{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T03:00:20Z","timestamp":1781319620919,"version":"3.54.1"},"reference-count":15,"publisher":"Walter de Gruyter GmbH","issue":"5","license":[{"start":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T00:00:00Z","timestamp":1772496000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,24]]},"abstract":"Abstract<\/jats:title>\n \n Objectives<\/jats:title>\n Antenatal testing is routinely recommended for high-risk pregnancies to reduce the risk of stillbirth, yet limited data guide counseling about likelihood of unscheduled iatrogenic delivery. We explored factors associated with clinical recommendations for unscheduled iatrogenic delivery prompted by antenatal testing and examined variables that influence obstetric outcomes.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n In this retrospective cohort study, we identified singleton pregnancies undergoing serial testing in an academic system from January 2022-May 2023. Indications for testing, recommendations made at the final testing visit before delivery, and obstetric outcomes were obtained. Primary outcomes were unscheduled iatrogenic delivery <39\u00a0weeks and unscheduled iatrogenic delivery <37\u00a0weeks recommended at the final visit. Stepwise regression models assessed associations between demographics, testing indications, and outcomes.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 3,959 patients were included. 11.3\u202f% (n=447) were recommended for delivery based on findings identified at their final testing visit. Of these, 352 patients (8.9\u202f%) underwent unscheduled iatrogenic term delivery <39\u00a0weeks, and 156 (3.9\u202f%) underwent unscheduled iatrogenic preterm delivery <37\u00a0weeks. After adjustment for confounders, chronic hypertension, hypertensive disorders of pregnancy, fetal growth restriction, and other fetal indications were associated with both primary outcomes. Only 40\u202f% of delivery recommendations were triggered by an abnormal test (NST, mBPP, BPP); most were prompted by other clinical concerns identified during testing encounters.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Patients undergoing antenatal testing should be counseled about the meaningful likelihood of an unscheduled iatrogenic delivery recommendation. Because most recommendations arise from clinical issues unrelated to the testing results themselves, our findings may help clinicians guide shared decision-making around testing frequency and protocols.<\/jats:p>\n <\/jats:sec>","DOI":"10.1515\/jpm-2025-0709","type":"journal-article","created":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T08:11:36Z","timestamp":1772439096000},"page":"915-921","source":"Crossref","is-referenced-by-count":0,"title":["Antenatal fetal surveillance and iatrogenic delivery"],"prefix":"10.1515","volume":"54","author":[{"given":"Hannah S.","family":"Foster","sequence":"first","affiliation":[{"name":"21798 Hospital of the University of Pennsylvania , Department of Obstetrics and Gynecology , Philadelphia , PA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Wu","sequence":"additional","affiliation":[{"name":"21798 Hospital of the University of Pennsylvania , Department of Obstetrics and Gynecology , Philadelphia , PA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markolline","family":"Forkpa","sequence":"additional","affiliation":[{"name":"Penn Medicine Women\u2019s Health Clinical Research Center , Philadelphia , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesse","family":"Chittams","sequence":"additional","affiliation":[{"name":"University of Pennsylvania School of Nursing , Philadelphia , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nehemiah","family":"Weldeab","sequence":"additional","affiliation":[{"name":"University of Pennsylvania School of Nursing , Philadelphia , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"McCoy","sequence":"additional","affiliation":[{"name":"Geisel School of Medicine , Dartmouth Department of Obstetrics and Gynecology , Philadelphia , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadav","family":"Schwartz","sequence":"additional","affiliation":[{"name":"21798 Hospital of the University of Pennsylvania , Department of Obstetrics and Gynecology , Philadelphia , PA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2026,3,3]]},"reference":[{"key":"2026061302442410665_j_jpm-2025-0709_ref_001","unstructured":"American College of Obstetricians and Gynecologists. Antepartum fetal surveillance. ACOG Pract Bull 2021. Available from: https:\/\/www.acog.org\/clinical\/clinical-guidance\/practice-bulletin\/articles\/2021\/06\/antepartum-fetal-surveillance."},{"key":"2026061302442410665_j_jpm-2025-0709_ref_002","unstructured":"American College of Obstetricians and Gynecologists. Indications for outpatient antenatal fetal surveillance. ACOG Comm Opin 2021. Available from: https:\/\/www.acog.org\/clinical\/clinical-guidance\/committee-opinion\/articles\/2021\/06\/indications-for-outpatient-antenatal-fetal-surveillance."},{"key":"2026061302442410665_j_jpm-2025-0709_ref_003","doi-asserted-by":"crossref","unstructured":"Freeman, RK, Anderson, G, Dorchester, W. A prospective multi-institutional study of antepartum fetal heart rate monitoring. I. Risk of perinatal mortality and morbidity according to antepartum fetal heart rate test results. Am J Obstet Gynecol 1982;143:771\u20137. https:\/\/doi.org\/10.1016\/0002-9378(82)90008-4.","DOI":"10.1016\/0002-9378(82)90008-4"},{"key":"2026061302442410665_j_jpm-2025-0709_ref_004","doi-asserted-by":"crossref","unstructured":"Signore, C, Freeman, RK, Spong, CY. Antenatal Testing\u00a0\u2013\u00a0a reevaluation: executive summary of a Eunice Kennedy Shriver National Institute of Child Health and Human Development workshop. Obstet Gynecol 2009;113:687\u2013701. https:\/\/doi.org\/10.1097\/AOG.0b013e318197bd8a.","DOI":"10.1097\/AOG.0b013e318197bd8a"},{"key":"2026061302442410665_j_jpm-2025-0709_ref_005","doi-asserted-by":"crossref","unstructured":"Miller, DA, Rabello, YA, Paul, RH. The modified biophysical profile: antepartum testing in the 1990s. Am J Obstet Gynecol 1996;174:812\u20137. https:\/\/doi.org\/10.1016\/S0002-9378(96)70305-8.","DOI":"10.1016\/S0002-9378(96)70305-8"},{"key":"2026061302442410665_j_jpm-2025-0709_ref_006","doi-asserted-by":"crossref","unstructured":"Grobman, WA, Rice, MM, Reddy, UM, Tita, ATN, Silver, RM, Mallett, G, et al.. Labor induction versus expectant management in low-risk nulliparous women. N\u00a0Engl J Med 2018;379:513\u201323. https:\/\/doi.org\/10.1056\/nejmoa1800566.","DOI":"10.1056\/NEJMoa1800566"},{"key":"2026061302442410665_j_jpm-2025-0709_ref_007","doi-asserted-by":"crossref","unstructured":"Avcio\u011flu, SNA, Altinkaya, S\u00d6, \u00d6m\u00fcrl\u00fc, \u0130K\u00d6, K\u00fc\u00e7\u00fck, MK, Demircan-Sezer, S, Y\u00fcksel, HY. Impacts of maternal anxiety on non-stress test parameters. Clin Exp Obstet Gynecol 2016;43:830\u20135. https:\/\/doi.org\/10.12891\/ceog3048.2016.","DOI":"10.12891\/ceog3048.2016"},{"key":"2026061302442410665_j_jpm-2025-0709_ref_008","doi-asserted-by":"crossref","unstructured":"\u015eim\u015fek K\u00fc\u00e7\u00fckkelep\u00e7e, D, Timur Ta\u015fhan, S. The effect of music on the results of a non-stress test: a non-randomized controlled clinical trial. Eur J Integr Med 2018;18:8\u201312. https:\/\/doi.org\/10.1016\/j.eujim.2018.01.002.","DOI":"10.1016\/j.eujim.2018.01.002"},{"key":"2026061302442410665_j_jpm-2025-0709_ref_009","doi-asserted-by":"crossref","unstructured":"Dangel, A, Shindgikar, P, Polio, A, Breeze, JL, House, M. Urgent follow up after outpatient non-stress tests and the potential for fetal monitoring at home. Am J Perinatol 2024;41:e2978\u201384. https:\/\/doi.org\/10.1055\/a-2184-1294.","DOI":"10.1055\/a-2184-1294"},{"key":"2026061302442410665_j_jpm-2025-0709_ref_010","doi-asserted-by":"crossref","unstructured":"Arkerson, BJ, Finneran, MM, Harris, SR, Rood, KM, Harper, LM, Clapp, MA, et al.. Remote monitoring compared with in-office surveillance of blood pressure in patients with pregnancy-related hypertension. Obstet Gynecol. 2023;142:855\u201361. https:\/\/doi.org\/10.1097\/AOG.0000000000005327.","DOI":"10.1097\/AOG.0000000000005327"},{"key":"2026061302442410665_j_jpm-2025-0709_ref_011","doi-asserted-by":"crossref","unstructured":"Bruno, B, Mercer, MB, Hizlan, S, Peskin, J, Ford, PJ, Farrell, RM, et al.. Virtual prenatal visits associated with high measures of patient experience and satisfaction among average-risk patients: a prospective cohort study. BMC Pregnancy Childbirth. 2023;23:234. https:\/\/doi.org\/10.1186\/s12884-023-05421-y.","DOI":"10.1186\/s12884-023-05421-y"},{"key":"2026061302442410665_j_jpm-2025-0709_ref_012","doi-asserted-by":"crossref","unstructured":"Ghimire, S, Martinez, S, Hartvigsen, G, Gerdes, M. Virtual prenatal care: a systematic review of pregnant women\u2019s and healthcare professionals\u2019 experiences, needs, and preferences for quality care. Int J Med Inf 2023;170:104964. https:\/\/doi.org\/10.1016\/j.ijmedinf.2022.104964.","DOI":"10.1016\/j.ijmedinf.2022.104964"},{"key":"2026061302442410665_j_jpm-2025-0709_ref_013","doi-asserted-by":"crossref","unstructured":"Hirshberg, A, Zhu, Y, Smith-McLallen, A, Srinivas, SK. Association of a remote blood pressure monitoring program with postpartum adverse outcomes. Obstet Gynecol 2023;141:1163\u201370. https:\/\/doi.org\/10.1097\/AOG.0000000000005197.","DOI":"10.1097\/AOG.0000000000005197"},{"key":"2026061302442410665_j_jpm-2025-0709_ref_014","doi-asserted-by":"crossref","unstructured":"Hamm, RF, Shkolnik, K, Keren, N, Reches, A, Purnell, J, McCabe, M, et al.. Experience with home-based, remote non-stress tests, including automatic decision support for interpretation of reactivity. Am J Obstet Gynecol. 2022;226:S95\u20136. https:\/\/doi.org\/10.1016\/j.ajog.2021.11.175.","DOI":"10.1016\/j.ajog.2021.11.175"},{"key":"2026061302442410665_j_jpm-2025-0709_ref_015","doi-asserted-by":"crossref","unstructured":"Hadar, E, Wolff, L, Tenenbaum-Gavish, K, Eisner, M, Shmueli, A, Barbash-Hazan, S, et al.. Mobile self-operated home ultrasound system for remote fetal assessment during pregnancy. Telemed J E Health.2022;28:93\u2013101. https:\/\/doi.org\/10.1089\/tmj.2020.0541.","DOI":"10.1089\/tmj.2020.0541"}],"container-title":["Journal of Perinatal Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/jpm-2025-0709\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/jpm-2025-0709\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T02:45:09Z","timestamp":1781318709000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/jpm-2025-0709\/html"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,3]]},"references-count":15,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,2,16]]},"published-print":{"date-parts":[[2026,6,24]]}},"alternative-id":["10.1515\/jpm-2025-0709"],"URL":"https:\/\/doi.org\/10.1515\/jpm-2025-0709","relation":{},"ISSN":["0300-5577","1619-3997"],"issn-type":[{"value":"0300-5577","type":"print"},{"value":"1619-3997","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,3]]}}}