Reactive Nonstress Test Research Articles

Fetomaternal Outcomes of Low-Risk Females Presenting with Perceived Reduced Fetal Movements at Moi Teaching and Referral Hospital, Eldoret, Kenya

Objective: To determine the fetomaternal outcomes of low-risk females presenting with perceived reduced fetal movements at Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya. Methods: This was a cross-sectional study among 133 females of gestation between 34–41 weeks presenting with a perception of reduced fetal movement, who were consecutively recruited. Pearson χ2 and Fischer’s exact tests of association were used to test the association between the non-stress test (NST) findings, biophysical profile (BPP) scores, and fetomaternal outcomes, where p≤0.05 was considered statistically significant. Results: A reactive NST finding was seen in 88 (66.2%) participants with 104 (78.2%) of all participants enrolled having a normal BPP score. Active management of the current pregnancy was offered to 89 (66.9%) of the participants, and 81 (60.9%) of the females had a vaginal delivery. Three quarters (76.7%) of the newborns had a 5-minute appearance, pulse, grimace, activity, and respiration (APGAR) score ≥7, 18 (13.5%) were resuscitated, 13 (9.8%) were admitted to the newborn unit, and four (3%) fresh stillbirths were noted. Both NST (p<0.001) and BPP (p<0.001) were good predictors of a 5-minute APGAR score ≥7, but poorly (p=0.086) predicted resuscitation. There was a statistically significant association between the NST findings and admission to newborn unit (p=0.034). Conclusion: A reactive NST is a good predictor of a 5-minute APGAR score greater than 7, and is associated with a reduced likelihood of both admission to the newborn unit and newborn resuscitation. Both reactive NST and normal BPP are good predictors of vaginal delivery as opposed to Caesarean delivery.

The effect of virtual reality and music on anxiety, non-stress test parameters, and satisfaction of high-risk pregnant women undergoing non-stress tests: Randomized controlled trial

BackgroundPrenatal tests cause high-risk pregnant women to experience high anxiety levels. AimThis paper investigated the effect of Virtual Reality (VR) and music on anxiety, non-stress test parameters, and satisfaction of high-risk pregnant women undergoing non-stress tests (NSTs). MethodsThis was a randomized controlled trial. The sample consisted of 102 participants randomized into three groups (VR = 34, music = 34, and control = 34). Maternal anxiety was assessed using the Spielberger State-Trait Anxiety Inventory-S (STAI-S) before and after NSTs. Satisfaction was evaluated using the Visual Analogue Scale (VAS) after NSTs. NST parameters were evaluated after NSTs. The findings were reported based on the Consolidated Standards of Reporting Trials (CONSORT). ResultsThe VR and music groups had significantly lower mean posttest STAI-S scores than the control group (p <.05). There was no significant difference in NST findings (reactive/nonreactive) between the groups (p >.05). The VR group had a significantly shorter reactive NST duration than the control group (p <.05). The VR and music groups had significantly higher mean VAS-satisfaction scores than the control group (p <.05) ConclusionVirtual reality and music during NSTs help high-risk pregnant women experience less anxiety and satisfy them more with the procedure. We recommend that obstetric midwives and nurses use these low-cost, simple, and noninvasive methods to reduce anxiety in high-risk pregnant women during prenatal testing.

Induction of Labour among Pregnant Women in the Department of Obstetrics and Gynaecology in a Tertiary Care Centre.

Induction of labour is the artificial initiation of uterine contraction by various means such as medical, surgical or mechanical with the aim of achieving vaginal delivery. Misoprostol, a prostaglandin E1 analogue is used popularly for the induction of labour in resource-limited health centres. The aim of the study was to find out the prevalence of induction of labour among pregnant women in the Department of Obstetrics and Gynaecology in a tertiary care centre. A descriptive cross-sectional study was conducted among pregnant women in a tertiary care centre from 3 February 2022 to 31 July 2022. Ethical approval was taken from the Institutional Review Committee. The women with a singleton pregnancy, reactive non-stress test, and adequate pelvis were included. Women with malpresentation, previous cesarean section, placenta previa, and cephalopelvic disproportion were excluded. Convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Among 1355 pregnant women, the prevalence of induction of labour was found to be 135 (9.96%) (8.37-11.55, 95% Confidence Interval). The prevalence of induction of labour among pregnant women was found to be similar to other studies done in similar settings. induction of labour; misoprostol; pregnancy.

Outpatient Cervical Ripening With Misoprostol to Prevent Post-Term Pregnancy: A Double-Blind Randomized Clinical Trial

Outpatient use of misoprostol is assessed in a few studies and usually in low doses and vaginal routes. This study aimed to evaluate cervical ripening by outpatient administration of misoprostol to prevent post-term pregnancy. This randomized clinical trial study was performed on 140 patients that were randomly allocated into two groups: 25 μg sublingual SL (group A) and 50 μg PO misoprostol (group B). The patients were primigravid with a gestational age of 40 weeks, with an amniotic fluid index (AFI) of ≥5 cm, a reactive non-stress test (NST) with no evident uterine contraction, Bishop Score of &lt;8, and no notable past medical history. Patients who had a normal vaginal delivery before 41 weeks were considered successful delivery. Maternal age, the number of misoprostol doses, vaginal examination, type of interventions before delivery, the indication of hospitalization, delivery route, the indication of cesarean section, delivery complications, and neonatal outcomes were compared using SPSS software. P&lt;0.05 was considered statistically significant. group A had mean age of 23.27±4.03 years and Group B had a mean age of 24.61±5.46 years with no significant difference (P=0.223). The number of misoprostol doses (P=0.001), extra misoprostol, and oxytocin application were significantly lower in group B (P=0.003). Maternal and neonatal complications showed no significant difference between the two groups (P&gt;0.05). Outpatient cervical ripening with misoprostol appears to be an optimal method. More prospective studies with higher sample sizes are required to ensure its safety for routine recommendations for cervical ripening to prevent post-term pregnancy.

Single Sporadic Deceleration during Reactive Nonstress Test-Clinical Significance and Risk for Cesarean Delivery.

Evidence regarding the clinical significance of a single sporadic variable deceleration (SSD) in reactive non-stress test (NST) is scarce, and optimal management has yet to be established. We aim to evaluate whether SSD during a reactive NST at term is associated with a higher risk for fetal heart rate decelerations during labor and the need for intervention. This was a retrospective, case-control study of singleton term pregnancies at one university-affiliated medical center in 2018. The study group consisted of all pregnancies with an SSD in an otherwise reactive NST. For each case, two consecutive pregnancies without SSD were matched in a 1:2 ratio. The primary outcome was the rate of cesarean delivery (CD) due to non-reassuring fetal heart rate monitoring (NRFHRM). 84 women with an SSD were compared to 168 controls. SSD during antenatal fetal surveillance did not increase the rate of CD overall or for NRFHRM (17.9% vs. 13.7% and 10.7% vs. 7.7%, respectively, p > 0.05). Rates of assisted deliveries and maternal and neonatal complications were similar between the groups. SSD during a reactive NST in term pregnancies is not associated with an increased risk for adverse perinatal outcomes. SSD should not necessarily require induction of labor, and expectant management is a reasonable alternative.

Rate of decline of fetal base excess after neuraxial anesthesia for scheduled cesarean delivery

In scheduled cesarean deliveries, the rate of decrease in the umbilical artery pH is related to the severity of maternal hypotension and the interval from spinal placement to delivery. Base excess values have greater use than umbilical artery pH values to time the duration of fetal acidemia because they demonstrate a linear rather than logarithmic correlation with the degree of acidosis. This study aimed to evaluate the rate of decline in the fetal base excess in scheduled cesarean deliveries that were converted to emergency cesarean delivery owing to fetal bradycardia following spinal anesthesia. All cases of scheduled cesarean deliveries in gestations at >34 weeks' gestation under spinal anesthesia that were converted to emergency cesarean deliveries owing to fetal bradycardia in the period May 2019 to May 2021 were reviewed. Included were those with (1) a preoperative reactive nonstress test and (2) fetal acidemia (umbilical artery pH <7.20). Excluded were those with anesthesia other than spinal and a birthweight below the 10th percentile for gestational age. Time intervals between the completion of spinal anesthesia and delivery were calculated and related to umbilical cord gas analytes. From a cohort of 1064 scheduled cesarean deliveries, 7 fulfilled the study criteria yielding 8 neonates. Mean ± standard error of the mean interval of spinal anesthesia to delivery was 15.0±1.9 minutes, and the decrease in mean blood pressure after spinal anesthesia was 39.1±3.0 mm Hg. Umbilical artery base excess ranged from -5.2 to -16.6 mmol/L (median, -8.0). Based on published normative data of prelabor fetal umbilical artery base excess (-2±0.6 mmol/L), the mean rate of base excess decrease was 0.38±0.25 mmol/minute. The rate of decrease in base excess when scheduled cesarean deliveries are converted to emergency cesarean deliveries owing to fetal bradycardia related to spinal anesthesia (1 mmol/2.6 min) matches the estimated rate of loss of base excess (1 mmol/2-3 minutes) reported in cases of severe bradycardia or sentinel events during labor.

Effect of maternal cortisol levels on fetal heart rate patterns in primiparous pregnant women in the third trimester

This study aimed to determine whether maternal cortisol levels affect fetal heart rate patterns in primiparous pregnant women in the third trimester. This cross-sectional descriptive study included 400 primiparous pregnant women with uncomplicated pregnancies between November and December 2022. The study included primiparous pregnant women over 18 years old in the third trimester who had not exercised for at least 2 h before the fetal heart rate monitoring and had a healthy pregnancy without consuming any food or drink. Fetuses with decelerating heartbeats and pregnant women who showed uterine contraction and cervical dilation during the fetal heart rate monitoring were excluded from the study. Research data were collected with the data collection form. The fetal heart rate data were collected using a cardiotocograph. At least two accelerations during the 20-min nonstress test period were the basis for diagnosing a reactive nonstress test. About 5 mL of maternal saliva for cortisol measurements was collected before fetal heart rate monitoring. Research data were analyzed with IBM SPSS Statistics for Macintosh, Version 28.0. A p-value of <0.05 was considered significant. There were no significant differences in the comparison of the groups in terms of education and income status, family type, fetal gender, pregnancy planning status, BMI and age averages, or gestational week averages (p>0.05). The number of at least two accelerations required for the diagnosis of reactive NST was also higher in Group 1 (maternal salivary cortisol level ≤24.20). A moderately positive relationship between fetal heart rate and maternal salivary cortisol was observed (r=0.448, p=0.000). In total, 11.9% of the total change in fetal heart rate level is explained by maternal cortisol (R2=0.119). Maternal cortisol increases fetal heart rate level (ß=0.349). These findings suggest that stress in primiparous pregnant women with high cortisol levels may influence fetal heart rate patterns. It was revealed that the increase in cortisol level, considered a stress hormone, may be a harbinger of fetal tachycardia.

Labor induction in term gravidas with prelabor rupture of membranes and unfavorable cervixes: Oxytocin versus vaginal misoprostol.

To compare maternal and neonatal outcomes between oxytocin and vaginal misoprostol induction in women with term prelabor rupture of membranes (PROM) and unfavorable cervixes. In this retrospective study, 589 pregnant women with term singleton fetuses in cephalic presentation, reactive nonstress tests, PROM of 2-24 h duration, Bishop score <6, and no previous uterine surgery were reviewed and divided into oxytocin (n= 301) and misoprostol (n= 288) groups. The primary outcomes were the rate of vaginal delivery and delivery within 24 h. After 24 h of induction, the misoprostol group showed a significantly higher proportion of vaginal delivery (64.6% vs. 49.5%, P< 0.001) and a lower cesarean section delivery rate (11.5% vs. 25.2%, P< 0.001) than the oxytocin group. More primiparas in the misoprostol group achieved vaginal delivery within 24 h than in the oxytocin group (60.5% vs. 45.4%, P= 0.001). Among primiparas, the misoprostol group had a significantly lower cesarean delivery rate (12.6% vs. 27.5%, P< 0.001). Vaginal misoprostol induction in term PROM gravidas with unfavorable cervixes was associated with lower cesarean section and higher vaginal delivery rates within 24 h than oxytocin infusion. Vaginal misoprostol and oxytocin infusion had similar maternal and neonatal outcomes.

Chocolate Or Fetal Doppler Sonography For Non-Reactive Non-Stress Test Patterns: Randomized Prospective Controlled Study

Aim: The aim of this study is to compare the effect of 20-second MCA Doppler ultrasonography and bitter chocolate on non-stress test (NST) patterns, fetal movements felt by the mother and cesarean delivery rates.&#x0D; Methods: Single pregnancies between 36-41 weeks with non-reactive NST pattern were included in the study and prospectively randomized to Doppler ultrasound, bitter chocolate, and non-intervention control groups. NSTs of the patients at the 5th and 30th minutes were examined.&#x0D; Results: The rate of improvement in the fetal movements felt by the mother did not differ significantly among groups (p ˃ 0.05). The 5th minute reactive NST ratio in the Doppler group was significantly higher (p ˂ 0.05) than in the follow-up and chocolate group. In the chocolate and non-intervention control group, the 5th minute reactive NST ratio did not differ significantly (p ˃ 0.05). In the 30th minute NST, patients with non-reactive results had significantly higher fetal distress rates in the Doppler group compared to the other groups (p ˂ 0.05).&#x0D; Conclusions: We think that with the application of Doppler, the length of hospital stay and accordingly patient’s anxiety will reduce. In addition, the patient should be monitored more carefully in terms of fetal distress because it quickly corrects false non-reactivity.

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.

Antenatal fetal surveillance of women with severe obesity

Objective To estimate the impact of body mass index (BMI) categories on duration of the nonstress test (NST), and the need for additional tests of fetal wellbeing or interventions. Methods We conducted a retrospective cohort study of women with singleton pregnancies who had an NST for the indications of severe obesity (BMI ≥40 kg/m2), diabetes (pre-gestational or gestational), hypertensive disorders (chronic, gestational, and preeclampsia), and others between 1 January 2015 until 31 December 2016. NST durations (<30 and ≥30 min) were compared between groups first based on BMI (kg/m2) categories (<30, 30–39, 40–49, and ≥50) and then based on BMI and comorbidities: (1) severe obesity alone, (2) severe obesity and comorbidities, and (3) comorbidities alone. We compared the results of the NSTs, any subsequent fetal testing or interventions, and pregnancy outcomes among groups. Demographic information was compared using t-tests for continuous data and χ 2 analyses or Fisher’s exact test, if the cells sizes were small, for categorical data. NST durations based on BMI groups, as well as BMI and comorbidities groups, were compared using linear mixed models and ANOVA. Results Three hundred and fifty-one women underwent 1665 NSTs during the study period. After excluding women <18 and >50 years, gestational age <30 weeks, fetal anomalies, and NSTs lasting longer than 60 min, the study population included 313 women and 1471 NSTs. The mean NST duration in minutes of the BMI ≥50 (32.2 ± 9.6) category was significantly longer than the NST duration of the other BMI categories (BMI <30: 29.4 ± 8.3; BMI 30–39: 29.7 ± 8.9; BMI 40–49: 29.9 ± 8.3) (p=.05). Additionally, there was an increased percentage of NSTs lasting ≥30 min as the BMI category increased (p=.005). Women in the severe obesity and comorbidities group (n = 79) were less likely to have a reactive NST than women with severe obesity alone (n = 56) or comorbidities alone (n = 178) (92% vs. 97% vs. 98%, p<.0001). They were also more likely to need a biophysical profile (BPP) (8% vs. 3% vs. 2%, p<.0001). Of the 25 women that were sent to the labor and delivery unit for evaluation, 20 (80%) were admitted and delivered. The reasons for delivery were hypertension (n = 9, 45%), an abnormal NST (n = 5, 25%), oligohydramnios (n = 4, 20%), and labor (n = 2, 10%). Conclusions We found an increase in NST duration as the BMI increased. Women with severe obesity and a comorbidity were more likely to have a nonreactive NST and require a subsequent BPP. Of the 20 patients delivered due to NST surveillance, the most common indication for delivery was hypertension.

Single sporadic deceleration during reactive nonstress test – clinical significance and risk for cesarean delivery

The nonstress test (NST) is a widely applied technique for antepartum fetal assessment despite a high false-positive rate. The evidence regarding the clinical significance of a single sporadic variable deceleration (SSD) in fetal heart rate (FHR) during reactive NST is scarce, and therefore, the optimal management of SSD in a term pregnancy without other signs of fetal compromise has not been established. Thus, we aim to evaluate whether SSD during a reactive NST at term is associated with a higher risk for FHR decelerations during labor and need for intervention.

A STUDY OF MATERNAL PERCEPTION OF DECREASED FOETAL MOVEMENT AND PERINATAL OUTCOME

BACKGROUND: Fetal movement is described as motion of the fetus perceived by the mother and is considered as a sign of foetal wellbeing. A reduction of foetal movements causes concern and anxiety, both to the mother and obstetrician.Decreased foetal movements are regarded as a marker for suboptimal intrauterine conditions,possibly of placental dysfunction and intrauterine stress. Evaluation of maternal perception of decrease foetal movement is done by taking proper history,daily foetal movement count (DFMC),non-stress test (NST) and ultrasonography. AIM AND OBJECTIVES: The aim of this study was to find out perinatal outcome among women with decreased foetal movements. The rational for the study is that our findings should contribute to maternal understanding of foetal wellbeing in utero,and possible ways to work with mothers to prevent intrauterine foetal deaths and stillbirths. MATERIAL AND METHODS: This is a hospital based descriptive study conducted at Obstetrics and Gynaecology department, Srimati Heera Kunwar Ba Mahila Chikitsalaya,Jhalawar Medical College Jhalawar from November 2018 to October 2019. Ethical approval was taken from ethical committee and written informed consent was taken from the participants.Total 192 women were included in the study with complain of decreased foetal movements.To ev aluate the foetal well-being daily foetal movement count (DFMC),non-stress test (NST) and ultrasonography was done. RESULT: There was no statistically significant association between DFMC and foetal outcome, but reactive NST is associated with good foetal outcome. CONCLUSION: W rd e conclude that reduced foetal movement during 3 trimester could be ominous sign. Our study suggests that NST,sonography and DFMC may be used to evaluate the women complaining of decrease foetal movement and may identify the women at risk for adverse perinatal outcome.

Investigation of Cesarean Rates and Perinatal Outcomes of Term Pregnancies Referred to the Delivery Unit from the Outpatient Clinic with Pre-Diagnosis of Non-Reactive Non-Stress Test

Objective: Cesarean rates and perinatal outcomes of pregnant women who admitted to our hospital for routine follow-up and were referred to the delivery room with pre-diagnosis of non-reactive nonstress test were investigated. Materials and Methods: A total of 100 pregnant women of 37-41 weeks gestation who were pre-diagnosed with non-reactive nonstress test during routine follow-up and referred to the delivery unit between January 2018 and December 2018 were retrospectively evaluated. High-risk pregnant women with risk factors that may have contributed to non-reactive nonstress test were not included in the study. Modes of delivery were documented and cesarean deliveries due to non-reactive nonstress test were investigated.Results: Of the 100 patients referred to the delivery room due to non-reactive nonstress test, 88 showed reactive nonstress test following fetal resuscitation. The remaining 12 patients were nonresponsive despite fetal resuscitation and other efforts and underwent emergency cesarean delivery. The primary cesarean rate of delivered pregnancies diagnosed with non-reactive nonstress test was 23.6%. There was no statistically significant difference between pregnancies diagnosed and not diagnosed with non-reactive nonstress test according to perinatal outcomes in fetal wellbeing follow-up (p&amp;gt;0.05). Conclusions: Primary cesarean rate was higher in delivered pregnancies diagnosed with non-reactive nonstress test.

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.

Effectiveness of Non Stress Test on Fetal, Neonatal and Maternal Outcomes to Prevent Chronic Consequences in Delivery Health Centers

Background: Non stress test (NST) is the most common and the first recommended test to assess the health of the fetus especially in high risk pregnancies in most studies. This study aimed to determine the effectiveness of non-stress test on fetal, neonatal and maternal outcomes to prevent chronic consequences in delivery health centers of West Azerbaijan. Methods: This was a classic case-control study conducted on 984 subjects in West Azerbaijan. The method of sampling was census during the last two years (2014 - 2015). Of 984 subjects, 500 subjects had undergone NST (case group) and 484 subjects had not been undergone NST (control group). Data were collected using records of mothers and checklist including variables related to maternal characteristics such as fetus characteristics, and the results of the NST. The data were analyzed using SPSS version 24 software. A P value of less than 0.05 was considered significant. Results: In the case group, 71.6% had a positive or reactive response and 28.4% had non-reactive test response. The rate of fetal death in centers without NST was 2.18% and fetal deaths were higher in centers without NST and all deaths in centers with NST occurred when this test was non-reactive (P < 0.05). There was a statistically significant relationship between NST with exposure to meconium and fetal distress. The main cause of NST was the premature rupture of the membranes (PROM) (41.7%). Post-term, meconium-stained amniotic fluid, decreased fetal movement (DFM) and post-term were other common causes. Meanwhile, 24.4% of mothers had abnormal movement tests, and this result was more non-reactive NST compared with reactive NST (P = 0.001). Conclusions: Using non stress test to observe the abnormal results of this test, midwives working in centers can quickly decide on appropriate referrals of mothers to hospitals and delivery centers, in such a way that this referral prevents mothers from developing adverse fetal and neonatal outcomes.

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.

116: The cost-effectiveness of various fetal surveillance strategies in pregnancies complicated by advanced maternal age

Advanced maternal age is associated with an increased incidence of intrauterine fetal demise (IUFD). Various strategies of antepartum surveillance have been proposed to decrease the incidence of IUFD, however these are associated with increased medical interventions. We designed a model to examine the cost-effectiveness of various antepartum surveillance strategies. A decision-analytic model with a Markov process was built using TreeAge Pro and incorporated probabilities, costs, and utilities from the literature. We compared the strategies of - starting at 37 weeks gestation - two times weekly non-stress testing (NST), one time weekly NST, and no scheduled antenatal surveillance. We assumed that a non- reactive NST was followed by a biophysical profile (BPP) and then either delivery or return to scheduled surveillance. This model was then applied to a theoretical cohort of 100,000 women, the cost-effectiveness threshold was set to $100,000 per quality-adjusted life year (QALY), and the robustness of the model was assessed with sensitivity analysis. In our model, two times weekly NST resulted in 34,304 positive tests and 487 indicated deliveries, which was 232 more then the one time weekly strategy. The two times weekly strategy resulted in 53 fewer IUFDs compared to the no additional surveillance strategy and 18 fewer IUFDs then the one time weekly strategy (table). In one-way sensitivity analysis, the two times weekly strategy was the cost-effective option up to a NST cost of $357, and up to a BPP cost of $4,418. The two times weekly strategy was the cost-effective strategy with an ICER of $36,610. In pregnancies complicated by advanced maternal age, two times weekly NST is the cost-effective strategy resulting in decreased IUFDs at the expense of increased medical interventions.

Strip of the Month: Complete Heart Block Masquerading as a Reactive Nonstress Test

Strip of the Month: Complete Heart Block Masquerading as a Reactive Nonstress Test