Nonstress Test Results Research Articles

The effect of music therapy on non-stress test results and anxiety levels in high-risk pregnant women: A randomized controlled trial.

This study was conducted to determine the effects of music therapy on non-stress test results and anxiety levels in high-risk pregnant women. This randomized controlled study was conducted in pregnant women who were hospitalized in the High-Risk Pregnancy Service of Meram Medical Faculty Hospital, Konya, Turkey, between April 1 and July 31, 2021. In the intervention group (n = 58), a 20-min music therapy with ney sounds was performed, while in the control group (n = 58), routine care practices were applied. Hüseyni maqam of ney was selected, a melodic mode used by Turks for music therapy. Data were collected using the Descriptive Information Form, the Non-Stress Test Evaluation Form, and the State-Trait Anxiety Inventory. After music therapy, the intervention group experienced increased mean acceleration (p = 0.010) and foetal movement rates (p < 0.001) while no such difference was observed in the control group. The state anxiety levels of pregnant women differed significantly between the intervention and control groups (p < 0.001). Regression analysis showed that music therapy reduced state anxiety levels in pregnant women by a factor of 4.6 (p < 0.001). Based on the findings, music therapy was found to enhance acceleration and foetal heart rate in high-risk pregnant women while reducing state anxiety levels.

Effect of Ramadan Fasting in Turkey Upon Fetal Well-being and Perinatal Outcomes During the Last-Trimester of Pregnancy.

Ramadan, a one-month period in which eating and drinking are prohibited from sunrise to sunset, is considered sacred by Muslims. According to Islamic rules, fasting is obligatory for adults and healthy people, but patients and travelers are exempted from this rule. It is not clear whether pregnant women can fast during Ramadan. This cross-sectional case-control study included low-risk pregnant women at 32-37weeks of gestation in Turkey. We examined healthy women in the last period of their pregnancy and found similar perinatal outcomes between the fasting and nonfasting participants. In the evaluation of fetal well-being, a decrease in the number of accelerations in the non-stresstest (NST)and the need to repeat the test were found to be statistically significantly higher in fasting pregnant women. We consider that this may prolong the evaluation period and increase unnecessary hospitalizations due to nonreactive NST results. More randomized controlled trials are needed to conclude that fasting during pregnancy is safe.

The Relationship of Non-stress Test Results and Pregnancy Outcomes in Insulin-treated Diabetic Pregnant Women

The Relationship of Non-stress Test Results and Pregnancy Outcomes in Insulin-treated Diabetic Pregnant Women

Evaluation of the Active Nursing Management on the Nonreactive Nonstress Test of Antenatal Mothers Above 32 Weeks of Gestation

Introduction: Nonstress test (NST) is a part of routine monitoring of pregnant women before delivery. It is the most common and significant test performed for assessing the well-being of the fetus by observing the fetal heart rate and its acceleration in response to fetal movement. Objective: To evaluate the active nursing management on the nonreactive NST of antenatal mothers above 32 weeks of gestation. Material and Methodology: A descriptive study was conducted at an obstetrics and gynecology OPD of a tertiary care teaching hospital in Chandigarh, India, for a period from October to December 2020. Ethical approval was obtained from the Institute Ethics Committee, PGIMER, Chandigarh. The total sample for the study includes 60 antenatal mothers above 32 weeks of gestation, who were enrolled by enumeration sampling technique. The tools used for collecting the data were as follows: (1) interview schedule that comprised of (a) sociodemographic profile and (b) obstetric profile, and (2) NST graph and pro forma to record the result of NST. The NST was performed in the left lateral position for 20 min and extended to 40 min if desired results were not obtained. Antenatal mothers with nonreactive NST were given active nursing management, such as having breakfast/juice and ambulation/walking around. Again, a half-hour later, NST was repeated. A Philips Avalon FM 30 fetal monitor was used to record all the NST tracings. The results obtained were evaluated by the same obstetrician and gynecologist. Data were analyzed using IBM SPSS version 20. Result: Findings revealed that the majority (85%) of the antenatal mothers had a reactive NST, whereas 10% of antenatal mothers had a nonreactive NST. Out of the 6 (10%) antenatal mothers who were nonreactive, five antenatal mothers were changed into reactive NST after the active nursing management, i.e., maternal ambulation, having breakfast/juice for hydration after half-hour elapsed, whereas one antenatal mother who remained nonreactive NST was referred to a clean labor room after an abnormal ultrasound biophysical profile result by the obstetrician and gynecologist for induction of labor. Conclusion: It is concluded that NST is a significant test to prevent stillbirth. Active nursing management, such as maternal ambulation, well-fed, and well hydration, of the antenatal mothers can change the nonreactive NST to a reactive NST result.

The effect of motivational video and nutrition on the non-stress test: a randomised controlled clinical trial

This study aimed to determine the effect of motivational video stimulation and nutrition on the non-stress test (NST). The sample of the study consisted of 360 pregnant women in total, including two experimental groups and one control group (120 pregnant women in each group). After the pregnant women in the study were divided into three groups at a 1:1:1 ratio with the computer-assisted random sampling method, the draw method was used to determine the experimental and control groups. The pregnant women in the first experimental group were allowed to consume cake and juice 30 min before the NST procedure. The pregnant women in the second experimental group were also allowed to consume cake and juice, while they were also shown a video with the content of development and changes in the mother and the foetus during pregnancy, with relaxing music, for about 15–20 min. There was no intervention made in the control group. The data were collected using a Participant Information Form and an NST Findings Registry Form which were created by the researchers based on their review of the relevant literature. The data were analysed using arithmetic means, percentage distributions, ANOVA, Bonferroni and chi-squared tests. It was found that the mean number of foetal movements and the mean number of accelerations in the cake + juice and motivational video groups were higher than those in the control group (p < 0.001). Besides, the pregnant women in the experimental groups were found to have more reactive NST results. As a result, it was determined that the motivational video and cake + juice interventions improved the movement of the foetus, the number of accelerations and the ratio of reactivity in NST, but the two interventions did not have any superiority over each other. It is recommended to offer cake and juice to pregnant women before NST or have them watch a motivational video during NST, for having good NST results. Impact statement What is already known about the topic? The false-positive rates of the NST, which enables monitoring foetal movements and foetal heart rates, are high. These false-positive rates of the NST lead to many obstetric complications, in addition to increasing the rates of cesarean-section deliveries. Recent studies showed that there are methods and factors that increase foetal movements and shorten the application period of the NST. It was identified that food intake, music therapy, foetal vibroacoustic and halogen light stimulation before the NST increases foetal movements and shortens the application period of the NST. What this paper adds? In the study, it was found that watching motivational videos and consuming cake and juice increased the number of foetal movements, the number of accelerations and the rate of reactive NST results, but the two interventions did not have superiority over each other. What are the implications of these findings for clinical practice and/or further research? In order to increase reactive NST rates, it is recommended that pregnant women consume cake and fruit juice before the procedure and watch a motivational video during the NST procedure.

Results of expectant management in singleton and twin pregnancies complicated by preterm premature rupture of membranes.

This study aimed to examine whether expectant management in twin pregnancies with preterm premature rupture of membranes (pPROM) is as safe as in singleton pregnancies. It was a retrospective cohort study comparing pregnancy course and outcome in singleton (n = 299) and twin pregnancies (n = 49) complicated by preterm premature rupture of membranes. Analysed factors included maternal diseases, gestational age at premature rupture of membranes (PROM), management during hospitalization, latency periods between PROM and delivery, gestational age at delivery, neonatal management and outcome. The difference in the proportion of patients with latency up to 72 hours, latency between 72 hours and seven days, and latency exceeding seven days were insignificant. The percentage of patients who received intravenous tocolysis and antenatal corticosteroids were similar; however, patients in twin pregnancies more often received incomplete steroids dose (p = 0.01). The occurrence of the positive non-stress test result and signs of intrauterine infection were similar between the groups. No statistically significant differences in the prevalence of neonatal complications except transient tachypnoea of the newborn were identified (24% in the singleton vs 13% in the twin group, p = 0.03). Expectant management of pPROM in singleton and twin pregnancies results in similar perinatal and neonatal outcome. Consequently, in case of no evident contraindications, expectant management of twin pregnancies seems to be equally as safe as in singleton pregnancies. Patients in twin pregnancies may be at higher risk of delivery before administration of full antenatal corticosteroids dose, therefore require immediate management initiation and transfer to a tertiary referral centre.

Effect of different maternal positions on comfort of antenatal mothers and fetal parameters during nonstress test.

Providing comfort to an antenatal mother is one of the critical components of the nonstress test (NST). An experimental study was conducted on 450 antenatal mothers beyond 34 weeks, who were randomly allocated into three groups - supine, left lateral, and semi-fowler's position, to explore the association of selected maternal positions on NST results and to find the impact of these positions on the comfort level of antenatal mothers. The fetal parameters were assessed by observing and recording biophysiological measurements from the NST and the maternal comfort of different positions by the Verbal Numerical Rating Scale. The data analyzed reveal a significant association between maternal positions and fetal parameters at P < 0.05 level. Antenatal women who were in semi-fowler's position exhibited more comfort and fetal NST reactivity as noted by significant variation in the baseline fetal heart rate, beat-to-beat variability, acceleration, deceleration, and fetal movements.

Effects of position on non-stress test results and maternal satisfaction.

The non-stress test (NST) is a simple non-invasive procedure commonly used in obstetrics clinics to assess fetal health. It is important that mothers feel comfortable during the NST and that the test results are obtained quickly. To determine the effects of maternal position on NST results and participants' satisfaction during the procedure. This was a randomized controlled experimental study conducted at the Department of Obstetrics and Gynecology Polyclinic of Erciyes University Hospital (Kayseri, Turkey) between October 2017 and March 2018. During the NST, either the supine, semi-Fowler or left lateral position was utilized. Questionnaire forms and NST tracings were collected from 275 participating mothers and analyzed. The χ2 test was used to determine whether the distribution of categorical variables differed between groups. The Kruskal-Wallis test was used to determine whether median scores differed between groups. A p-value <0.05 was considered statistically significant. Most participants in the left lateral (78.9%) and semi-Fowler positions (88.4%) reported feeling satisfied compared to only 24.2% of participants in the supine position (p < 0.001). Participants also felt more comfortable in the left lateral (92.2%) and semi-Fowler positions (87.2%). In the supine position, most participants (68.7%) reported experiencing back pain (p < 0.001). There were no significant differences among groups in terms of basal heart rate (p = 0.497), reactivity time (p = 0.421) or percentage of reactivity (p = 0.676). The number of accelerations was 5.0 in the left lateral position, 4.5 in the semi-Fowler position and 4.0 in the supine position (p = 0.051). Our findings support the use of the semi-Fowler and left lateral positions during the NST. Participants reported high satisfaction in these positions and felt more comfortable, and no procedure-related problems occurred.

IMPROVED PREGNANCY OUTCOME IN WOMEN WITH GESTATIONAL HYPERTENSION AS A RESULT OF OBSTETRICIAN AND CARDIOLOGIST TEAMWORK

Objective: Gestational hypertension remains the leading cause of maternal, fetal and neonatal morbidity and mortality worldwide. In spite of ESH and ESC guidelines (2011–2013) regarding the use of low-dose aspirin for preventing poor obstetric outcome due to preeclampsia and in spite of the many studies involving aspirin published by FMF our national obstetrical guidelines didn’t mentioned aspirin prophylaxis until 2018. So for many years the first to recommend aspirin to a pregnant women was the cardiologist and not the obstetrician. To asses the outcome of the second pregnancy in women of high risk for early onset/sever preeclampsia after introducing low dose aspirin in early gestation. Design and method: A case series of secundiparous women (2017–2019), with history of poor maternal and fetal outcome because of sever preeclampsia (2014–2015), was assessed after starting 150 mg of aspirin daily from the onset of the second gestation until week 36. In this retrospective study no women with diabetes, chronic hypertension, obesity, any type of autoimmune disease, kidney disease or multiple gestation were included. The followed-up of these patients was done both by the obstetrician and cardiologist. The evaluation criteria for assessing the obstetrical outcome were: gestational age at onset of hypertension, Doppler velocity indices and non-stress test results, time and mode of delivery, birth weight, Apgar score, length of hospitalization; all compared to the outcomes of the first pregnancy. Results: None of the patients developed severe preeclampsia or early onset hypertension, but all of them de late onset gestational hypertension or mild preeclampsia needing antihypertensive therapy. There were no preterm babies, all women delivered at term, week 38–39, by elective C-section or after induced labor. There were no cases of intrauterine growth restriction, no signs of fetal distress according to Doppler ultrasound examination or on CTG monitoring. The Apgar score was no lower than 8 and there was no NICU admission. Antihypertensive therapy was no longer required after birth and all mothers began brestfeeding. Conclusions: This improved obstetrical outcome was the result of team approach in the management of pregnant women with high risk of hypertensive disorders.

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.

Evaluation of cord blood creatine kinase (CK), cardiac troponin T (cTnT), N-terminal-pro-B-type natriuretic peptide (NT-proBNP), and s100B levels in nonreassuring foetal heart rate

Aim To evaluate the possible associations between creatine kinase (CK), cardiac troponin T (cTnT), N-terminal-pro-B-type natriuretic peptide (NT-proBNP), and s100B levels in umbilical cord blood and nonstress test results, cord-blood gas analyses and Apgar scores. Material and methods A total of 93 cesarean section deliveries after 34 + 0/7 gestational week (GW) were evaluated. The study (n = 50) and control (n = 43) groups consisted of type III and type I nonstress test (NST) according to the 2008 National Institute of Child Health and Human Development workshop report on electronic fetal monitoring. The serum levels of ProBNP II, S100-B, CK-MB, and cTnT were measured in cord blood and were evaluated according to the NST results, cord-blood gas analyses (pH and base-excess values) and 1- and 5-minute Apgar scores. Exclusion criteria for both groups included congenital abnormalities, multiple pregnancy, chorioamnionitis, oligohydramnios, polyhydramnios, intrauterine growth retardation (IUGR), and placental abruption. Results Mean age, weight, height, gestational age, and birth weight were comparable in type I and III NST groups. 1- and 5- minute Apgar, umbilical artery and vein pH values, and base deficiency were significantly lower in type III NST group compared to the type I NST group. The serum 100B (1616 ± 119 versus 533 ± 95 ng/L, p < .001), CK-MB (28.67 ± 21.17 versus 14.20 ± 11.26 ng/L, p < .001), cTnT (657 ± 396 versus 230 ± 132 ng/L, p < .001) and proBNP (1727 ± 379 versus 1069 ± 721 ng/L, p < .001) levels were significantly elevated in the NST type III compared to the NST type I group. The serum 100B, CK-MB, cTnT and proBNP levels were significantly elevated in the cord pH < 7.00 (n = 10) compared to pH = 7.00–7.15 group (n = 18). The serum 100B and proBNP were significantly elevated in the cord pH = 7.00–7.15 compared to the pH > 7.15 group (n = 65), whereas serum cTnT and proBNP levels were comparable in the latter two groups. In the study group, S100B, cTnT, and proBNP had negative correlations with 1- and 5-minute Apgar scores. All of the four markers showed negative correlations with A. umbilicalis pH and base excess. Conclusions Mean S100B, CK-MB, cTnT, and NT-proBNP were significantly higher in the study group compared to the control group. The serum 100B, CK-MB, cTnT, and proBNP levels were significantly elevated in the cord pH < 7.00 compared to pH = 7.00–7.15 group. The serum 100B and proBNP were significantly elevated in the cord pH = 7.00–7.15 compared to the pH > 7.15 group.

The effect of music on the non-stress test and maternal anxiety

ObjectiveThis study aimed to determine the effect of music that was listened to by pregnant women during the non-stress test (NST) on the test result and maternal anxiety. Materials and methodsThe study utilized a non-randomized controlled trial design. Sequential sample selection method was used. The pregnant women in the experimental group listened to music during the NST (20 min). ResultsThere were significant differences between the two groups in terms of mean numbers of acceleration deceleration and reactive NST results (p = 0.001). There were statistically significant differences between the intergroup mean scores of pre- and post-music in favor of the control group (p = 0.001). ConclusionThis study concluded that music is an effective method of reducing pregnant women's deceleration numbers and increasing their acceleration numbers and reactive NST rates. The use of music during NSTs can be recommended.

Diagnostic Value of Non-stress Test Interpreted by Smart Interpretive Software

Background and aim: Using appropriate methods for the assessment of fetal health including non-stress test during high-risk pregnancies due to possible placental insufficiency is of paramount importance. Due to complexity in medical decisions, using information systems is being increased to support complex medical decisions. We conducted this study to measure the diagnostic value of non-stress test interpreted by smart interpretive software. Materials and Methods: This study was carried out on 400 non-stress tests obtained from patients’ records regardless of the results of tests in Bent-Ul-Hoda Hospital, Bojnord, Iran. Then, to increase the accuracy of tests, they were interpreted by two specialists with Master’s degree in Midwifery. Finally, the tests were interpreted by the given software. The diagnostic test accuracy was measured using sensitivity and specificity of the software. Results: Out of 400 selected tests, experts interpreted 126 tests with reaction and 274 cases without reaction. The diagnostic accuracy, sensitivity, and specificity of the software were 92.45%, 94.07, and 88.40, respectively. Conclusion: According to the results, the use of this software for interpreting non-stress test results, reduce false- positive and false-negative diagnoses.

What is the amniotomy effect on non stress test in patients meconium stained amniotic fluid?

Objective: Meconium stained amniotic fluid is a frequently encountered situation, it can really disturb an obstetrician, as it increases the rates of neonatal morbidity and mortality and it is difficult to prevent meconium passage in utero. Noninvasive tests are needed to predict the meconium staining of the amnion fluid without making amniotomy or making a fetal invasive procedure. Non stress test is a commonly used method to determine the status of intrapartum fetal wellbeing. The purpose of this study was to predict fetal meconium release during labor by examining the fetal heart rate traces without performing an amniotomy procedure. Materials and Methods: A total of 280 patients who have been diagnosed with active labor were included in the study. 140 of them demonstrated meconium stained fluid and 140 of them clear amniotic fluid. The patients’ labor courses have been watched and non-stress test results have been recorded besides obstetric outcomes. Results: Non-stress tests performed before amniotomy; 52 (37.1%) of the non-stress tests in the meconium group were non-reactivated, whereas in the control group this count was 19 (13.5%) before amniotomy. When we accepted the deceleration entity as fetal distress; fetal distress was seen in 62(44.3%) of the patients in the meconium group and in 21(15.1%) of the patients in the control group. Conclusion: In the presence of non-reactive non stress test pattern; we should be suspicious of meconium-stained amniotic fluid. In this case, caution should be taken in terms of fetal distress.

The effect of music on the results of a non-stress test: A non-randomized controlled clinical trial

IntroductionThe non-stress test (NST) is one of the most commonly used tests to assess foetal well-being because of its high sensitivity, fast implementation, and ambulatory use. This study was conducted to determine the effect of music played to pregnant women during the non-stress test on the test result. MethodsA non-randomized controlled clinical trial was conducted in the NST polyclinic from March 3, to June 25, 2013. The population of the study included women who had applied to the NST polyclinic, had experienced a minimum of one live birth, had previously undergone the NST, and whose gestational week was ≥33. The sample comprised 96 pregnant women who met the study criteria. Pregnant women visiting the NST polyclinic on Mondays were included in the experimental group, while those visiting on Wednesdays were included in the control group. A Participant Introductory Form and NST Findings Registry Form were used for data collection. The data were evaluated using descriptive statistics, t-test for independent groups, chi-square test, and Fisher’s exact test. ResultsThe study revealed that the experimental group felt happier/more comfortable than the control group (p < .05). In addition, averages of foetal movement numbers, acceleration numbers, and reactive NST results in the experimental group were higher than the control group (p < .05). The experimental group had a higher reactive NST result than the control group (p < .05). The results of this study did not suggest a significant difference in the average heart rate of the experimental and control groups (p > .05). ConclusionOur study findings demonstrate that music played to pregnant women during NST increases foetal movement and acceleration numbers and leads them to experience more positive feelings during the test.

Legal Briefs: Head and Shoulder Trauma

A 4,580-g, 38 5/7 weeks’ gestation male infant was delivered by a 33-year-old gravida 5, para 1, aborta 1 woman whose pregnancy had been unremarkable. One month before delivery, the woman reported a decrease in fetal movement, but fetal activity resumed subsequently and the nonstress test result was normal. The pregnancy continued without problems. However, when labor began and the fetus did not descend, she received oxytocin to augment labor. Fetal tachycardia, decreased variability, and excessive uterine activity were noted. Also, inadequate rest time between contractions appeared as the second stage of labor was approaching. The plaintiff obstetrician pointed out that the fetus was being stressed since the peak of 1 contraction to the next peak should be at least 2 minutes, and the end of 1 contraction to the beginning of the next should be at least 1 minute. He also discussed that oxytocin should have been discontinued because of the lack of descent and the excessive uterine activity. The obstetrician retained by the defense said that technically tachysystole was not present and the tracing was category 2. He stated that the continuation of oxytocin was acceptable because the fetus was not descending adequately. The plaintiff obstetrician maintained that the tracings were concerning; the progression of labor was not appropriate; and it was clear, hours before delivery, that the pregnant woman could not safely deliver this fetus vaginally. Two and a half hours before delivery when the station was −1 and the cervix was fully effaced and dilated, the membranes were artificially ruptured. Thin, light brown, meconium-stained fluid was noted. The defense obstetrician said that the decreased fetal movement that had …

Effectiveness of B-type Natriuretic Peptide in Caring for Preterm Infants

Objective: Volume and pressure loading of the ventricles are associated with increased plasma B- type natriuretic peptide (BNP) levels. Hemodynamically significant patent ductus arteriosus (hsPDA) is a risk factor for life-threatening conditions in preterm infants. We compared follow-up data such as echocardiograms, BNP levels, comorbidities, and prognosis in preterm infants with PDA, and investigated the relationship between maternal prenatal factors and BNP. Methods: This single-center study performed between January 2015 and August 2016 included 63 preterm infants with a gestational age of <35 weeks. We retrospectively evaluated the BNP levels on postnatal day 1, 3, and 7, clinical features, treatment method for PDA, mortality, and maternal prenatal factors. Results: Lower gestational age and smaller birth weight were associated with a higher incidence of hsPDA (P<0.01). Postnatal day 3 BNP levels were significantly higher in the hsPDA group. BNP levels were not associated with failure of medication in the hsPDA group. Postnatal day 1 BNP levels were associated with an abnormal umbilical artery flow (P=0.017), and deceleration in fetal non-stress test result (P=0.01) but not with other maternal states. Conclusion: BNP levels are a useful predictive biomarker for hsPDA in preterm infants during the 3rd days of life; however, they do not help in decision-making regarding treatment. BNP levels on the 1st postnatal day showed a positive correlation with prenatal factors such as abnormal umbilical artery flow and deceleration in fetal NST result.

58: EVALUATION OF THE EFFECTS OF ACOUSTIC STIMULATION AND FEEDING MOTHER STIMULATION ON NON-REACTIVE NON-STRESS TEST

Background and aims:Non-stress test (NST) is known as one of the most common assessments for evaluation of fetus wellbeing. Since the prevalence of its false positive resultsishigh and majority of...

Characteristics of long-range monitoring of fetal heart rate in third trimester with atypical non-stress test

Objective To analyze the characteristics of long-range monitoring of fetal heart rate in the third trimester fetuses with atypical non-stress test (NST). Methods Long-range monitoring of fetal heart rate was performed in low-risk pregnant women who received antenatal care between April 2014 and October 2015 in Peking University Third Hospital. All subjects underwent NST from the 36th gestational week, and divided into normal NST (30 cases) and atypical NST (36 cases) groups according to the results of NST. The clinical data, including maternal age, gestational age at delivery, termination of pregnancy, neonatal asphyxia, hospitalization rate and umbilical cord blood peak-systolic/diastolic ratio value were collected. The data of long-range monitoring were analyzed by specially designed computer software. T test and Chi-square test were applied for statistical analysis. Results There were no differences in maternal age, gestational age at delivery, mode of delivery and incidence of neonatal asphyxia between the two groups (all P>0.05). In atypical NST group, fetal heart rate baseline was higher [(138.05±5.65) vs (135.10±5.39) bpm] (t=-2.170, P<0.05), and fetal heart rate baseline variability was lower than in normal NST group [(5.19±1.07) vs (6.28±1.15) bpm] (t=3.960, P<0.001). Compared with normal NSTs, the percentage of mild baseline variability was significantly increased in atypical NST group [(40.79±9.97) vs (51.17±10.84)%], while that of moderate variability was significantly decreased [(56.57±8.86) vs (46.72±10.24)%] (t=-4.018 and 4.133, both P<0.001). In atypical NSTs, the average ratio of time of acceleration/the whole time of monitoring [(37.41±4.60)%] and acceleration area per unit time[(1.42±0.48) cm2/20 min] were decreased compared with normal NSTs [(40.78±4.23)% and (2.03±0.67) cm2/20 min] (t=3.079 and 4.359, both P<0.05). Conclusions Long-range monitoring of fetal heart rate in the third trimester fetuses with atypical NST is characterized by the declined fetal heart rate baseline variability, increased proportion of mild variability and unit time acceleration area; but these are not associated with pregnancy outcomes and short-term prognosis. Key words: Fetal monitoring; Heart rate, fetal; Pregnancy trimester, third; Electrocardiography

A mixed methods study of clinical information availability in obstetric triage and prenatal offices.

To determine the effect of availability of clinical information from an integrated electronic health record system on pregnancy outcomes at the point of care. We used provider interviews and surveys to evaluate the availability of pregnancy-related clinical information in ambulatory practices and the hospital, and applied multiple regression to determine whether greater clinical information availability is associated with improvements in pregnancy outcomes and changes in care processes. Our regression models are risk adjusted and include physician fixed effects to control for unobservable characteristics of physicians that are constant across patients and time. Making nonstress test results, blood pressure data, antenatal problem lists, and tubal sterilization requests from office records available to hospital-based providers is significantly associated with reductions in the likelihood of obstetric trauma and other adverse pregnancy outcomes. Better access to prenatal records also increases the probability of labor induction and decreases the probability of Cesarean section (C-section). Availability of lab test results and new diagnoses generated in the hospital at ambulatory offices is associated with fewer preterm births and low-birth-weight babies. Increased availability of specific clinical information enables providers to deliver better care and improve outcomes, but some types of clinical data are more important than others. More available information does not always result from automated integration of electronic records, but rather from the availability of the source records. Providers depend upon information that they trust to be reliable, complete, consistent, and easily retrievable, even if this requires multiple interfaces.