Movement and pulse index: A clinical prediction model to improve fetal surveillance

Background: Fetal health assessment aims to identify fetuses at risk for stillbirth or neonatal mortality but the poor validity of the current tests can lead to iatrogenic intervention. Most tests are high-technology, which limits their use in low resources settings. In 2009, an NIH committee identified the need for innovation in antenatal testing, with specific attention toward fetal movement assessments and novel combinations of test results. Methods: Our team piloted two innovative combined tests: 1) Movement and Pulse index (MAPi), a clinical prediction model that uses appropriate statistical methods to combine novel and extant indicators of fetal well-being and 2) MobileMAPi, a low-cost, low-technology model for use in low-resource settings. We studied pregnant women receiving standard antenatal testing (NST: Non-Stress Test, AFI: Amniotic Fluid Index), and added a newly developed Fetal Movement and Behavior Log and the Auscultated Acceleration Test (AAT), a low-technology test developed in 1986 by midwives as an innovation in low-technology fetal assessment. Results: 51 participants were recruited into our pilot study, for a total of 194 AATs, 97 NSTs, and 55 AFIs performed, and 260 completed Fetal Behavior and Movement Logs. The rate of neonatal morbidity was 5.3%, and the rate of cesarean delivery was 34.2%. Pilot results confirmed feasibility for combining parameters from each assessment modality to develop MAPi and MobileMAPi, and will inform our subsequent research in this area. Conclusion: Mapi and MobileMAPi are innovations that could reduce stillbirth rates and maternal-newborn morbidity, and enhance the availability of fetal surveillance methods in low-resource settings.