The high-risk pregnancies of 203 patients were prospectively studied to test the hypothesis that the maternal perception of fetal movement is as useful as antepartum fetal heart rate testing (AFHRT) in assessing fetal welfare. Evidence for an active fetus (186 cases, 92%) was usually followed by a normal AFHRT result (320/330 results, 97%). Furthermore, a favorable perinatal outcome was equally predicted by an active fetus (168/186 cases, 90%) and a normal AFHRT result (173/190 cases, 91%). Evidence for an inactive fetus was less sensitive but not significantly different from an abnormal AFHRT in predicting an unfavorable perinatal outcome (10/17 cases versus 11/13 cases, p > 0.05). However, an abnormal AFHRT result coincident with fetal inactivity was highly predictive of an unfavorable neonatal outcome in nine of 10 cases. In conclusion, the data reveal that a record of fetal activity by the compliant patient is a reliable alternative to AFHRT for the initial screening of fetal well-being.