Pregnancy outcome in the patient with a nonreactive nonstress test and a positive contraction stress test.

The pregnancy outcomes for 41 patients with high-risk pregnancies who had undergone antepartum fetal heart rate testing between July 5, 1977, and April 10, 1980, and demonstrated a nonreactive nonstress test (NST) and a positive contraction stress test (CST) were reviewed. The estimated gestational ages of the time of the positive CST ranged from 28 to 44 weeks' gestation. Of the 41 pregnant women with a positive CST, 30 were allowed to labor. The remaining 11 patients underwent immediate cesarean section (8) or were managed expectantly because of immature phospholipid profiles (3). In the laboring group, 60.0% had evidence of late decelerations. Cesarean section for persistent late decelerations was necessary in 33.3%. The overall cesarean section rate for the positive CST group was 58.5%. The neonatal outcome for these 41 pregnancies demonstrated 29.3% of fetuses to be growth retarded and 17.1% of fetuses to have congenital abnormalities. The overall perinatal mortality rate was 7.3%. This investigation further substantiates the increased fetal and neonatal risks associated with a nonreactive NST and a positive CST. Induction of labor with direct fetal monitoring should be attempted in a term gestation where the cervix is ready for induction of labor and where rapid intervention by cesarean section is possible.