Perform CST on preterm pregnancy?

mugwump · Jun 11, 2005

you could do a CST but definatly nipple stim. But I agree whats the point. If she was a preterm labor patient anyway definatly not. I'm curious why was she getting the NST anyway did you Aucoutsic stim her?

SierraN · Jun 11, 2005

you could do a CST but definatly nipple stim. But I agree whats the point. If she was a preterm labor patient anyway definatly not. I'm curious why was she getting the NST anyway did you Aucoutsic stim her?

She wasn't in preterm labor - just preterm (33 weeks). I asked about the FAS and the doc stated that she didn't even know if they had one since they never used it...that was kind of frustrating to me. I have heard people say there is research that shows the FAS isn't really a good indicator - can't even remember why though...something about it stresses the baby...Do you know? It's hard to go from one place where you are used to doing things a certain way and then go to another facility. The doctor sent her from the office for decreased fetal movement. She was 33 weeks. I had her on the monitor for about three hours where she had a few isolated contractions in which the fetus did well. Actually had an accel after on of them. She just didn't have a 15 by 15 acel..more like 10 by 10.

RNKitty · Jun 11, 2005

A CST is inappropriate in a preterm patient. They medically wouldn't be inducing a 33 week patient, anyway, without serious risk of lawsuit. If it is determined that the mother is no longer a good gestational host, then delivery is indicated. However, hopefully the doctor will reeval the patient with a BPP and AFI.

fourbirds4me · Jun 11, 2005

pp. 268 FHM Principles and Practices (AWHONN).... " The OCT (CST) is generally not recommended for pregnant women with a relative contraindication to uterine contractions, such as prematurity, a diagnosed placenta previa, a classical uterine incision scar, a history of extensive uterine surgery, or preterm rupture of membranes (Freeman, 1975; Ocak et al., 1992; AAP & ACOG, 2002).

I think a BPP would have been safer and more reliable.

SierraN · Jun 11, 2005

thanks for the reply - i'm printing it as I type

JaneyW · Jun 11, 2005

Could her dates be wrong? If she is more like 29 weeks or 30 weeks, aren't the accels sometimes not as high? Was the variability good? It is so frustrating when docs want to do things like this. You want to go whisper in the pt's ear to RUN! I guess that would be part of the "only one day" thread.

babyktchr, BSN, RN · Jun 11, 2005

Seems to me you had your CST if you had contractions and there were no decels. At 33 weeks, 10x10 accels may have been an ok thing. Was there circumstances for the patient that may have interfered...such as medication, smoking? A BPP would've been the thing to do...even if the patient were term in my opinion. And 3 hours monitoring before that is way out standard. Fetal well being should be assessed no more than 80 mins after non reassuring strip.

Also...accoustic stim can be done even without the little machine. Any loud noise will do.

Seems a followup AFI was needed anyway...so why not do the BPP.

Heavy sigh...don't you just want to scream sometimes/???

SierraN · Jun 12, 2005

Seems to me you had your CST if you had contractions and there were no decels. At 33 weeks, 10x10 accels may have been an ok thing. Was there circumstances for the patient that may have interfered...such as medication, smoking? A BPP would've been the thing to do...even if the patient were term in my opinion. And 3 hours monitoring before that is way out standard. Fetal well being should be assessed no more than 80 mins after non reassuring strip.
Also...accoustic stim can be done even without the little machine. Any loud noise will do.
Seems a followup AFI was needed anyway...so why not do the BPP.
Heavy sigh...don't you just want to scream sometimes/???

I did want to scream! Like, give me a break..first of all, she is 33 weeks gestation, why perform the CST - she sent her from the office for "decreased fetal movement" for "prolonged monitoring". You know, as you put the monitor on you see the baby kicking....I asked about meds and smoking, made sure she had eaten (even brought her more food) just in case that would help... On some things these doctors are over the top - she said that she was going to keep her in the hospital...then on other things you wonder what's going on in their heads.. she couldnt even show up for the delivery of another one of her patients that same day...it's not like we didn't call her a couple of times and tell her the patient was going fast without an epidural...but whatever - i'm :deadhorse Thanks for all the input.

madwife2002, BSN, RN · Jun 12, 2005

I've worked nights for years and recently started working 3-11 in a differant hospital. On night shift we didn't perform CSTs.. Well, yesterday the doctor discussed performing a CST on a 33 weeker because her NST was not reactive...she had accels but not 15 by 15...I asked about a biophysical profile and the doctor told me that they had one that showed an AFI of 7 which was concerning to the doctor. I read a while ago that CST are contraindicated in pretermers because of the risk of putting the mother into preterm labor. I need more information. Do you perform CST on pretermers? How about nipple stim CSTs? What is the standard?

What is CST? and NST? as we must use different abbreviations in UK. Thank you

SierraN · Jun 12, 2005

What is CST? and NST? as we must use different abbreviations in UK. Thank you

A CST is a contraction stress test..you make the woman have contractions to see how the baby does with them - it's used to determine how the fetus responds to decreased oxygen delivery during contractions - it's mainly used as a follow-up test for a nonreactive NST, usually in addition to a BPP....somtimes we use pitocin (low dose), sometimes we use nipple stim (which i HATE doing) - goal is 3 contractions that last 40 or more seconds in a 10 minute period. ...The NST is a a nonstess test - monitor the fetus and we call it "reactive" if (after 32 weeks gestation) we get 2 15 by 15 accels within a 20 minute period..

Tashia · Jun 12, 2005

I was just going to ask...