A contraction stress test checks to see if
your unborn baby (fetus) will stay healthy during the
reduced oxygen levels that normally occur during contractions when you are in
labor. This test includes
external fetal heart monitoring. The test is done when you are
34 or more weeks pregnant.
During a uterine contraction, the
blood and oxygen supply to your baby drops for a short time. This is not a
problem for most babies. But the heart rate of some babies gets slower. This
change in heart rate can be seen on the external fetal monitoring
For a contraction stress test, the hormone oxytocin is
given to you in a vein (intravenously, or IV) to cause labor
contractions. You may also massage your nipples. This tells your body to
release oxytocin. If your baby's heart rate slows down (decelerates) in a
certain pattern after a contraction instead of speeding up (accelerating), your
baby may have problems with the stress of normal labor.
contraction stress test is usually done if you have an abnormal nonstress test or
biophysical profile. A biophysical profile uses
ultrasound during a nonstress test to measure a series
of physical characteristics of your baby. You may have more than one contraction stress test during your
Some doctors may do a biophysical profile or a
Doppler ultrasound test instead of a contraction
A contraction stress test is done to
A contraction stress test may be done when results from a
nonstress test or a biophysical profile are not in the normal range.
You may be asked to not eat or drink
for 4 to 8 hours before the test. Empty your bladder before the test.
If you smoke, stop for 2 hours before the test because smoking can lower
your baby's activity and heart rate.
You will be asked to sign a
consent form before a contraction stress test. Talk to your doctor about any
concerns you have regarding the need for the test, its risks, how it will be
done, or what the results will mean. To help you understand the importance of
this test, fill out the
medical test information form(What is a PDF document?).
A contraction stress test may be done
in your doctor's office or hospital by a
family medicine doctor or an
obstetrician and a trained laboratory technician or
nurse. You usually do not need to stay overnight.
During the test,
you will lie on a bed with your back raised. You will be tilted a little to
your left side so you will not have pressure on the blood vessels in your
belly. Two belts with sensors will be placed around your belly. One belt holds
the sensor that records your baby's heart rate; the other sensor measures your
uterine contractions. Gel may be used on your skin with the heart rate sensors.
The sensors are hooked to a recording unit. The heart rate monitor may be moved
if your baby changes position. Your baby's heart rate and your contractions are
recorded for 10 minutes. Your blood pressure and other vital signs are also
The hormone oxytocin is given in a low dose and
increased until you have three contractions within 10 minutes, each one lasting
longer than 45 seconds. Or you may be asked to massage one of your nipples by
hand to start contractions. If you don't have a second contraction within 2
minutes of the first, you will massage your nipple again. If contractions do
not occur within 15 minutes, you will stimulate both nipples.
After the test, you will be watched until your contractions go away or
slow down to what they were before the test. A contraction stress test may take
You may need to lie on your left side for
the test. This position may be uncomfortable or painful when you are having
labor contractions. The belts holding the sensors may be uncomfortable. Most
women say this test is uncomfortable but not painful.
Fetal heart monitoring may indicate that your baby is having problems when your baby is actually healthy. Fetal heart
monitoring can't detect every type of problem, such as a birth defect.
The risks from having oxytocin include:
A contraction stress test checks to see
if your unborn baby (fetus) will
stay healthy during the reduced oxygen levels that normally occur during
contractions when you are in labor.
Results of the test tell your
baby's health for 1 week. The test may need to be done more than once during
Normal test results are called negative.
baby's heart rate does not get slower (decelerate) and stay slow after the
contraction (late decelerations). Note: There may be a
few times during the test when your baby's heart rate decelerates, but it
doesn't stay slow so it is not a problem.
If three contractions
occur during a 10-minute period of nipple stimulation or oxytocin infusion and
there are no late decelerations in your baby's heart rate, your baby is
expected to be able to handle the stress of labor.
Abnormal test results are called positive.
baby's heart rate gets slower (decelerates) and stays slow after the
contraction (late decelerations). This happens on more than half of the contractions.
Late decelerations may
mean that your baby will have problems during normal labor.
Reasons you may not be able to
have the test or why the results may not be helpful include:
CitationsFischbach FT, Dunning MB III, eds. (2009).
Manual of Laboratory and Diagnostic Tests, 8th ed.
Philadelphia: Lippincott Williams and Wilkins.Other Works ConsultedFischbach FT, Dunning MB III, eds. (2004).
Manual of Laboratory and Diagnostic Tests, 7th ed.
Philadelphia: Lippincott Williams and Wilkins. Handbook of Diagnostic Tests
(2003). 3rd ed. Philadelphia: Lippincott Williams and Wilkins.Pagana KD, Pagana TJ (2010). Mosby’s Manual of Diagnostic and Laboratory Tests, 4th ed. St. Louis: Mosby.
June 18, 2012
Sarah Marshall, MD - Family Medicine & William Gilbert, MD - Maternal and Fetal Medicine
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