Perform CST on preterm pregnancy?

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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?

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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.

Well...with an AFI of 7 at 33 weeks....ok it is a borderline oligo at such an early gestation....but do we know why?? I mean were there further tests on the baby to see if all was well in the kidney area? Seems to me if we were worried about that..prolonged monitoring should've been accompanied by IV hydration and a repeat AFI to see if it helped.

Decreased fetal movement and an equivocal NST SHOULD have bought this patient a BPP!!!!!

Be careful in feeding your patients for the non reactive strip. It is not evidenced based, although EVERYONE does it. If there were to be an adverse tracing and subsequent delivery via c/s...the patient has the potential to aspirate and then you are negligent. Studies show that increasing maternal blood sugar has no effect on fetal movement....it is really from the accoustic stimulation of the food or liquid hitting the maternal stomach that causes the fetus to react. Stick to clear liquids when trying the jump start a baby to move.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
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.
ABSOLUTELY. this is a very questionable practice. Either the baby or mom are doing well or not, to make things worse by initiating preterm labor is not useful at all.We do not do CSTs where I work. We do NSTs and if baby fails those, a BPP is in order. Why exactly, would a CST be necessary or useful, when you have the other (less invasive and bothersome options) available? I don't get it.
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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Well...with an AFI of 7 at 33 weeks....ok it is a borderline oligo at such an early gestation....but do we know why?? I mean were there further tests on the baby to see if all was well in the kidney area? Seems to me if we were worried about that..prolonged monitoring should've been accompanied by IV hydration and a repeat AFI to see if it helped.

Decreased fetal movement and an equivocal NST SHOULD have bought this patient a BPP!!!!!

Be careful in feeding your patients for the non reactive strip. It is not evidenced based, although EVERYONE does it. If there were to be an adverse tracing and subsequent delivery via c/s...the patient has the potential to aspirate and then you are negligent. Studies show that increasing maternal blood sugar has no effect on fetal movement....it is really from the accoustic stimulation of the food or liquid hitting the maternal stomach that causes the fetus to react. Stick to clear liquids when trying the jump start a baby to move.

I find the BEST intervention is plain very cold water, not food. I agree with you---feeding them to get a baby to react is a bad idea.
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I find the BEST intervention is plain very cold water, not food. I agree with you---feeding them to get a baby to react is a bad idea.

Thanks for the advice - so from now on - Cold water.

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ABSOLUTELY. this is a very questionable practice. Either the baby or mom are doing well or not, to make things worse by initiating preterm labor is not useful at all.We do not do CSTs where I work. We do NSTs and if baby fails those, a BPP is in order. Why exactly, would a CST be necessary or useful, when you have the other (less invasive and bothersome options) available? I don't get it.

I agree with you completely...I posted to see if perhaps i was wrong in thinking the CST was not indicated... In my former place of employment, we didn't do CSTs....so I'm a little confused why they think it's a good idea here. I asked another doc about the CST and he told me that it was a better indicator of fetal well-being then a BPP...what do you know about this?

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
I agree with you completely...I posted to see if perhaps i was wrong in thinking the CST was not indicated... In my former place of employment, we didn't do CSTs....so I'm a little confused why they think it's a good idea here. I asked another doc about the CST and he told me that it was a better indicator of fetal well-being then a BPP...what do you know about this?
Honestly I know nothing of this. I would ask him to point you to the literature/studies supporting this theory, myself. I would love to learn something new, honestly. If you hear anything would you mind telling us? I have never been anyplace where CST was used on preterm fetuses to assess wellbeing. I obviously dont' know everything, so I am willing to learn what supports this practice. Thanks. :)
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Honestly I know nothing of this. I would ask him to point you to the literature/studies supporting this theory, myself. I would love to learn something new, honestly. If you hear anything would you mind telling us? I have never been anyplace where CST was used on preterm fetuses to assess wellbeing. I obviously dont' know everything, so I am willing to learn what supports this practice. Thanks. :)

I was surprised to hear this myself. The next time I see him, I will ask about the literature/studies and get back to you. This is a great place to learn...like from now on, it's cold water, not a roast beef sandwich..just kiddin' about the sandwich :) I just feel like a fish out of water sometimes at this new hospital.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

There is so much to learn----I continually learn new things being an AWHONN member and reading my journals. Honestly I have never, ever read or heard of this being done on preterm fetuses. Anymore, the "CST" is really no more than a trial of labor or induction, on a TERM (37+ week, 36 if IDDM/PIH sometimes) fetus ( "induction" meaning use of AROM, Pitocin, cytotec to initiate labor).

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I work in a high risk antepartum unit and We have done 1 CST on a patient. With nipple stimulation. I can't even remember why. I do remember if she passed she could go home. I belive it was a mom we had for a while where the baby sometime deceled and she was now 35 weeks now and if she passed the CST she could go home until she delivered. I think that's why we did it but don't quote me. Although unfortunatly working on my unit we have a lot of incidental cst's. Preterm patient that are actually contracting 3 times in 10 minutes (although we are usually trying to stop them) and the baby does wonderful.

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