Non-stress test, and contraction stress test, presentation

Non-stress test, and contraction stress test timing, purpose, indication,contraindication,procedure

1. NON STRESS TEST/ CONTRACTION STRESS TEST KANCHAN MEHRA M.Sc. NURSING 1 ST YEAR PCNMS

2. INTRODUCTION : The Non Stress Test (NST) monitors the fetal heart rate in response to fetal movement in order to assess fetal well being.

3. DEFINITION: A non- stress test is used to evaluate a baby's health before birth. The goal of a non- stress test is to provide useful information about your baby's oxygen supply by checking his or her heart rate and how it responds to your baby's movement. The test might indicate the need for further monitoring, testing, treatment or delivery to prevent fetal death.

4. TIMING OF NST: NST are generally performed after 28 weeks of gestation . Before 28 weeks, the fetus is not developed enough to respond to the test protocol.

5. PURPOSE OF NST: To assess the fetal ability to cope with continuation of a high risk pregnancies. To assess the fetal status in women for whom CST is contraindicated such as previous caesarean section, placenta previa , or threatened abortion, otherwise, the indication for an NST are the same as those for CST.

6. INDICATION OF NST: MATERNAL:- Post dated pregnancy Rh sensitization Maternal age 35 or more Chronic renal disease Hypertension Diabetes Premature rupture of membrane History of stillbirth Trauma Vaginal bleeding in 2 nd and 3 rd trimester FETAL: Decrease fetal monitoring IUGR Oligohydramnios Polyhydamnios

7. CONTRAINDIATION: Gestational age <24 weeks Any contraindication to labor is contraindication to NST.

8. ARTICLE NEEDED FOR NST: Electronic fetal monitoring Ultrasound transducer Tocotransducer Monitor strip Ultrasound gel Belt to hold the transducers in place

9. PROCEDURE: Explain the mother about the procedure and its purpose and how she has to co- operate. Make sure that the woman had eaten food and ask her to empty the urinary bladder. Turn on the monitor and press the test button to see that if it is working and adjust the paper speed. Perform an abdominal palpation(Leopold’s Maneuver) Confirm the fetal heart tones with a fetoscope or stethoscope and note the area of maximum intensity

10. Position the women in semi – fowler’s or lateral tilt position and place the monitor belt under her back. Connect the ultrasound transducer and tocotransducer to the fetal monitor . Apply ultrasound gel to the ultrasound transducer. Place the ultrasound transducer on the fetal back. Move the transducer until clear, audible fetal heart sound are heard. Secure the device in place with belt. Place the tocotransducer on the fundus of the uterus and secure in place with the belt. Run the monitor and evaluate the quality of the tracing to determine if it is adequate for interpretation. If it is not, reposition the transducer until interpretable ,data is obtained.

11. Give the hand button to the woman and ask her to press the button every time she feels the fetal movement. Run the monitor and obtain a tracing for at least 20 minutes. On completion, put off the monitor and take out the stripes of paper. Remove the abdominal straps and wipe off the gel from the abdomen and transducer. Make the woman comfortable and give a relevant instructions.

12. INTERPRETATION: Reactive test: A reactive test is one in which a normal fetal reactivity pattern is demonstrated. This is evidenced by fetal heart rate acceleration of 15 beats per minute above the baseline lasting for 15 – 30 sec in association with fetal movement. Two or more occurrence of this acceleration pattern within a 10 min period or five or more accelerations within a 20 minutes are considered healthy fetus .

13. Non- reactive test: A non- reactive test is one which there a persistent decreased variability with an absence of accelerations in fetal heart rate in response to fetal movement. This is evidence by fetal heart rate accelerations of less than 15 beats per minute above the baseline or lasting less than 15sec in association with fetal movement. Unsatisfactory or Suspicious NST- T his test is one which there we can not interpretate because of poor quality of fetal heart rate. If test is suspicious it should be repeated in 24 to 48 hours. The NST can be repeated and continued at any desired frequency without concern for adverse effect to the fetus.

14. COMPLICATION: A NST is a non- invasive test which that means it does not involve physical pain or danger that poses no known risks or side effects or complication to mother or baby.

15. CARE AFTER PROCEDURE : Clean the gel that is used during procedure. Make the client in comfortable position. Replace all article to the utility room. Wash hands Record the date and time of NST Document the recording

16. ROLES AND RESPONSIBILITY OF MIDWIFERY : Explain the procedure to the patient. Provide privacy. Maintain a safe, comfortable position for the client. Gather all the article needed for NST The woman must empty her bladder. Patient should be lie in semi fowler’s or left lateral position. FHR is then maintained for approximate 20-30 min. It is important that fetus not be in sleep state during entire procedure. An  abdominal palpation can be used  to arouse the fetus .

17. CONTRACTION STRESS TEST

18. INTRODUCTION: The Contraction Stress Test(CST) also called a stress test or an oxytocin challenge test, may be done during pregnancy to measure the baby's heart rate during uterine contractions. Its purpose is to make sure the baby can get the oxygen he needs from the placenta during labor.

19. DEFINITION : A contraction stress test (CST) is performed near the end of pregnancy to determine how well the fetus will cope with the contractions of childbirth. The aim is to induce contractions and monitor the fetus to check for heart rate abnormalities using a cardiotograph . A CST is one type of antenatal fetal surveillance technique.

20. TIMING OF CST: Women may get a contraction stress test at 32 weeks or later. Before that, the test may not be safe. The number of times you need the test depends on your situation .

21. PURPOSES: To assess the ability to cope with the continuation of high risk pregnancy. To determine the projected ability of fetus to withstand the stress the stress of labor.

22. INDICATIONS : Post maturity IUGR History of previous stillbirth Meconium stained amniotic fluid obtained at amniocentesis. Falling or abnormal estriol values. Gestational Diabetes. Chronic hypertension Chronic lung disease Sickell cell disease

23. CONTRAINDICATION : Vaginal bleeding. Multiple gestation. Previous classic uterine incision(caesarian section) Hydramnios Premature rupture of membrane .

24. PROCEDURE : The woman bladder should be emptied(to promote comfort and avoid disruption). Give either a semi fowler’s or left lateral position(to avoid supine hypotension ). The mother blood pressure should be checked to obtained a baseline recording.

25. NIPPLE STIMULATION TEST: This is the procedure that relies on endogenous release of oxytocin following nipple stimulation, and is conducted by the patient. At the beginning of the test warm wash cloths are applied to the breast. Zink oxide(A+D) ointment is applies to the nipples to prevent the soreness. The woman then stimulates her nipple by either rolling them or gently pulling them. Stimulation is initially unilateral.

26. If contraction are still inadequate, intravenous oxytocin is used. Nipple stimulations provides adequate contractions approximately in 75% of women using this method.

27. OXYTOCIN CHALLENGE TEST : The administration of oxytocin to induce contractions is called an oxytocin challenge test or oxytocin contraction test(OCT). A venipuncture is done by an intravenous line is established, and a very dilute solution of oxytocin 30 IU diluted in 500 mL IV solution controlled by an infusion pump, is administered via a piggyback setup to another bag of intravenous solution. To rate of infusion is increased at intervals until the contractions are occurring at a frequency of at least 3 in a 10 minutes period and lasting at least 30 second. The recording is then interpreted and the infusion stopped.

28. Both the monitoring and the intravenous solution, without oxytocin in it, are continued until the contractions have diminished to their baseline activity This is to assure that the oxytocin has not put the woman into labor without knowing about it.

29. COMPLICATION: It may cause labor to start sooner than your expected delivery date. It may cause contractions that go on for a long time. This may cause problems with your baby. The contractions usually stop when the oxytocin is stopped. You may get a medicine to stop the contractions. In very rare cases, the contractions don't stop. If that happens, your doctor may suggest delivery.

30. CARE AFTER PROCEDURE Clean the ointment that is used during nipple stimulation procedure. Make the client in comfortable position. Replace all article to the utility room. Wash hands Record the date and time of CST Document the recording .

31. ROLES AND RESPONSIBILITY OF MIDWIFERY: Explain the procedure to the patient. Provide privacy. Maintain a safe, comfortable position for the client. You may be asked to not eat or drink for 4 to 8 hours before the test. Empty your bladder before the test. If you smoke, stop for 2 hours before the test. Smoking can lower your baby's activity and heart rate. You will be asked to sign a consent form that says you understand the risks of the test Patient should be lie in semi fowler’s or left lateral position.

32. SUMMARY: The non stress test (NST) monitors the fetal heart rate in response to fetal movement in order to assess fetal well being. The fetal non stress test is a simple, non – invasive test performed in pregnancies over 28 weeks gestation. Used to assess the fetal ability to cope with continuation of a high risk pregnancies. And also to assess the fetal status in women for whom CST is contraindicated such as previous caesarean section, placenta previa , or threatened abortion, otherwise, the indication for an NST are the same as those for CST. Contraction stress test assesses fetal placental functioning and the fetus’s projected ability to cope with the continuation of high risk pregnancy and the stress of labor. It aid the physician in selecting the optimal time for delivery of a high risk fetus.