Early intrapartum fetal
assessment helps in identifying the fetus at risk of developing fetal distress
during labor and requiring prompt caesarean delivery. A negative or reactive
test may indicate a low probability of adverse outcome and thus reassuring. On
the other hand, a positive or nonreactive test may imply a significant risk of
fetal compromise that may lead to prompt abdominal delivery. A reliable fetal
admission test may help in accurately identifying such high-risk fetuses so
that limited perinatal resources can be utilized better and fetal distress
resolved expeditiously by caesarean delivery.
Mean testing time for mBPP was 23
minutes and for mBPP with VAST was 5 minutes, so addition of VAST significantly
reduces the testing time by one fourth. This finding was comparable with sood
atul Kumar et al 2011 where mean testing time was 4.86+0.72
min1. Among 110 women, who underwent modified biophysical profile,
80(72.7%) showed reactive response and 30(27.3%) showed non reactive response.
110 women, in whom modified biophysical profile was combined with VAST,
100(91%) showed reactive response and 10(9%) showed non reactive response. In
sood atul Kumar et al (2011) study, of the 210 fetuses subjected to VAS/mFBP,
200 (95.2%) were reactive and 10 (4.8%) nonreactive1.
With modified biophysical profile
along VAST, 91(82.7%) neonates had favourable outcome, 19(17.2%) neonates had 5
mints Apgar score <7 and among 19, 7(6.4%) underwent NICU admission. There were 2(1.8%) perinatal mortality. This finding was comparable with sood atul Kumar et al 2011 as there were 198 (94.3%) favourable and 12 (5.7%) adverse perinatal outcomes with 2 (0.95%) perinatal deaths. In terms of perinatal morbidity, Modified biophysical profile with VAST had a high specificity (98.9% vs. 77.7%), negative predictive value (90% vs. 87.5%) & positive predictive value (90% vs. 33.3%) but low sensitivity (47.3% as compared to modified biophysical profile. Test accuracy for predicting perinatal morbidity was more than mBPP (90% vs. 72.7%).This finding was comparable to those reported by Tongprasert et al 2005, mBPP with VAST had a sensitivity of 50.0%, specificity of 99.07%, positive predictive value of 50.0%, and negative predictive value of 99.07% and an accuracy of 98.18% 3. Sood atul Kumar et al reported similar finding with sensitivity 66.7%, positive predictive value 80%, specificity 99%, negative predictive value 98%, and accuracy 97% with mBPP along with VAST1. In the present study, when statistical comparison for predicting perinatal mortality was done. Modified biophysical profile with VAST had a high sensitivity (100% vs. 80%), specificity (92.5% vs. 75.2%), negative predictive value (100% vs. 98.7%) & positive predictive value (20% vs. 13.3%) as compared to modified biophysical profile. Test accuracy for predicting perinatal mortality was more than mBPP (92.7% vs. 75.4%). Results were comparable with O. Petrovi?, et al in 1998 who reported that sensitivity, specificity and positive and negative predictive values of the mBPP score in predicting adverse perinatal outcome were 60, 99, 66.7 and 98.7%, respectively4. The sensitivity, specificity and positive and negative predictive values of the VAST along with mBPP were 66.7, 100, 100 and 99.4%, respectively. Sood atul Kumar et al also reported comparable results in terms of perinatal deaths with sensitivity 100%, specificity 96.2%, positive predictive value 20%, negative predictive value 100%, and accuracy 96.2%1. VAST has increased in use over recent years as various researchers have found it comparable, cheaper, faster and less invasive than other tests of fetal well-being.