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Re-Evaluating the Contraction Stress Test for Term Fetal Growth Restriction Fetuses: A Retrospective Study
Roie Alter1, Hagar Herz2, Adiel Cohen1
1Department of Obstetrics and Gynecology, Hadassah Ein Kerem Medical Center, Faculty of Medicine, Hebrew University, Jerusalem 9112001, Israel.
Journal of Clinical Medicine
|August 28, 2025
Summary
A negative contraction stress test (CST) did not improve outcomes for fetuses with fetal growth restriction (FGR). This suggests routine CST use may not benefit term FGR pregnancies, requiring further research for better management strategies.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Neonatology
Background:
- Fetal growth restriction (FGR) significantly increases perinatal risks, yet optimal intrapartum management remains debated.
- The contraction stress test (CST) is used to assess fetal well-being, but its prognostic value in FGR pregnancies is not well-established.
- Small-for-gestational-age (SGA) fetuses serve as a comparison group for evaluating FGR outcomes.
Purpose of the Study:
- To evaluate the utility of the contraction stress test (CST) in predicting perinatal outcomes for term fetuses with FGR.
- To compare perinatal outcomes between FGR fetuses with negative CST results and those without CST.
- To compare outcomes between FGR and SGA fetuses.
Main Methods:
- Retrospective cohort study of term singleton deliveries over two years.
- FGR defined by birthweight <3rd percentile or prenatal diagnosis <10th percentile with abnormal Doppler.
- SGA defined by birthweight between 3rd and 10th percentiles.
- Groups: FGR with negative CST, FGR without CST, and SGA without FGR.
- Primary outcome: emergency cesarean delivery rate. Secondary outcomes: neonatal and combined maternal/neonatal adverse events.
Main Results:
- Emergency cesarean delivery rates were similar for FGR with negative CST (15.2%) and FGR without CST (14.9%), both higher than SGA (9.7%).
- Composite neonatal adverse events were not significantly different between FGR groups (21.2% vs. 24.7%) but were higher than in the SGA group (8.1%).
- Combined maternal and neonatal adverse events were also similar between FGR groups (30.3% vs. 33.5%) and higher than in the SGA group (15.1%).
Conclusions:
- A negative CST prior to labor induction did not reduce adverse maternal or neonatal outcomes in FGR pregnancies.
- Routine use of CST appears to offer limited prognostic benefit for term FGR evaluation.
- Further research is needed to establish evidence-based surveillance and management strategies for high-risk FGR pregnancies.
