NON STRESS TEST

The non-stress test is most widely used and accepted method of antenatal fetal surveillance. It is
usually performed on outpatient basis and is readily interpreted. No particular stess is placed on
the fetus by performing such a test. A non-stress test involves attaching a belt with fetal heart
rate and uterine contractions monitors around the mother’sabdomen. The heart rate is recorded
for approximately 20-30 minutes, during which time the mother indicates whether she feels any
fetal movements.

The idea behind a non-stress test is that proper amounts of oxygen are required for the brain to
send signals that will be transmitted via nerves to the heart, signals to which the heart will
respond appropriately. When oxygen levels are low, the brain, nerves and heart may not respond
normally, and resulting fetal heart rate patterns will not reactive.

INDICATIONS OF NST

 Women with pre-existing medical conditions such as diabetes, hypertension

 Baby is less active than the normal
 Small for its age or not growing properly
 Amniotic fluid is either too much or too little
 Women have have lost previously their babies during the second trimester
 Women with pregnancies continuing after 40 week to basically check on well being of
baby
 Women who had a procedure of external cephalic version
 Amniocentesis

HOW TO PERFORM NST

 Usually done as outpatient care

 Time taken 20 minutes, rarely 40 minutes, in extended cases.
 Patient may be seated in semi fowler position or in a reclining chair
 Care taken to avoid supine hypotension syndrome, due to pressure on inferior vena cava
by producing a left lateral tilt by placing a pillow / wedge below the right hip of the
patient.
 Patient’s blood pressure is to be recorded before starting the test and every 10 minutes
subsequently.
 Place the Doppler ultrasound transducer to the maternal abdomen for measuring fetal
heart rate. the tocodynamometer is applied to detest uterine contractions
 Fetal activity may be recorded by the patient using on event marker switch or noted by
the assistant performing the test
A reactive test: is considered when there are at least two accelerations of the fetal heart rate of
15 bpm amplitude and of 15 seconds duration observed over 20 minutes of monitoring. A
reactive non stress test is a good predictor of adequate fetal oxygenation and most reactive fetus
do well for atleastan otherWeek.

A non-reactive test (abnormal NST) a test is considered to be non-reactive when there is absence
of acceleration in fetal heart rate in relation to fetal movements. When the fetal heart acceleration
is less than 15 beats per minutes or lasts less than 15 seconds in relation with fetal movements,
the test is considered to be abnormal.

The NST is to analyse taking into consideration the following variables:

 Baseline fetal heart rate (FHR)

 Variability of the FHR
 Presence or absence of accelerations
 Presence or absence of decelerations

Baseline fetal heart rate (FHR): The normal baseline FHR frequency is between 110 and 160
bpm. There may be tachycardia (more than 160 bpm) or bradycardia(less than 110bpm) these
changes may occur due to maternal heart rate changes, body temperature and even in fetal
hypoxia.

Variability of the FHR: the fetal variability depends upon the fetal sympathetic and
parasympathetic nervous system and is influenced by the gestational age, maternal medication
fetal congenital anomalies, fetal acidosis and fetal tachycardia. A non -reactive NST associated
with decreased or absent variability is mostly due to fetal hypoxia.

Presence or absence of accelerations and decelerations

The absence of acceleration may be indicated of fetal sleep. The absence of deceleration in the
NST is reassuring.

The presence of spontaneous severe variable or late decelerations is problematic and may
indicate fetal compromise. Variable decelerations may be seen often if these are mild and non-
repetitive, then they do not suggest fetal compromise. However repetitive variable decelerations,
especially in the absence of f etal movements or uterine activity, suggest fetalcompromise.

Principle

The sympathetic and parasympathetic components of ANS control cardiac fetal behaviour

FHR accelerations in response to fetal movements is a sign of healthy featus.

ADVANTAGES:
 It is non- invasive test
 The test is simple , in expensive and takes less time
 There are no contraindications or complications of this test
 No special expertise is required in performance of the test
 This test provides an immediate answer
BOOK REFERENCES:

 Dutta’s D.C. Textbook of obstetrics. 9th edition. Published by jaypee brothers medical
publishers (P) ltd. Mohammadpur , Dhaka Bangladesh India.2018.

 BhideAmarnath. Arias’ practical guide to high risk pregnancy and delivery. 4th edition.
Published by Elsevier (p) ltd IMT Manesar , Haryana India. 2015.

 KumariNeelam . Textbook of midwifery and gynecological nursing 11th edition.

Published by s. Vikas and company ( medical publishers) (P) ltd. Jalandhar India 2012.

INTERNET REFERENCES

 https://www.slideshare.net/DebbieFritz/antepartum-testing

 https://www.webmd.com › Pregnancy ›

 http://www.ucsfcme.com
 M.M COLLEGE OF NURSING, MULLANA, AMBALA

CLINICAL DEMONSTRATION
ON
NST AND CST

SUBJECT: OBSTETRICS ANDGYNECOLOGICAL NURSING

SUBMITTED TO: SUBMITTED BY:

DR. POONAM SHEORAN NADIYA RASHID

H.O.D M.Sc. (N) IST YEAR

OBG DEPARTMENT ROLL NO. 1918721

SUBMITTED ON: 01-04-19