Contraction Stress Test Research Articles

Labor Induction in Case of Fetal Growth Restriction (FGR)

Clinicians consider a range of variables when formulating decisions regarding the diagnosis, monitoring plan, and ultimately the decision to recommend the delivery of a growth-restricted fetus. The differential diagnosis of a pathological fetal growth pattern is initially considered via the history, a physical and laboratory examination of the pregnant person, as well as a comprehensive fetal ultrasound examination. These factors allow a broad distinction between pre-existing disease in the pregnant person, constitutionally small normal growth, placenta-mediated Fetal Growth Restriction (FGR), and intrinsic fetal disease. Most commonly, pathological growth restriction is mediated by underlying placental diseases, of which maternal vascular malperfusion is the most common, and often results in co-existent hypertension. A program of combined monitoring of the pregnant person and fetus, comprising hypertension assessment, and serial fetal ultrasound, including Doppler studies is then instituted, and may be combined with biochemical markers, such as Placental Growth Factor, for greater clinical precision. Recommendations on timing to deliver the growth-restricted fetus worldwide are converging, with similar guidance from clinical practice guidelines informed by high-quality Randomized Controlled Trials (RCTs) and large cohort studies. In most instances, it is reasonable to recommend delivery of all growth-restricted fetuses by approximately 38 weeks. Timing of delivery should take into consideration both short-term neonatal outcomes and long-term outcomes at school age. Mode of delivery is based on many factors, and induction of labor is a safe approach, especially after 34 weeks. Mechanical methods of induction may be preferred to pharmacologic methods, although both have a role and the choice of method is based on individualized assessment. Elective Cesarean birth thereby bypassing fetal stress during labor, is recommended in preterm growth-restricted fetuses with signs of adaptive fetal compromise, especially when ductus venosus flow is abnormal, or a contraction stress test is positive.

Comparing Non-Stress Test versus Umbilical Artery Doppler Velocimetry among Aample of High-risk Pregnant Women in Erbil City

Background: The mainstay of care for lowering maternal and perinatal mortality and morbidity is antepartum foetal surveillance. Numerous techniques are used, including fetal movements, Vibroacoustic stimulation tests, contraction stress tests, biophysical profiles of the fetus, modified biophysical profiles, non-stress testing and Doppler Umbilical artery of the fetus's. The fetal heart reaction to internal and extrinsic stimuli is seen on electronic fetal monitoring devices. The benefit of high resolution dynamic ultrasonography and Doppler imaging is that it allows for the visualization of the fetus and its surroundings as well as the monitoring of fetal health by measuring utero-placental circulation. Patients and techniques: The cross-sectional investigation including 120 pregnant women who visited the Maternity Teaching Hospital between 26 June and 31 August 2022 and complained of decreased uterine contractions have been included. The questionnaire included sociodemographic data, obstetrical data, information on the fetal outcome and method of delivery. In accordance with the American Academy of Obstetricians and Gynecologists, cardiotopography was utilized to conduct a non-stress test, and the outcomes were categorized as reactive and non-reactive. Cardiotopography was used to perform a non-stress test, and the results were classified as reactive or non-reactive in accordance with the American Academy of Obstetricians and Gynecologists. Also, during 32 weeks or more of gestation, the inferior vena cava was not compressed by the gravid uterus during ultrasonography of the umbilical arteries, which was performed in a semi-recumbent position with a slight lateral tilt. Result: Based on NST and Doppler velocimetry of the umbilical artery, all cases were classified into two groups. The outcomes of the two tests didn't significantly differ from one another. The rate of Cesarean section (CS) was 46.1% among women with non-reactive (abnormal) CTG, compared with 25% among women with normal CTG (p = 0.0316). Only one neonate (1.3%) died among women with normal CTG, while none of the neonates died among women with abnormal CTG. The rate of CS among women with abnormal ultrasonography was 80% compared to women (11%) with normal ultrasonography. Furthermore, one neonate (2.1%) in the group of abnormal doppler, compared with 0% in the normal group. Conclusion: NST and umbilical artery Doppler of are sensitive and specific tests with strong positive prognostic value to suggest a poor prognosis for the newborn. Doppler velocimetry of umbilical artery is more important than a non-stress test because it lowers the likelihood of a CS birth in non-reactive non-stress test situations without increasing the risk of perinatal morbidity and mortality. Bangladesh Journal of Medical Science Vol.22 (Special Issue) 2023 p.10-17

The role of umbilical artery Doppler analysis in estimating perinatal morbidity and mortality in hypertensive pregnancy

Aims: Uteroplacental (uterine artery systolic/diastolic (S/D) ratio) and fetal circulation changes (umbilical artery pulsatility Index (PI) value) can be evaluated non-invasively by using Doppler ultrasonography spectral analysis. The present study aimed to demonstrate how Doppler ultrasonography should be combined with classical well-being tests to detect perinatal morbidity and mortality in hypertensive pregnancy. Methods: This prospective research was carried out with 88 pregnant women diagnosed with high-risk pregnancy and hypertension between April 1992 and May 1994. A non-stress test (NST) was performed in all cases, and fetal distress was evaluated by a biophysical profile (BP) and/or a contraction stress test (CST) subsequent to a non-reactive NST. Following the diagnosis of hypertension, longitudinal maternal (uterine artery) and fetal (umbilical artery) Doppler analyses were initiated at 7–10-day intervals. In the study, the Acuson 128 XP 10 device (Research project No. 515/080555592 was funded by the İstanbul University Research Fund) and a 3.5-5 MHz curvilinear probe were used. No Doppler pathology was considered solely in the timing of delivery. Results: There was no case of perinatal loss, antepartum and intrapartum fetal distress, neonatal asphyxia, and oligohydramnios in the group with normal uterine and umbilical artery Doppler analyses. There was one case with umbilical artery Doppler flow pathology only, which was delivered by preterm cesarean section with the diagnosis of antepartum fetal distress. Fetus diagnosed to have a fetal growth restriction (FGR) and the findings of fetal distress, FGR, and cesarean delivery were concordant with the literature. There was also increased perinatal mortality (9.1%) among patients with pathological uterine artery Doppler and normal umbilical artery Doppler group, but there was no case of oligohydramnios in this group and the rate of neonatal asphyxia (5.min Apgar score <7) was 21.7%. The antepartum loss was 27%, the neonatal loss was 23.8%, and perinatal mortality was 44.8% in the group with pathological uterine and umbilical artery Doppler findings, and this group had all cases of oligohydramnios. Conclusion: Overall, it seems reasonable to identify any pathologies with Doppler ultrasonography in hypertensive pregnant women in the early pregnancy and to follow them up with classical fetal antepartum surveillance tests at appropriate intervals related to their umbilical artery Doppler pathologies.

Study on Effective Communication Skills for Good Cancer Care

Even though communication is a key clinical skill in oncology, few physicians and cancer nurses have conventional formal training in this area. Inadequate communications may be upsetting for a patient or family since they frequently need much more information than is often delivered. Many clients leave consultations with questions regarding their diagnosis and prognosis, the value of more tests, and whether or not they are necessary for the management framework or the therapy's underlying therapeutic purpose. Furthermore, communication issues may prevent patients from enrolling in clinical trials, resulting in the delay of useful new treatments in clinics. Inadequate communication between experts or departments may lead to misunderstandings and a loss of trust among team members. Lack of communication and management skills training, according to oncologists, is a big role in their stress, work satisfaction, and emotional tiredness. As a result, many efforts aiming at strengthening cancer healthcare personnel's fundamental effective communication have been launched in recent years. Some of the problems that affect communications in an oncology context, and hence patient care, are discussed in this study. The fundamental conclusion of this research is that communication is beneficial in the treatment of any condition. In this paper, the author provides a comprehensive study on effective communication skills for good cancer care. Further research on the effectiveness of the Contraction Stress Test (CST) in improving healthcare professional communication should focus on improving patient outcomes rather than healthcare workers' views of their abilities.

Umbilical Artery Systolic/Diastolic Ratio and Amniotic Fluid Index in Prediction of Adverse Perinatal Outcome in Term Pregnancies.

Background:Antenatal fetal surveillance is a field of increasing importance in modern obstetrics. It is based on fetal heart rate monitoring using nonstress test and contraction stress test, ultrasound biometry and amniotic fluid assessment, Doppler blood flow studies of fetal and uteroplacental circulation, and an evaluation of biophysical fetal parameters. The combination of these methods leads to improvements in fetal morbidity and mortality.Aim:The present study aimed to assess the sensitivity, specificity, and positive and negative predictive values of umbilical artery (UA) systolic/diastolic (S/D) ratio, and amniotic fluid index (AFI) in term pregnancies for the prediction of perinatal outcome and their relation with perinatal outcome.Methods:This study was conducted at a tertiary care hospital on 100 pregnant women where all the term singleton pregnancies (37–42 weeks) admitted in maternity were subjected to color Doppler for UA S/D ratio assessment and AFI estimation. Further, management of patients was done according to color Doppler findings and their relation with perinatal outcome.Results:Out of 100 pregnant women, 68% had AFI >8 (normal), while 32% of women had AFI <8 (abnormal), with the mean AFI being 9.39 ± 2.55 cm, whereas70% had S/D ratio <3 (normal) and 30% of women had S/D ratio >3 (abnormal), with the mean S/D ratio of 2.61 ± 0.450. UA S/D ratio had better performance values (i.e., sensitivity, specificity, and positive and negative predictive value) than AFI in predicting adverse perinatal outcomes.Conclusion:AFI and UA S/D ratio are important for predicting low appearance, pulse, grimace, activity, and respiration score, meconium, respiratory complications, and perinatal mortality in high as well as low-risk pregnancy cases. However, UA S/D ratio is a better predictor of perinatal outcome in high-risk pregnancies.

How and when to recommend delivery of a growth-restricted fetus: A review.

Clinicians consider a range of variables when formulating decisions regarding the diagnosis, monitoring plan, and ultimately the decision to recommend the delivery of a growth-restricted fetus. The differential diagnosis of a pathological fetal growth pattern is initially considered via the history, a physical and laboratory examination of the pregnant person, as well as a comprehensive fetal ultrasound examination. These factors allow a broad distinction between pre-existing disease in the pregnant person, constitutionally small normal growth, placenta-mediated Fetal Growth Restriction (FGR), and intrinsic fetal disease. Most commonly, pathological growth restriction is mediated by underlying placental diseases, of which maternal vascular malperfusion is the most common, and often results in co-existent hypertension. A program of combined monitoring of the pregnant person and fetus, comprising hypertension assessment, and serial fetal ultrasound, including Doppler studies is then instituted, and may be combined with biochemical markers, such as Placental Growth Factor, for greater clinical precision. Recommendations on timing to deliver the growth-restricted fetus worldwide are converging, with similar guidance from clinical practice guidelines informed by high-quality Randomized Controlled Trials (RCTs) and large cohort studies. In most instances, it is reasonable to recommend delivery of all growth-restricted fetuses by approximately 38 weeks. Timing of delivery should take into consideration both short-term neonatal outcomes and long-term outcomes at school age. Mode of delivery is based on many factors, and induction of labor is a safe approach, especially after 34 weeks. Mechanical methods of induction may be preferred to pharmacologic methods, although both have a role and the choice of method is based on individualized assessment. Elective Cesarean birth thereby bypassing fetal stress during labor, is recommended in preterm growth-restricted fetuses with signs of adaptive fetal compromise, especially when ductus venosus flow is abnormal, or a contraction stress test is positive.

The role of non-stress test as a method to evaluate the outcome of high-risk pregnancy: a tertiary care center experience

Background: Non-stress test (NST) is a graphical recording of changes in fetal heart activity and uterine contraction along with fetal movement when uterus is quiescent. NST is primarily a test of fetal condition and it differs from contraction stress test which is a test of uteroplacental function. The present study aimed at evaluating the efficacy and diagnostic value of NST for antenatal surveillance in high-risk pregnancy and comparing the mode of delivery with test results.Methods: A clinical study of NST was done between November 2014 to October 2015. NST was used for their surveillance from 32 weeks of gestation and NST was recorded weekly, biweekly, on alternate days or even on daily basis depending on high risk factors and were followed up.Results: A total of 100 cases were enrolled in the study. The mean age of patients was 25.09±3.78 years. In all 14 cases (23.3%) with reactive NST underwent lower caesarean section (LSCS) whereas 36 cases (90%) with non-reactive NST underwent LSCS. The mean NST delivery interval with reactive NST was 9.8±7.1 hours and in cases with non-reactive NST it was 9.2±8.6 hours, the difference was statistically not significant (p=0.70).Conclusions: NST tells about acute fetal hypoxia and decision to delivery time can be made for those patients with fetal distress so that a major improvement in the outcome among parturient can be achieved with abnormal NST results. An abnormal NST should alert the clinician of fetal compromise and has to be followed up by other biophysical tests.

Can Fetal Heart Rate Responses to Maternal Exercise Be Used for Antepartum Surveillance?

The contraction stress test (CST) is currently the only modality used to test for placental insufficiency. It is rarely used due to possible complications. We propose a new test to assess placental reserves by measuring fetal heart rate (FHR) fetal responses to maternal exercise (FRME). A cohort of 640 term patients underwent FRME for accepted clinical indications. There was a total of 1680 tests, performed using a motorized treadmill in a moderate exercise regimen. Monitoring was provided by using standard Philips equipment (Avalon CTS and FM40). FRME was interpreted as negative (absence of decelerations, possible presence of accelerations), positive (presence of late decelerations or sustained bradycardia), or inconclusive. The results demonstrated 1506 tests were negative, 58 were positive, and 312 were inconclusive. If the test was negative, only 2% of the fetuses experienced adverse outcomes, versus 14%, when the test was positive. Positive tests were associated with 29% of category III FHR tracing, 11.6% of 5-minute Apgar score of less than 7, 9.8% admissions to the intensive care nursery, 2.2% of growth restrictions, and 1.2% of fetal or early neonatal demises. FRME if positive is associated with adverse perinatal outcome and could be included into the armamentarium of fetal testing.

Management of fetal growth restriction using the contraction stress test: a case-control study

Purpose: Fetal growth restriction (FGR) is a concerning health issue. However, studies on FGR management are limited due to its rarity. We aimed to evaluate the efficacy of the contraction stress test (CST) for FGR management.Materials and methods: A case-control retrospective study design. Our institute innovated CST in FGR management in 2017. We included women in their 33rd–40th week of pregnancy with a diagnosis of FGR and retrospectively divided them into groups: the CST group (FGR management with CST) and no CST group (FGR management without CST) before and after CST development. Neonatal outcome, pH, and pO2 of umbilical artery (UA) were compared between the two groups.Results: No significant differences in the rate of birth weight, Apgar score <7 (5 minutes), neonatal death, hospitalization to newborn childhood intensive care unit (NICU), and UA pH were found between groups. Average UA pH was 7.29 ± 0.05 and 7.29 ± 0.04 in the CST and no CST groups, respectively (p = .864). Average UA pO2 values were 21.1 ± 8.6 and 15.7 ± 5.0 mmHg in the CST and no CST groups, respectively (p = .016), showing significant differences.Conclusions: Neonatal outcomes and UA pH were slightly different between the groups managed with and without CST. However, UA pO2 values significantly differed between the groups. For FGR management, the use of a CST may allow for early intervention before fetal acidemia and acidosis. For establishing the effects of a CST for FGR management, analysis including several cases and investigation of long-term outcomes of newborn infants is necessary.

No. 197a-Fetal Health Surveillance: Antepartum Consensus Guideline.

This guideline provides new recommendations pertaining to the application and documentation of fetal surveillance in the antepartum period that will decrease the incidence of birth asphyxia while maintaining the lowest possible rate of obstetrical intervention. Pregnancies with and without risk factors for adverse perinatal outcomes are considered. This guideline presents an alternative classification system for antenatal fetal non-stress testing to what has been used previously. This guideline is intended for use by all health professionals who provide antepartum care in Canada. Consideration has been given to all methods of fetal surveillance currently available in Canada. Short- and long-term outcomes that may indicate the presence of birth asphyxia were considered. The associated rates of operative and other labour interventions were also considered. A comprehensive review of randomized controlled trials published between January 1996 and March 2007 was undertaken, and MEDLINE and the Cochrane Database were used to search the literature for all new studies on fetal surveillance antepartum. The level of evidence has been determined using the criteria and classifications of the Canadian Task Force on Preventive Health Care (Table1). This consensus guideline was jointly developed by the Society of Obstetricians and Gynaecologists of Canada and the British Columbia Perinatal Health Program (formerly the British Columbia Reproductive Care Program or BCRCP) and was partly supported by an unrestricted educational grant from the British Columbia Perinatal Health Program. RECOMMENDATION 1: FETAL MOVEMENT COUNTING: RECOMMENDATION 2: NON-STRESS TEST: RECOMMENDATION 3: CONTRACTION STRESS TEST: RECOMMENDATION 4: BIOPHYSICAL PROFILE: RECOMMENDATION 5: UTERINE ARTERY DOPPLER: RECOMMENDATION 6: UMBILICAL ARTERY DOPPLER.

124: The role of the contraction stress test in deliveries with oligohydramnios

To examine the implementation of the contraction stress test (CST) to decide the mode of delivery in pregnancies with oligohydramnios. Retrospective cohort study. Once labor induction was indicated, CST was performed to all women from 34 gestational weeks with oligohydramnios (AFI<5cm) between 2005-2011. Women with abnormal CST (i.e positive or equivocal), underwent cesarean delivery (CD) without a trial of labor and those with negative CST had a trial of labor. Patients' flow chart is described in the figure. Among 1221 patients with oligohydramnios, a CST was performed in 987 patients (80%). Eighteen patients (1.8%) were operated on due to the CST results without a trial of labor. The rest (N=969; 98.2%) were allowed a trial of labor. Significant risk factors for abnormal CST were primiparity, increased gestational week and IUGR fetuses (table). Among the negative CST cases, 95 (11%) delivered by CS. of them, 78 (69%) women were operated on due to non reassuring fetal monitoring. Seventy (90%) women were operated on in the latent phase, while only 6 (8%) and 2 (3%) women were operated on in the active phase and second stage of labor, respectively. Negative CST in oligohydramnios is associated with favorable delivery outcome, particularly once the woman has entered the active phase of labor. It is a poor predictor for fetal compromise during labor in women with oligohydramnios, however, it may be beneficial when oligohydramnios is associated with primiparity, increased gestational week or IUGR fetuses.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Effect and Safety of Labor Epidural Analgesia with Intermittent Boluses of 0.1% Bupivacaine with Fentanyl on Fetal and Maternal Outcomes and Wellbeing.

Background:Labor analgesia has been shown to have few undesirable effects on the course and outcome of the labor as well as on the fetal well-being.Aims:This study aims to assess neonatal outcome following lumbar epidural analgesia with intermittent boluses of 0.1% bupivacaine with fentanyl. The secondary objectives included assessment of maternal analgesia, complications, and outcome of labor.Setting and Design:Prospective observational study conducted at a tertiary care teaching institute.Subjects and Methods:Sixty-three patients for labor epidural analgesia were recruited. Epidural catheter was inserted in L4–L5 or L3–L4 interspace. After confirmation of the position of catheter, 3 mL of 0.5% bupivacaine with 20 μg of fentanyl made to 15 mL was administered. After 30 min, efficacy of analgesia was assessed by visual analog scale (VAS). The same bolus dose was repeated after 90 min if the patient complained of pain. A maximum of five top-up doses were allowed.Statistical Test Used:Mean and standard deviation, number and percentageResults:After 30 min of first bolus dose, 93.3% had VAS score of <4. More than 90% patients had adequate analgesia till 4th epidural bolus. During contraction stress test, only two fetuses had late deceleration. About 80% and 98.3% newborns had Apgar of >7 at 1 and 5 min, respectively. Umbilical cord blood pH was ≥7.1 in 98.3% neonates with base excess of >−12. 58.3% delivered normally, 23.3% had instrumental vaginal delivery, and 18.3% required cesarean section.Conclusion:Lumbar epidural analgesia with 0.1% bupivacaine with fentanyl provides optimal neonatal outcome, labor analgesia, and labor outcome.

515: The role of the contraction stress test for improving obstetrical outcomes in pregnancies with small for gestational age fetuses

515: The role of the contraction stress test for improving obstetrical outcomes in pregnancies with small for gestational age fetuses

Uterine Tachysystole with Prolonged Deceleration Following Nipple Stimulation for Labor Augmentation

Breast stimulation for inducing uterine contractions has been reported in the medical literature since the 18th century. The American college of Obstetricians and Gynecologists (ACOG) has described nipple stimulation as a natural and inexpensive nonmedical method for inducing labor. We report on a 37 year old P2 with a singleton pregnancy at 40 weeks gestation who developed tachysystole with a prolonged deceleration after nipple stimulation for augmentation of labor. Initial resuscitative measures, including oxygen by mask, a bolus of intravenous fluids and left lateral positioning, did not restore the fetal heart rate to normal. After the administration of Terbutaline 250 mcg subcutaneously, the tachysystole resolved and the fetal heart rate recovered after five minutes of bradycardia. Most trials of nipple stimulation for induction or augmentation of labor have had small study populations, and no conclusions could be drawn about the safety of nipple stimulation, though its use is widespread. While there have been a few reports of similar complications during nipple stimulation for contraction stress testing, there are no previous reports of tachysystole with sustained bradycardia following nipple stimulation for labor augmentation. In this report, we draw attention to the dangers of nipple stimulation so that providers will be aware of this potential complication.

OP26.02: A contraction stress test before induction of labour for small‐for‐gestational age fetuses: does it decrease the rate of Caesarean during labour?

OP26.02: A contraction stress test before induction of labour for small‐for‐gestational age fetuses: does it decrease the rate of Caesarean during labour?

715: The role of the contraction stress test in deliveries with suspected intrauterine growth restricted fetuses

715: The role of the contraction stress test in deliveries with suspected intrauterine growth restricted fetuses

Commentary on 'Antenatal cardiotocogram quality and interpretation using computers'.

Commentary on 'Antenatal cardiotocogram quality and interpretation using computers'.

The Relationship between Modified Biophysical Profile, Standard Biophysical Profile, and Neonatal Outcomes of High-risk Pregnancies

Introduction: High-risk pregnancies can result in many complications for the fetus. In these pregnancies, different tests such as non-stress test (NST), biophysical profile (BPP), oxytocin contraction stress test (OCT), and Doppler sonography can be used to evaluate fetal health. As standard BBP requires more time and expertise, in this study, we evaluated the relationship between standard BPP, modified BPP, and neonatal outcomes. Therefore, in case there was a significant relationship, we could use modified BPP as a replacement for standard BPP. Methods:Overall, 106 high-risk pregnant women in their third trimester, who were admitted to the gynecology ward of Imam Reza Hospital, were included in this study. Unless the subjects had any problems leading to emergent termination of pregnancy, standard BPP and modified BPP were concurrently performed to evaluate fetal health; these tests were repeated once or twice a week. In case of delivery, the last BPP scores (both standard and modified) were compared with the neonatal outcomes. Results: In the evaluation of the last standard BPP scores, 83.1% and 16.9% of the patients obtained normal and abnormal scores, respectively; on the other hand, 73.6% and 26.4% of the patients obtained normal and abnormal scores in the last modified BPP, respectively. There was a significant relationship between neonatal outcomes and standard BPP results (P=0.05). Also, the relationship between standard BPP and modified BPP was significant (P=0.003). However, there was not a significant relationship between modified BPP and neonatal outcomes. Conclusion: As the results indicated, modified BPP score had a significant relationship with standard BPP score, and standard BPP score had a significant correlation with neonatal outcomes. Therefore, the modified test can replace the difficult and time-consuming standard method. In addition, if the modified test showed any abnormalities, standard BPP or other fetal health evaluation methods should be applied.

Uterine Tachysystole Rates and Survival of the Fittest Effect

Childbearing Paper Presentation Objective To determine incidence of uterine tachysystole and its association with decelerations and cesarean birth. Design Retrospective. Setting Suburban hospital in a mid‐Atlantic city. Sample Women (6,234) with singleton cephalic presenting infants at a gestational age of 37 weeks or more, who were monitored electronically in the last 4 hours prior to delivery. Methods Clinical data were obtained from an institutional perinatal database that extracts data from the electronic medical record (PeriBirth, Princeton, NJ). The digital tracings were analyzed using PeriCALM Patterns (Princeton, NJ). We divided each tracing into 10‐minute segments that were numbered according to proximity to birth, 0 representing the last 10 minutes before birth and 24 occurring 240 minutes earlier. We counted the number of contractions and decelerations in each time segment Results In this study, 18.0% of women experienced at least one episode of uterine tachysystole. The incidence of uterine tachysystole was around 2.7% at 4 hours prior to delivery and rose to 8.0% times close to delivery. Continuous uterine tachysystole for more than 120 minutes was very uncommon. Persistent uterine tachysystole was not associated with more decelerations (R = .28) or with higher cesarean rates (R = .23). Only 55% or 0.88% of women in this study met the criteria for labor intolerance. These women had fewer episodes of high contraction rates. In contrast, they showed a much higher deceleration response to contractions especially at very low contraction rates. Overall, the rate of cesarean was positively associated with rising rates of decelerations per contractions (R = .92). Conclusion/Implications for Nursing Practice We can conclude that some infants tolerate uterine tachysystole well, and some do so for very prolonged periods. These findings are consistent with the principle underlying the contraction stress test (CST), in which a controlled stress via induced contractions was used to determine fetal well‐being antepartum. Labor is the ultimate CST, and this analysis showed that infants with the low tolerance to labor demonstrated strong deceleration responses to even small amounts of contraction stress, whereas others tolerated long periods of uterine tachysystole.

Properties of Composite Materials Used for Bracket Bonding

The purpose of this study was to evaluate in vitro the shear bond strength to enamel, flexural strength, flexural modulus, and contraction stress of one orthodontic composite and two flowable composites. Orthodontic brackets were bonded to 45 human maxillary premolars with the composites Transbond XT, Filtek Z-350 flow and Opallis flow and tested for shear bond strength. For measurement of flexural strength and flexural modulus, specimens were fabricated and tested under flexion. For the contraction stress test, cylindrical specimens were tested and an extensometer determined the height of the specimens. The data were subjected to one-way ANOVA and Tukey's test (α=0.05). The shear bond strength values were significantly lower (p<0.05) for the flowable composites compared with the orthodontic composite. For the flexural strength, no statistically significant difference was found among the composites (p>0.05) while the flexural modulus was significantly higher (p<0.05) for Transbond XT than for Filtek Z-350 flow and Opallis flow. The orthodontic composite presented significantly lower contraction stress values than the flowable composites (p<0.05). The light-activated orthodontic composite material presented higher flexural modulus and shear bond strength and lower contraction stress than both flowable composites.