Diagnostic Procedures in Pregnancy

Overview

• Discussion on diagnostic procedures:
  • Nonstress Tests (NST)
  • Biophysical Profiles (BPP)
  • Contraction Stress Tests (CST)
• Personal experience with NST and BPP shared at the end.

Nonstress Test (NST)

• Purpose: Monitor fetal well-being without stressing baby or mother.
• Procedure:
  • Use of a tocometer to measure uterine stress/contractions.
  • Use of fetal heart rate transducer (Doppler).
  • Sometimes involves a button for the mother to press when fetal movement is felt.
• Results:
  • Reactive NST: Desired result where the baby's heart rate increases by 15 bpm for at least 15 seconds twice within 20 minutes.
  • Non-reactive NST: Indicates the need for further testing as the fetal heart rate does not accelerate appropriately.
• Usage:
  • Conducted for various reasons such as reduced fetal movement, advanced maternal age, history of complications, or post-date pregnancies.

Biophysical Profile (BPP)

• Purpose: Further assessment if NST is non-reactive; combines NST with ultrasound.
• Components:
  1. Fetal Heart Rate (via NST) - 2 points if reactive, 0 if not.
  2. Fetal Breathing Movements - 2 points if present, 0 if not.
  3. Gross Body Movements - 2 points if there are 3 or more, 0 if fewer.
  4. Fetal Tone - 2 points if extension and flexion of head/neck is seen, 0 if not.
  5. Amniotic Fluid Volume - 2 points if there's a pocket ≥2cm, 0 if not.
• Scoring:
  • 8-10: Normal, reassuring
  • <8: Indicative of fetal hypoxia, potential need for delivery

Contraction Stress Test (CST)

• Purpose: Assess fetal response to contractions, rarely used now due to ultrasound availability.
• Procedure:
  • Induce contractions via nipple stimulation or administering oxytocin.
  • Monitor fetal heart rate response.
• Results:
  • Negative CST: Desirable, no late decelerations with contractions.
  • Positive CST: Undesirable, late decelerations indicate placental insufficiency and potential oxygen deprivation.

Personal Experience

• Frequent NSTs due to genetic condition.
• Daughter often non-reactive and resulted in delivery after a low BPP score.
• Son consistently had reactive NSTs.

Conclusion

• NST checks fetal oxygenation without stress.
• BPP provides a comprehensive overview of fetal health.
• CST assesses fetal response to actual contractions but is less commonly used now.

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