A recent study of high-risk patients failed to detect a difference in the incidence of nonreactive
nonstress tests, meconium-stained amniotic fluid cesarean delivery for fetal distress, low Apgar scores, or infants with a cord pH of <7.10 when oligohydramnios (AFI <5.0 cm) was present (LOE: 1).
She and her associates had hypothesized that treatment with labetalol would increase the rate of nonreactive
nonstress tests, but found no evidence of that.
The question of who needs a
nonstress test has not been clearly resolved, in part because of the low predictive value of a nonreactive test.
No proteinuria is detected, blood testing results for preeclampsia (complete blood count, liver enzymes, serum creatinine, and uric acid) are normal, and the
nonstress tests are reactive in both fetuses.
In patients whose pregnancy is at 30 weeks or less, delivery may be postponed so long as
nonstress tests and umbilical artery Doppler findings remain reassuring.
Now you can use my simple "box trick" to evaluate
nonstress tests. If you see two accelerations that measure, "a box-and-a-half by a box-and-a-half" within 20 minutes, the
nonstress test is reactive.
Alternative recommendations range from only a
nonstress test and discharge if normal[8,14] to a full 24-hours' monitoring for all patients.[5,7] Monitoring before the age of viability (Middle to late second trimester) is not advised because delivery would not be an option.
A
nonstress test was initially nonreactive and then became reactive, and a biophysical profile score was reassuring.
Belfort orders a
nonstress test, amniotic fluid index, and lab tests every 3-4 days or more often depending on the clinical circumstances.
The protocol for all [PGE.sub.2] gel insertions was as follows: (1) Before gel insertion, all patients underwent a
nonstress test, which was considered reactive if two fetal accelerations (15-beat acceleration for 15 seconds or at least 10% of baseline) were seen associated with fetal movement within 10 minutes.
C should have admitted her to the hospital to ensure strict bed rest and monitoring of her blood pressure--and also should have ordered a
nonstress test.
Nonstress test; Breathing movements (at least one episode of rhythmic fetal breathing movements lasting 30 seconds or more in 30 minutes); Movement (at least three discrete body or limb movements within 30 minutes); Tone (at least one episode of extension of fetal extremity with return to flexion, or opening or closing of hand); and Fluid volume (a single vertical pocket of amniotic fluid exceeding 2 cm).
