abstract

Non-stress testing (NST) is one of the basic antepartum surveillance tests. It is being used as a tool for triage and intrapartum management in high-risk pregnancies; however, its utility and diagnostic performance as an admission test should be continually evaluated to optimize intrapartum management, triage, and prediction of perinatal outcomes.

To assess the use of the admission NST as a screening tool in high-risk pregnancies and find its correlation with intrapartum events, mode of delivery, and composite adverse perinatal outcomes.

They did an observational study of 107 high-risk pregnant women who were admitted for delivery. An admission NST was performed and classified into reactive or non-reactive, using the standard cardiotocographic parameters. Maternal, intrapartum, and perinatal outcomes were compared between the two groups. Diagnostic performance parameters (sensitivity, specificity, positive or negative predictive values) were computed, and a multivariable logistic regression analysis was used to determine the independent risk factors for adverse composite perinatal outcomes.

The 107 participants had a reactive admission NST (78.5%, n=84) and a non-reactive NST (21.5%, n=23). Operative deliveries were significantly higher in the non-reactive group (73.9% vs. 26.2%), and the rates of meconium-stained amniotic fluid (56.5% vs. 14.3%) and intrapartum fetal heart rate abnormalities (69.6% vs. 11.9%) were also significantly higher (all p < 0.001) in the non-reactive group. The non-reactive group had a higher rate of adverse composite perinatal outcomes (78.3%) than the reactive group (17.9%) (p < 0.001). The overall sensitivity, specificity, PPV, and NPV of the admission NST were 54.5%, 93.2%, 78.3%, and 82.1%, respectively, and the overall diagnostic accuracy was 81.3%. The non-reactive admission NST was the most important independent predictor of the adverse composite perinatal outcome (adjusted OR 11.42, 95% CI 3.28–39.75; p < 0.001) in multivariable logistic regression.

Admission NST is an important specific test which can be used to predict bad perinatal outcomes in high-risk pregnancies. A non-reactive NST is highly indicative of higher intrapartum fetal compromise, operative procedures, and bad neonatal outcomes. These results highlight the importance of the admission NST for clinical triage, risk stratification, and intrapartum decision-making process in high-risk obstetric populations.