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A COMPARISON OF TWO TIME INTERVALS FOR THE AUSCULTATED ACCELERATION TEST

Authors

  • Lisa L. Paine CNM, DrPH, FAAN, FACNM,

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    • Lisa L. Paine is a professor and chair of the Department of Maternal and Child Health at the Boston University School of Public Health, and professor of Obstetrics and Gynecology at the Boston University School of Medicine, Boston, Massachusetts. Dr. Paine was an assistant professor, Gynecology and Obstetrics, at the Johns Hopkins School of Medicine, and director of Nurse-Midwifery Services, Johns Hopkins Hospital, Baltimore, Maryland, at the time the study reported herein was conducted. Dr. Paine and her colleagues began development of the auscultated acceleration test (AAT) in the mid-1980s and their first reports about this work were published in the Journal of Nurse-Midwifery in 1988. Dr. Paine is editor-in-chief of the Journal of Midwifery & Women's Health.

  • Lynn R. Zanardi MD, MPH,

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    • Lynn R. Zanardi is a medical epidemiologist at the Child Vaccine-Preventable Diseases Branch of the National Immunization Program at the Centers for Disease Control and Prevention in Atlanta, Georgia. Dr. Zanardi is a graduate of the Maternal and Child Health Leadership Program at the Boston University School of Public Health, and she serves as an editorial consultant for the Journal of Midwifery & Women's Health.

  • Timothy R. B. Johnson MD,

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    • Timothy R. B. Johnson is professor and chair of the Department of Obstetrics and Gynecology at the University of Michigan School of Medicine in Ann Arbor, Michigan. At the time of this study, Dr. Johnson, one of the original AAT research team, was medical director of the Fetal Assessment Center at the Johns Hopkins Hospital where the study took place. Dr. Johnson is a member of the board of trustees of the ACNM Foundation, Inc., and is an editorial consultant for the Journal of Midwifery & Women's Health.

  • Jo-Anna L. Rorie CNM, MSN, MPH, FACNM,

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    • Jo-Anna L. Rorie is assistant professor, Maternal and Child Health, and associate director of the Nurse-Midwifery Education Program at the Boston University School of Public Health, Boston, Massachusetts. She is member of the board of trustees of the ACNM Foundation, Inc., and currently serves as an associate editor for the Journal of Midwifery & Women's Health. Ms. Rorie presented this research at the ICM meeting in Phillipines in May, 1999.

  • Mary K. Barger CNM, MPH, DSc(c), FACNM

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    • Mary K. Barger is assistant professor, Maternal and Child Health, and director of the Nurse-Midwifery Education Program at the Boston University School of Public Health, Boston, Massachusetts. She is also a doctoral candidate in epidemiology at the Boston University School of Public Health, and an associate editor for the Journal of Midwifery & Women's Health.


  • Note: Adapted from a paper, co-authored by LL Paine, MK Barger, JL Rorie, LR Zanardi and TRB Johnson which was presented by Jo-Anna L. Rorie at the 25th Triennial Congress of the International Congress of Midwives, May 22-27, 1999, Manila, Phillipines.

Department of Maternal and Child Health, Boston University School of Public Health, 715 Albany Street, T5W, Boston, MA 02118-2526.

ABSTRACT

Objective: Interest in an inexpensive, easy-to-administer antenatal screening test that did not rely on the use of electronic fetal monitoring led to development of the fetoscope administered auscultated acceleration test (AAT) in the late 1980s. More recent efforts have been directed toward providing those who may use the AAT with important information about the most effective and clinically appropriate AAT procedures. The purpose of this study was to determine the screening test validity performance of two AAT time intervals—6 minutes and 10 minutes.

Methods: Two auscultated acceleration tests (AAT6 and AAT10) were simultaneously performed using different time intervals on 205 women with high-risk pregnancies undergoing simultaneous nonstress tests (NSTS) who were referred to a tertiary care unit for antepartum testing. Standard measurements of screening test validity were calculated for each test in the prediction of selected perinatal outcomes. NST findings were included for comparative purposes.

Results: The AAT6 yielded an overall higher specificity as compared with the AAT10 at the expense of a slightly lower sensitivity for most perinatal outcomes; these differences were not significant at the .05 level. Relative risk ratios were similar for the AAT6 and AAT10 for both fetal distress and neonatal morbidity, with both AAT being a more effective predictor of neonatal morbidity than for fetal distress. Both tests yielded better sensitivity when compared with NST.

Conclusions: Even though there was a nonsignificant trend toward higher sensitivities and lower specificities for the 10-minute AAT, this study showed that the differences in prediction of perinatal outcomes between the 6-minute and 10-minute AAT were minimal. In view of the added labor required for the 10-minute AAT in the absence of enhanced screening test validity, the 6-minute AAT is clinically preferred. This study has prompted new research questions for the continued development of the AAT as a low-technology fetal assessment technique with potential usefulness by midwives and their colleagues in a variety of settings worldwide.

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