Contraction Stress Test?

[babynurse357]

The other day we had a G5L4 (all delivered in the last 5 years) with decreased fetal movement. She was 31 weeks and some change. Her biophysical profile was 6/10 in the dr's office so he wanted to do a contraction stess test with oxytocin. We are only a level II facility AND this pt has a history (per pt's verbal report because no prenatal record was available) of multiple preterm deliveries between 30-35 weeks. We refused to start the pit due to her hx. Are CST's even very common anymore-especially preterm? I've been doing this for 5 years and have NEVER done one.

(Pt ended up getting t/f'd to a level III hospital and was sent home the next day-they thought she was fine.)

TIA

[SmilingBluEyes]

My understanding is CST are rarely performed anymore. Most ob's and perinat's prefer to either deliver the baby or allow things to wait, based on data already gathered. Stressing out an already compromised baby just to "see how it will do" is not the idea, much of the time. Now, planning to deliver the baby----to get him or her out of what may be a hostile uterine environment; that is often done. But that is basically induction of labor, which in and of itself entails a " contraction stress test". The baby either can tolerate labor, or not, and we go from there---with the plan to deliver the baby fairly promptly, based on how he/she is doing. If the uterine environment is preferable to the outside, the baby is better off there---and not further stressed in the process, is the thinking of most OBs I know.

Does this make sense?

[Elvish, BSN, DNP, RN, NP]

I have never ever seen CSTs done, at least not in the hospital and I can't imagine why they'd do it in an outpatient setting. Esp not on a multip with a history of preterm delivery. That's asking for trouble.

[SmilingBluEyes]

Yes, exactly what Elvish said. Particularly not in outpatient and not in a patient with a history of preterm labor like this.

[babyktchr, BSN, RN]

You have probably done a CST without even really knowing it. You can essentially do one if the patient is already contracting....if there are no decels with existing contractions, so be it. In this situation, what was the BPP off for? Was there a reactive NST and points taken off for other areas? Standard of care would be to hydrate and repeat the BPP in 6 hours and see what you got. If there was no improvement (or worsening of the situation) then delivery would be prudent. I wonder if that isn't what the receiving facility did.

We don't do CST's routinely/purposely or otherwise.

[babynurse357]

Points off for tone and breathing movement. He claims her strip was nonreactive but at 31 weeks looked fine to me. Intermittent minimal variability, but also average at times, 10 X 10 accels, no epidsodic decels even with occasional ctx. What more could you ask for at 31 weeks?

She came for decreased fetal movement, also states she hadn't eaten anything but breakfast and it's now almost 8 pm. DUH-feed and hydrate her! I brought this to his attention but he didn't care. He already had his panties in a twist because I wouldn't start the pit.

(and yes I was patting myself on the back when I heard she was sent home the next morning and everything was fine-she didn't need to be t/f'd in the first place!)

[hoppermom3]

We rarely do CSTs - I can only think of maybe 3 times in the past 2 years. We did one a few weeks ago on a 38 weeker - nonreactive NST, BPP 8/10. CST was negative, we ended up waiting another week (doing NSTs every other day) and then induced. Pt ended up in C/S with cord entanglement. Babe was healthy.