Antepartum Evaluation of Fetal Well-Being

The fetal death rate in the United States has stabilized at approximately 6 fetal deaths per 1,000 live births since 2006. Although acute events such as cord accidents can be unpredictable, antepartum screening tests are essential for identifying fetuses at risk for chronic in-utero compromise, potentially preventing fetal death and neonatal morbidity. This chapter provides an overview of perinatal, fetal, and infant mortality, along with common antepartum tests and their effectiveness in predicting fetal death. An ideal fetal assessment should reduce fetal death and associated morbidities, with evaluations often indicated for viable at-risk pregnancies. Methods include maternal perception of fetal movement, electronic fetal monitoring through nonstress tests and contraction stress tests, and ultrasound to assess amniotic fluid volume and perform biophysical profiles. Although these tests exhibit high sensitivity, their specificity varies widely, and current studies have yet to confirm a consistent reduction in perinatal mortality linked to specific antenatal testing strategies.