What is an appropriate indicator for performing a contraction stress test?

1

Pose SV, Castillo JB, Nora-Rojas EO et al: Test of fetal tolerance to induce uterine contractions for the diagnosis of chronic distress. In: Perinatal Factors Affecting Human Development, p 96. Washington, DC, Pan American Health Organization, 1969

2

Kubli FW, Kaeser O, Hinselmann M: Diagnostic management of chronic placental insufficiency. In Pecile A, Finzi C (eds): The Foeto-Placental Unit, p 323. Amsterdam, Excerpta Medica Foundation, 1969

3

Devoe LD, Castillo RA, Sherline DM: The nonstress test as a diagnostic test: A critical reappraisal. Am J Obstet Gynecol 152: 1047, 1985

4

Thacker SB, Berkelman RL: Assessing the diagnostic accuracy and efficacy of selected antepartum fetal surveillance techniques. Obstet Gynecol Surv 41: 121, 1986

5

Dalton KJ, Dawes GS, Patrick JE: The autonomic nervous system and fetal heart rate variability. Am J Obstet Gynecol 146: 456, 1983

6

Martin CB Jr: Regulation of the fetal heart rate and genesis of FHR patterns. Semin Perinatol 2: 131, 1978

7

Murata Y, Martin CB, Ikenoue T et al: Fetal heart rate accelerations and late decelerations during the course of intrauterine death in chronically catheterized rhesus monkeys. Am J Obstet Gynecol 144: 218, 1982

8

Bocking AD, Harding R, Wickham PJD: Effects of reduced uterine blood flow on accelerations and decelerations in heart rate of fetal sheep. Am J Obstet Gynecol 154: 329, 1986

9

Itskovitz J, LaGamma EF, Rudolph AM: Heart rate and blood pressure responses to umbilical cord compression in fetal lambs with special reference to mechanism of variable decelerations. Am J Obstet Gynecol 147: 451, 1983

10

Natale R, Nasello-Patterson C, Turok R: Longitudinal measurements of fetal breathing, body movements, heart rate, and heart rate accelerations and decelerations at 24 to 32 weeks of gestation. Am J Obstet Gynecol 151: 256, 1985

11

Sorokin Y, Pillay SK, Dierker LJ et al: The association between fetal heart rate patterns and fetal movements in pregnancies between 20 and 30 weeks' gestation. Am J Obstet Gynecol 143: 243, 1982

12

Aladjem S, Vuolo K, Pazos R et al: Antepartum fetal testing: Evaluation and redefinition of criteria for clinical interpretation. Semin Perinatol 5: 145, 1981

13

Patrick J, Carmichael L, Chen L et al: Accelerations of the human fetal heart rate at 38 to 40 weeks' gestational age. Am J Obstet Gynecol 148: 35, 1984

14

Martin CB: Behavioral states in the human fetus. J Reprod Med 26: 425, 1981

15

Assali NS, Brinkman CR, Woods JR et al: Development of neurohumoral control of fetal, neonatal and adult cardiovascular function. Am J Obstet Gynecol 129: 748, 1977

16

Campbell K: Ultradian rhythms in the fetus during the last 10 weeks gestation: A review. Semin Perinatol 4: 301, 1980

17

Visser GHA, Goodman JDS, Levine DH et al: Diurnal and other cyclic variations in human fetal heart rate near term. Am J Obstet Gynecol 142: 535, 1982

18

Dalton KJ, Dawes GS, Patrick JE: Diurnal, respiratory and other rhythms of fetal heart rate in lambs. Am J Obstet Gynecol 127: 414, 1977

19

Patrick J, Campbell K, Carmichael L et al: Patterns of fetal gross body movements over 24-hour observation intervals during the last 10 weeks of pregnancy. Am J Obstet Gynecol 142: 363, 1982

20

Gelman SR, Spellacy WN, Wood S et al: Fetal movements and ultrasound: Effect of maternal intravenous glucose administration. Am J Obstet Gynecol 137: 459, 1980

21

Richardson B, Briggs ML, Toomey C et al: The effect of maternal glucose administration on the specificity of the nonstress test. Am J Obstet Gynecol 137: 459, 1980

22

Artal R, Rutherford S, Romen Y et al: Fetal heart rate responses to maternal exercise. Am J Obstet Gynecol 155: 729, 1986

23

Devoe LD, Arthur M, Searle N: The effects of maternal ambulation on the nonstress test. Am J Obstet Gynecol 157: 240, 1987

24

Rayburn WF, Motley ME, Zuspan FP: Conditions affecting nonstress test results. Obstet Gynecol 59: 490, 1982

25

Devoe LD, O'Dell BE, Castillo RA et al: Metastic pheochromocytoma in pregnancy: The fetal biophysical effects following maternal administration of alpha-adrenergic, beta-adrenergic, and dopamine antagonists. Obstet Gynecol 68 (3 Suppl): 15S, 1986

26

Margulis E, Binder D, Cohen DW: The effect of propranolol on the nonstress test. Am J Obstet Gynecol 133: 579, 1979

27

Keegan KA, Paul RH, Broussard PM et al: Antepartum fetal heart rate testing: III. The effect of phenobarbital on the nonstress test. Am J Obstet Gynecol 133: 579, 1979

28

Quigley ME, Sheehan KL, Wilkes MM et al: Effects of maternal smoking on circulating catecholamine levels and fetal heart rates. Am J Obstet Gynecol 133: 685, 1979

29

Peeters LL, Shelton RE, Jones MD et al: Blood flow to fetal organs as a function of arterial oxygen content. Am J Obstet Gynecol 135: 637, 1979

30

Sheldon RE, Peeters LLH, Jones MD et al: Redistribution of cardiac output and oxygen delivery in the hypoxemic fetal lamb. Am J Obstet Gynecol 135: 1071, 1979

31

Nathanielsz PW, Bailey A, Poore ER et al: The relationship between myometrial activity and sleep state and breathing in fetal sheep throughout the last third of gestation. Am J Obstet Gynecol 138: 653, 1980

32

Powell OH, Melville A, MacKenna JL: Fetal heart rate acceleration in labor: Excellent prognostic indicator. Am J Obstet Gynecol 134: 36, 1979

33

Hammacher K: The clinical significance of cardiotocography. In Huntingford P, Hunter M, Saling E (eds): Perinatal Medicine, pp 80–93. New York, Academic Press, 1970

34

Lee CY, Diloreto PC, O'Lane JM: A study of fetal heart rate acceleration patterns. Obstet Gynecol 45: 142, 1975

35

Rochard F, Schifrin BS, Goupil F et al: Nonstressed fetal heart rate monitoring in the antepartum period. Am J Obstet Gynecol 126: 699, 1976

36

Brown R, Patrick J: The nonstress test: How long is enough? Am J Obstet Gynecol 141: 646, 1981

37

Devoe LD, McKenzie J, Searle NS et al: Clinical sequelae of the extended nonstress test. Am J Obstet Gynecol 151: 1074, 1985

38

Devoe LD: Antepartum fetal heart rate testing in pre-term pregnancy. Obstet Gynecol 60: 431, 1982

39

Druzin ML, Fox A, Kofut E et al: The relationship of the nonstress test to gestational age. Am J Obstet Gynecol 153: 386, 1985

40

Smith CV, Phelan JP, Paul RH: A prospective analysis of the influence of gestational age on the baseline fetal heart rate and reactivity in a low risk population. Am J Obstet Gynecol 153: 780, 1985

41

Lawson GW, Belcher R, Dawes GS et al: A comparison of ultrasound (with autocorrelation) and direct electrocardiogram fetal heart rate detector systems. Am J Obstet Gynecol 147: 721, 1983

42

Divon MY, Torres FP, Yeh SY et al: Autocorrelation techniques in fetal monitoring. Am J Obstet Gynecol 151: 2, 1985

43

Klapholz H: Techniques of fetal heart rate monitoring. Semin Perinatol 2: 119, 1978

44

Neldam S, Jessen P: Fetal movements registered by the pregnant women correlated to retrospective estimations of fetal movements from cardiotocographic tracings. Am J Obstet Gynecol 136: 1051, 1980

45

Devoe LD, McKenzie J, Searle N et al: Nonstress test: Dimensions of normal reactivity. Obstet Gynecol 66: 617, 1985

46

Visser GHA, Zeelenberg HJ, DeVries JIP et al: External physical stimulation of the human fetus during episodes of low heart rate variation. Am J Obstet Gynecol 145: 579, 1983

47

Read JA, Miller FC: Fetal heart rate acceleration in response to acoustic stimulation as a measure of fetal well-being. Am J Obstet Gynecol 129: 512, 1977

48

Smith CV, Phelan JP, Broussard PM, Paul RH: Fetal acoustic stimulation testing. A retrospective analysis of the fetal acoustic stimulation test. Am J Obstet Gynecol 153: 567, 1985

49

Smith CV, Phelan JP, Platt LD et al: Fetal acoustic stimulation testing. II. A randomized comparison with the nonstress test. Am J Obstet Gynecol 155: 131, 1986

50

Gagnon R, Hunse C, Patrick J: Fetal responses to vibratory acoustic stimulation: Inflection of basal heart rate. Am J Obstet Gynecol 159: 835, 1988

51

Devoe LD, Searle NA, Ruedrich DA et al: The effects of vibroacoustic stimulation on baseline heart rate, breathing activity, and body movements of normal term fetuses. Am J Obstet Gynecol 161: 524, 1989

52

Devoe LD, Gardner P, Arnold P, Searle BA: The effects of vibratory acoustic stimulation on baseline fetal heart rate in term pregnancy. Am J Obstet Gynecol 160: 1086, 1989

53

Smith CV, Satt R, Phelan JP, Paul RH: Intrauterine sound levels: Intrapartum assessment within intrauterine environment. Am J Perinatol 7: 312, 1990

54

Nyman M, Barr M, Westgren M: A four-year followup of hearing and development in children exposed in utero to vibroacoustic stimulation. Br J Obstet Gynecol 99: 685, 1992

55

Maeda K: Studies on new ultrasonic doppler fetal actograph and continuous recordings of fetal movement. Acta Obstet Gynaecol Jpn 36: 280, 1984

56

Schmidt W, Gnirs J: Das KCTG-erste klinische Erfahrungen beim, Einsatz des Kinetocardiotokogramms. Geburtshilfe Frauenheilkd 51: 437, 1991

57

Besinger RE, Johnson TRB: Doppler recordings of fetal movement: Clinical correlation with realtime ultrasound. Obstet Gynecol 74: 277, 1989

58

Melendez TD, Rayburn WF, Smith CV: Characterization of fetal body movement recorded by Hewlett Packard M1350A fetal monitor. Am J Obstet Gynecol 167: 700, 1992

59

Stanco LM, Rabello Y, Medearis AL et al: Does doppler-detected fetal movements decrease the incidence of nonstress tests? Obstet Gynecol 82: 999, 1993

60

Devoe L, Boehm F, Paul R et al: Clinical experience with the Hewlett Packard M-1350 fetal monitor: Correlation of doppler-detected fetal body movements with fetal heart rate parameters and perinatal outcome. Am J Obstet Gynecol 170: 650, 1994

61

Searle JR, Devoe LD, Phillips MC, Searle NS: Computerized analysis of resting fetal heart rate tracings. Obstet Gynecol 71: 407, 1988

62

Dawes GS, Moulden M, Redman CWG: System 8000: Computerized antenatal FHR analysis. J Perinat Med 19: 47, 1991

63

Schneider E, Schulman H, Farmakieds G, Paksima S: Comparison of the interpretation of antepartum fetal heart rate tracings between a computer program and experts. J Mat Fet Invest 1: 205, 1991

64

Hiett AK, Devoe LD, Youssef A et al: A comparison of visual and automated methods of analyzing fetal heart rate tests. Am J Obstet Gynecol 168: 1517, 1993

65

Blumkofe KA, Broussard PM, Walla CA, Platt LD: Computerized versus visual analysis of fetal heart rate: A reduction in testing time. Am J Obstet Gynecol 166: 415, 1992

66

Evertson LR, Gautier RJ, Schifrin BS et al: Antepartum fetal heart rate testing: I. Evolution of the nonstress test. Am J Obstet Gynecol 133: 29, 1979

67

Keegan KA, Paul RH: Antepartum fetal heart rate testing: IV. The nonstress test as a primary approach. Am J Obstet Gynecol 136: 75, 1980

68

Mendenhall HW, O'Leary JA, Phillips KO: The nonstress test: The value of a single acceleration in evaluating the fetus at risk. Am J Obstet Gynecol 136: 87, 1980

69

Visser GHA, Huisjes HS: Diagnostic value of the unstressed antepartum cardiotocogram. Br J Obstet Gynaecol 84: 321, 1977

70

Krebs HB, Petres RE: Clinical application of a scoring system for evaluation of antepartum fetal heart rate monitoring. Am J Obstet Gynecol 130: 765, 1978

71

Lyons ER, Bylsma-Howell M, Siamsi S et al: A scoring system for nonstressed antepartum fetal heart rate monitoring. Am J Obstet Gynecol 133: 242, 1979

72

Devoe LD, Yanowitch G, Azor H: The application of multiple-parameter scoring to antepartum fetal heart rate testing. J Reprod Med 26: 250, 1981

73

Pearson JF, Weayer JB: A six-point scoring system for antenatal cardiotocographs. Br J Obstet Gynaecol 85: 321, 1978

74

Devoe LD, Castillo R, McKenzie J et al: Sequential non-stress testing using each fetus as its own control. Am J Obstet Gynecol 154: 931, 1986

75

Schifrin BS, Foye G, Amato J et al: Routine fetal heart rate monitoring in the antepartum period. Obstet Gynecol 54: 21, 1979

76

Elynn AM, Kelly J, O'Connor M: Unstressed antepartum cardiotocography in the management of the fetus suspected of growth retardation. Br J Obstet Gynaecol 86: 106, 1979

77

Lin CC, Devoe LD, River P et al: Oxytocin challenge test and intrauterine growth retardation. Am J Obstet Gynecol 140: 282, 1981

78

Devoe LD, Sholl JS: Postdates pregnancy: Assessment of fetal risk and obstetric management. J Reprod Med 28: 576, 1983

79

Yeh SY, Read JA: Management of post-term pregnancy in a large obstetric population. Obstet Gynecol 60: 282, 1982

80

Lavin JP, Miodovnik M, Barden TP: Relationship of nonstress test reactivity and gestational age. Obstet Gynecol 63: 338, 1984

81

Bailey D, Flynn AM, Kelly J et al: Antepartum fetal heart rate monitoring in multiple pregnancy. Br J Obstet Gynaecol 87: 561, 1980

82

Devoe LD, Azor H: Simultaneous nonstress fetal heart rate testing in twin pregnancy. Obstet Gynecol 58: 450, 1981

83

Blake GD, Knuppel RA, Ingardia CJ et al: Evaluation of nonstress testing in multiple gestations. Obstet Gynecol 63: 528, 1984

84

Nayot D, Mor-YoSef S, Granat M et al: Antepartum fetal heart rate pattern associated with major congenital malformations. Obstet Gynecol 63: 414, 1984

85

Powell-Phillips WD, Towell ME: Abnormal fetal heart rate associated with congenital abnormalities. Br J Obstet Gynaecol 87: 270, 1980

86

Vorher H: Placental insufficiency in relation to post-term pregnancy and fetal postmaturity. Am J Obstet Gynecol 123: 67, 1975

87

Young BK, Katz M, Wilson SJ: Sinusoidal fetal heart rate: I. Clinical significance. Am J Obstet Gynecol 136: 587, 1980

88

Boehm FH, Salyer S, Shah DM et al: Improved outcome of twice weekly nonstress testing. Obstet Gynecol 67: 566, 1986

89

Ray M, Freeman RK, Pine S et al: Clinical experience with the oxytocin challenge test. Am J Obstet Gynecol 114: 1, 1972

90

Freeman RK: The use of the oxytocin challenge test for antepartum clinical evaluation of uteroplacental respiratory function. Am J Obstet Gynecol 121: 481, 1975

91

Trierweiler MW, Freeman RK, James J: Baseline fetal heart rate characteristics as an indicator of fetal status during the antepartum period. Am J Obstet Gynecol 125: 618, 1976

92

Fox HE, Steinbrecher M, Ripton B: Antepartum fetal heart and uterine activity studies: I. Preliminary report of accelerations and the oxytocin challenge test. Am J Obstet Gynecol 126: 61, 1976

93

Farahani G, Fenton AN: Fetal heart rate acceleration in relation to the oxytocin challenge test. Obstet Gynecol 49: 163, 1977

94

Braly P, Freeman RK: The significance of fetal heart rate reactivity with a positive oxytocin challenge test. Obstet Gynecol 50: 689, 1977

95

Huddleston JF, Sutliff G, Robinson D: Contraction stress test by intermittent nipple stimulation. Obstet Gynecol 63: 699, 1984

96

Devoe LD: Clinical implications of prospective antepartum fetal heart rate testing. Am J Obstet Gynecol 137: 983, 1980

97

Keane MW, Horger ED, Vice L: Comparative study of stressed and nonstressed antepartum fetal heart rate testing. Obstet Gynecol 57: 320, 1981

98

Lee CY, Drukker B: The nonstress test for the antepartum assessment of fetal reserve. Am J Obstet Gynecol 134: 460, 1979

99

Leveno KJ, Williams ML, DePalma RT et al: Perinatal outcome in the absence of antepartum fetal heart rate acceleration. Obstet Gynecol 61: 347, 1983

100

Phelan JP: The nonstress test: A review of 3000 tests. Am J Obstet Gynecol 139: 7, 1981

101

Mashini IS, Devoe LD, McKenzie J et al: Comparison of uterine activity induced by nipple stimulation and oxytocin. Obstet Gynecol 69: 74, 1987

102

Freeman RK, Anderson G, Dorchester W: A prospective multi-institutional study of antepartum fetal heart rate monitoring: I. Risk of perinatal mortality and morbidity according to antepartum fetal heart rate test results. Am J Obstet Gynecol 143: 771, 1982

103

Devoe LD: Clinical features of the reactive positive contraction stress test. Obstet Gynecol 63: 523, 1984

104

Staisch KJ, Westlake JR, Bashore RA: Blind oxytocin challenge test and perinatal outcome. Am J Obstet Gynecol 138: 399, 1980

105

Baskett TF, Sandy EA: Oxytocin challenge test and antepartum fetal assessment. Br J Obstet Gynaecol 84: 39, 1977

106

Schifrin BS, Lapidus M, Doctor GS et al: Contraction stress for antepartum fetal evaluation. Obstet Gynecol 45: 433, 1975

107

Trimbos JB, Keirse MJNC: Significance of antepartum cardiotocography in normal pregnancy. Br J Obstet Gynaecol 85: 907, 1978

108

Phelan JP, Lewis PE: Fetal heart rate decelerations during a nonstress test. Am J Obstet Gynecol 57: 228, 1981

109

O'Leary JA, Adrinopoulous GC, Gioroano PC: Variable decelerations and the nonstress test: An indication of cord compromise. Am J Obstet Gynecol 137: 704, 1980

110

Pazos R, Vuolo K, Aladjem S et al: Association of spontaneous fetal heart rate decelerations during antepartum nonstress testing and intrauterine growth retardation. Am J Obstet Gynecol 144: 574, 1982

111

Bourgeois FJ, Thiagarajah S, Harbert GM: The significance of fetal heart rate decelerations during nonstress testing. Am J Obstet Gynecol 150: 213, 1984

112

Druzin ML, Gratacos J, Keegan K, Paul RH: Antepartum fetal heart rate testing: VII. The significance of fetal bradycardia. The significance of fetal bradycardia. Am J Obstet Gynecol 139: 194, 1981

113

Odendaal HJ: Hyperstimulation of the uterus during the oxytocin stress test. Obstet Gynecol 51: 380, 1978

114

Gabbe SG, Freeman RK, Goebelsmann U: Evaluation of the contraction stress test before 33 weeks' gestation. Obstet Gynecol 52: 649, 1978

115

Klapholz H, Burke L: Intrauterine fetal demise with a negative oxytocin challenge test. J Reprod Med 15: 169, 1975

116

Lorenz RP, Pagano JS: A case of fetal death after a negative oxytocin challenge test. Am J Obstet Gynecol 130: 232, 1978

117

Salerno NJ, Thomas RK: A further challenge to the validity of the weekly interval between oxytocin challenge tests. Am J Obstet Gynecol 130: 232, 1978

118

Evertson LR, Gauthier RJ, Collea JV: Fetal demise following negative contraction stress tests. Obstet Gynecol 51: 671, 1978

119

Liggins GC, Howie RN: A controlled trial of antepartum glucocorticoid treatment for prevention of the respiratory distress syndrome in premature infants. Pediatrics 50: 515, 1972

120

Bissonnette JM, Johnson K, Toomey C: The role of a trial of labor with a positive contraction stress test. Am J Obstet Gynecol 135: 292, 1979

121

Odendaal NJ: The fetal and labor outcome of 102 positive contraction stress tests. Obstet Gynecol 54: 591, 1979

122

Devoe KD, Morrison J, Martin J et al: A prospective comparative study of the extended nonstress test and nipple stimulation contraction stress test. Am J Obstet Gynecol 157: 531, 1987

123

Devoe LD, Castillo R, Saad S et al: Percent acceleration time: A new method of fetal assessment. Obstet Gynecol 67: 191, 1986

124

Beischer BA, Drew JH, Ashton PW et al: Quality of survival of infants with critical fetal reserve detected by antenatal cardiotocography. Am J Obstet Gynecol 146: 662, 1983

125

Trimbos JB, Keirse MJ: Observer variability in assessment of antepartum cardiotocograms. Br J Obstet Gynaecol 85: 900, 1978

126

Hage ML: Interpretation of nonstress tests. Am J Obstet Gynecol 153: 490, 1985

127

Boehm FH, Fields LM, Hutchinson JM et al: The indirectly obtained fetal heart rate: Comparison of first and second generation electronic fetal monitors. Am J Obstet Gynecol 155: 10, 1986

128

Brown V, Sawers RS, Parsons RJ et al: The value of antenatal cardiotocography in the management of high risk pregnancy: A randomized controlled trial. Br J Obstet Gynaecol 89: 716, 1982

129

Flynn AM, Kelly J, Mansfield H et al: A randomized controlled trial of nonstress antepartum cardiotocography. Br J Obstet Gynaecol 89: 427, 1982

130

Kidd LC, Patel NB, Smith R: Nonstress antenatal cardiotocography—a prospective randomized clinical trial. Br J Obstet Gynaecol 92: 1156, 1985

131

Lumley J, Lester A, Anderson I: A randomized trial of weekly cardiotocography in high risk obstetric patients. Br J Obstet Gynaecol 90: 1018, 1983

132

Neilson JP: Cardiotocography for antepartum fetal assessment in pregnancy and childbirth module. In Enkin MW, Keirse MJNC, Renfrew MJ, Neilson JP (eds): Cochrane Database of Systematic Reviews. Review no. 03881, March 24, 1993. Disk Issue 1. Oxford, Update Software, 1994

133

Devoe LD, Gardner P, Dear C, Castillo RA: The diagnostic values of concurrent nonstress testing, amniotic fluid measurement, and doppler velocimetry in screening a general high risk population. Am J Obstet Gynecol 163: 1040, 1990

134

Platt LD, Paul RH, Phelan J et al: Fifteen years of experience with antepartum fetal testing. Am J Obstet Gynecol 156: 1509, 1987

135

Garite TJ, Freeman RK, Hochleutner I et al: Oxytocin challenge test: Achieving the desired goals. Obstet Gynecol 51: 614, 1978

What are indications for a contraction stress test?

Your doctor may schedule a contraction stress test if they're concerned about how your baby will respond to contractions or to see how the fetal heart rate responds to stimulation. However, the test can induce labor.

What is required for a positive contraction stress test?

If your baby's heart beats more slowly after more than half of your contractions, the test result is positive, signaling that your baby may be under stress and unable to tolerate labor contractions.

Which problem is indicated by a positive contraction stress test CST )?

The contraction stress test was most commonly used in the past as a follow-up evaluation after a nonreactive stress test. Experimental data suggest that the occurrence of late decelerations with contractions, the basis for a positive (abnormal) stress test, is an early warning sign of uteroplacental insufficiency.