Another question for you....

midwife2b · Aug 10, 2005

Just how common are contraction stress tests? Under what circumstances are they performed? When I worked L & D, I didn't see or hear any references to contraction stress tests, and this was in a large teaching hospital. If these are still being done, do they use the nipple stimulation or pitocin? Thanks for any insight you can give me... :)

In theory, any attempt to induce contractions (such as with induction of labor) can be considered a "contraction stress test". I work in a tertiary care facility and we will do a CST if there is a suspicion that the fetus may not tolerate labor. (Ex: suspicious decels on a tracing in a mom with risk factors such as PIH, diabetes, renal disease, etc.) It is done with pitocin 99.9% of the time, and the procedure is similar to pitocin induction: Labs are drawn, consents are signed, and the pt is aware why the test is being done. Appropriate personnel must be available if the test is positive; i.e., to prepare for a Cesarean birth. If the test is negative, induction of labor usually proceeds. So this test is only done when it is judged that delivery of the infant is in order; the method of delivery will be decided by the test result.

Jolie, BSN · Aug 11, 2005

In my neck of the woods, CSTs seem to be far less common than they once were. Now we seem to rely much more on NSTs and biophysical profiles.

VickyRN, MSN, DNP, RN · Aug 11, 2005

Thanks for the information... this really helps :)

SmilingBluEyes · Aug 11, 2005

Really a CST is incorporated into a trial of labor----

meaning a person is either induced/augmented with pitocin, prostaglandins or nipple stim and then when contractions ensue, the CST is part and parcel ----it's just called a "trial of labor", most commonly now.

You will commonly see labor induced in cases of maternal conditions like diabetes, gestational hypertension or Pre-eclampsia, or fetal problems like IUGR or LGA infants----- (but greater than 4000-4100g, a csection is seriously considered to avoid dystocia).

We may also induce labor in other cases where it is anticipated the baby may NOT tolerate labor---and in situations where it is suspected a fetus MAY not tolerate labor well (particularly over 41 weeks'). Placental functioning is very easy to determine when a woman is in labor and being monitored.

Now, repeated late decelerations noted with contractions are indicative of positive and non-reassuring result. But there is so much more involved than that--we could go and on about fetal heart monitoring etc, and I know you don't want to go there....

I will say, in my experience, rare is the OB using CST nowadays to assess fetal wellbeing. Like said above: First we will do an NST. IF that is negative (meaning no accels in the strip)-----we proceed to BPP's (biophysical profiles) that are less invasive yet very effective as a means to assess fetal wellbeing. Failing that, the mom may or may not be put to trial of labor, depending on conditions. She may proceed to csection if the result is very ominous.

Hope this helps; as usual, I probably said way too much. :uhoh21:

RNnL&D · Aug 11, 2005

I aqgree with the above. We see alot of NST's and BPP's to determine fetal well being.

In 2 1/2 years, I have done one CST, and that was with nipple stim.

BETSRN · Aug 12, 2005

Just how common are contraction stress tests? Under what circumstances are they performed? When I worked L & D, I didn't see or hear any references to contraction stress tests, and this was in a large teaching hospital. If these are still being done, do they use the nipple stimulation or pitocin? Thanks for any insight you can give me... :)

I haev NEVER seen one done.

MOM2TWO · Aug 13, 2005

I too, have never seen one.

Editorial Team / Admin · Aug 14, 2005

Really a CST is incorporated into a trial of labor----
meaning a person is either induced/augmented with pitocin, prostaglandins or nipple stim and then when contractions ensue, the CST is part and parcel ----it's just called a "trial of labor", most commonly now.
You will commonly see labor induced in cases of maternal conditions like diabetes, gestational hypertension or Pre-eclampsia, or fetal problems like IUGR or LGA infants----- (but greater than 4000-4100g, a csection is seriously considered to avoid dystocia).
We may also induce labor in other cases where it is anticipated the baby may NOT tolerate labor---and in situations where it is suspected a fetus MAY not tolerate labor well (particularly over 41 weeks'). Placental functioning is very easy to determine when a woman is in labor and being monitored.
Now, repeated late decelerations noted with contractions are indicative of positive and non-reassuring result. But there is so much more involved than that--we could go and on about fetal heart monitoring etc, and I know you don't want to go there....
I will say, in my experience, rare is the OB using CST nowadays to assess fetal wellbeing. Like said above: First we will do an NST. IF that is negative (meaning no accels in the strip)-----we proceed to BPP's (biophysical profiles) that are less invasive yet very effective as a means to assess fetal wellbeing. Failing that, the mom may or may not be put to trial of labor, depending on conditions. She may proceed to csection if the result is very ominous.
Hope this helps; as usual, I probably said way too much. :uhoh21:

Very accurate, indeed. This is a textbook explanation of the CST and NST. CST's have fallen out of favor with many OB specialists.

Excellent answer and no, you did not say too much!! :)