Accelerations of fetal heart rate with fetal movement indicate a healthy fetus with an alert nervous system and adequate oxygenation.  Lack of accelerations may or may not indicate a problem.  Patients should eat and drink normally prior to having the NST.                          

Indications for screening in the low-risk clinics:

 

1.       Gestational age of 41 weeks (should also include assessment of amniotic fluid      volume).

2.       Patient perceives decrease in fetal movement after 28-30 weeks of gestational age, e.g. less than 10 movements a day or less than 4 movements in 1 hour period at least once per day.

 

1.       History of intrauterine fetal demise (IUFD) – Begin NSTs at 32 weeks, or 2 weeks prior to previous gestational age of IUFD (whichever is sooner).    

2.       Suspected intrauterine growth restriction.

3.       Oligohydramnios.

4.       After consultation, certain other high risk conditions of pregnancy, but most will usually be managed at the High Risk Clinic.

 

Procedure:

 

Reactive (normal)- Fetal heart rate acceleration of 15 beats per minute, lasting for 15 seconds with or without associated fetal movement or with a spontaneous uterine contraction, observed at least twice during a 20  minute period.

 

Nonreactive (abnormal) - Less than 15 beats per minute lasting less than 15 seconds observed for a 20 minute time period. If nonreactive, consult with the medical provider for possible referral to DUMC. 

 

 

Prepared in conjunction with the

Division of Maternal-Fetal Medicine

Duke University Medical Center

 

                                                            ___________________

                                                            Director

 

                                                            ___________________

                                                            Date

Non-Stress Testing (NST)

1.       Kidd LC, Patel NB, Smith R. Non-stress antenatal cardiotocography - a prospective randomized clinical trial.  Br J. Obstet Gynaecol. 1985; 92:1156-1159.

 

2.       Manning FA, Lange IR, Morrison I, Harman CR. Fetal biophysical profile score and     the nonstress test: a comparative trial.  Obstet Gynecol. 1984; 64:326-331.

 

3.       Ott WJ, Doyle S. Routine antepartum biophysical screening.  J Reprod Med. 1982; 27:389-391.

 

 

 

The Clinical Care Guidelines Development Committee of the Perinatal Improvement Board of Duke University Health System has developed a series of multi-disciplinary protocols to offer guidance to health care providers who are caring for pregnant women with high risk conditions.

 

These protocols are designed to assist health care providers in the management of a variety of problems that occur in pregnancy and the time of delivery. They should not be interpreted as standard of care, but instead represent only general guidelines for the care of pregnant women with high risk conditions.  We recognize that services offered by individual providers depend not only on their training, experience and institutional resources, but on the medical facts and circumstances of the specific care situation.

The protocols remain the intellectual property of the Duke University Health System.  They cannot be reproduced in whole or part without the expressed permission of the Health System.

 

These protocols are reviewed by the Department of Obstetrics and Gynecology Division of Maternal-Fetal Medicine, the Department of Pediatrics Division of Neonatology and the Department of Anesthesiology Division of Women’s Anesthesia.  Please contact Andra H. James (andra.james@duke.edu), Chair, Clinical Care Guidelines Development Committee of the Perinatal Improvement Board with ideas for additional protocols.