(280) Patient-reported burdens of antenatal fetal surveillance: stillbirth prevention at what cost?

Objective: Recommendations regarding the type, timing of initiation, and frequency of antenatal fetal surveillance (AFS) are based largely on expert opinion. Patient-centered experiences of AFS to guide AFS strategies that maximize stillbirth prevention and minimize cost and time burdens is lacking.

Study Design: We performed a cross-sectional survey of patients undergoing AFS in a maternal fetal medicine ultrasound unit. The primary aim was to describe the burden of AFS and determine if these burdens differed by frequency of AFS. Patients were eligible for inclusion if undergoing any type or frequency of AFS and were English or Spanish speaking. The survey responses of those undergoing once and twice-weekly testing were compared by creating a burden group (any “agree” response) and no burden group (any “disagree” response) by Chi square and Fisher’s exact test as appropriate and by individual response as a continuous variable with student’s t-test.

Results: Of 213 unique survey responses, 169 (79.3%) attended once and 44 (20.7%) twice-weekly. Most respondents had children and did not work outside the home. The most common self-reported indication for AFS was obesity. Patients reported that coming to clinic for AFS interfered with daily life (25.8%) and with work (14.6%), and 16.4% reported missing prenatal care to attend AFS. Twice-weekly patients were significantly more likely to report that AFS interfered with work (p=0.03), was too expensive (p< 0.01), required cost cutting in other areas (p< 0.01), and reported missing AFS visits (p=0.03) (Table 1).

Conclusion: Patients report financial and employment related difficulties attending AFS, and statistically significantly more burdens with twice compared to once-weekly testing. Strategies for stillbirth screening should consider potential harms of such regimens and the clinician should use shared decision-making when deciding on the frequency of AFS. Consideration should be given to innovation that relieves these burdens, such as remote, telehealth administered AFS.