A comparison of two time intervals for the ausculated acceleration test.

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.

Nutritional concerns in women's primary care.

The midwife needs to be aware of current guidelines for nutritional monitoring, including those in Healthy People 2000, to provide primary care screening for nutritional factors that affect the health status of women. This article reviews the relationship between dietary habits and specific health concerns, including cardiovascular disease, obesity, osteoporosis, cancer, and diabetes; special attention is paid to high-risk groups. It also examines the relationship between improved nutritional status and the reduction of the major causes of morbidity in women.

Public health approaches to community-based needs. Boston's infant mortality crisis as a case study.

In light of a 10-year infant mortality crisis in Boston, a comprehensive public health approach was undertaken in which an extensive community-based needs assessment was used to develop a citywide maternal and child health improvement agenda. On the basis of the needs assessment, recommendations were made calling for community-based perinatal initiatives and midwifery services as critical elements in care for underserved communities and enhancement of perinatal services. A case description of one perinatal initiative illustrates the challenges of public health practice and describes a practice setting in which midwives provided leadership and guidance by using an interdisciplinary team approach in the implementation of a community empowerment project.

Primary care for women. Cultural competence in primary care services.

The assessment of cultural competence in providing primary care services for women is addressed. Emphasis is placed on the ways in which cultural competency attainment can ensure the availability of key primary care components to all women, especially those from certain vulnerable populations and those who have specific primary health care needs. A cultural competence continuum is described that will assist providers in an assessment of their own cultural competency levels, as well as those of the service settings in which they practice. Six scenarios are provided, describing experience at each level of the continuum that may hinder the development and delivery of effective primary care service interventions. Examples of ways in which nurse-midwives can provide leadership in the area of cultural competence in women's primary care are also included.

Primary care for women. An overview of the role of the nurse-midwife.

The nurse-midwife's past, present, and future roles in the primary care of women are explored using a recent Institute of Medicine report on primary care as a framework for discussion. Primary care, the scope of services, and the role of the primary care clinician are described, and specific strategies for a primary care emphasis in basic nurse-midwifery education are addressed. The nurse-midwife's future roles in collaborative practice for the primary care of women and the need for continuing education opportunities in primary care are also discussed.