The nonstress test (NST) remains in widespread use for antepartum fetal surveillance. Our institutional experience with 14,028 patients and 38,645 tests over eight years reveals a fetal death rate of 2.6 per 1000 within seven days of a reactive NST. The autopsy findings of 53 fetal deaths are presented. The most common findings, in descending order of frequency, were meconium aspiration, perinatal infection, and abnormal umbilical cord position. These findings support changes we have made in our antepartum assessment protocols.