Management of abnormal test results

1. Maternal reports of decreased fetal movement should be evaluated by an NST, CST, BPP, or modified BPP. These results, if normal, usually are sufficient to exclude imminent fetal jeopardy. A nonreactive NST or an abnormal modified BPP generally should be followed by additional testing (either a CST or a full BPP). In many circumstances, a positive CST result generally indicates that delivery is warranted.

2. A BPP score of 6 is considered equivocal; in the term fetus, this score generally should prompt delivery, whereas in the preterm fetus, it should result in a repeat BPP in 24 hours. In the interim, maternal corticosteroid administration should be considered for pregnancies of less than 34 weeks of gestation. Repeat equivocal scores should result either in delivery or continued intensive surveillance. A BPP score of 4 usually indicates that delivery is warranted.

3. Preterm delivery is indicated for nonreassuring antepartum fetal testing results that have been confirmed by additional testing. At term, additional testing can be omitted since the risk from delivery is small. Depending on the fetal heart rate pattern, induction of labor with continuous FHR and contraction monitoring may be attempted in the absence of obstetrical contraindications. Repetitive late decelerations or severe variable decelerations usually require cesarean delivery.

References: See page 184.

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