Comparison of the Manual Stimulation Test and the Nonstress Test: A Randomized Controlled Trial
Wirawit Piyamongkol MD, PhD*, Sompong Trungtawatchai MD*, Pharuhas Chanprapaph MD*, Theera Tongsong MD*
Affiliation : * Department of Obstetrics and Gynaecology, Faculty of Medicine, Chiang Mai University, Chiang Mai
Objective : To evaluate manual fetal stimulation (MST) through the maternal abdomen in comparison to
standard nonstress test (NST) in terms of nonreactive rates and testing time.
Materials and Methods : Five hundred and forty high-risk singleton pregnancies at 28 gestational weeks or
more were assigned to have either NST or MST using blocked randomization (270 each). All fetal heart rate
(FHR) tracings were analyzed blindly using standard NST criteria by one perinatologist.
Results : The MST group provided a significantly higher reactive rate than that of the NST group, 98.9% and
84.4% respectively, p < 0.001. Mean testing time of the reactive results of the MST group was also significantly
shorter than that of the NST group, 7.94 + 6.27 min and 13.91 + 9.58 min respectively, p < 0.001.
Conclusion : This is the first randomized controlled trial (RCT) to demonstrate the distinctive benefit of the
simple and less expensive MST. MST significantly reduces the time to reactivity and increases the frequency of
reactivity when compared to NST alone.
Keywords : Electronic fetal heart rate monitoring, Fetal surveillance, Fetal well being, Manual stimulation test, Nonstress test
