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The nonstress test: the false negative test

J P Phelan, A D Cromartie, C V Smith

    American Journal of Obstetrics and Gynecology
    |February 1, 1982
    PubMed
    Summary
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    A reactive nonstress test (NST) usually indicates good fetal health, but rare fetal deaths can occur. Close monitoring for decelerations may help identify high-risk pregnancies, though no test offers complete fetal well-being reassurance.

    Area of Science:

    • Obstetrics and Gynecology
    • Fetal Monitoring
    • Perinatal Medicine

    Background:

    • The nonstress test (NST) is a standard method for assessing fetal well-being.
    • A reactive NST generally correlates with favorable pregnancy outcomes.
    • However, rare instances of fetal demise following a reactive NST necessitate further investigation.

    Purpose of the Study:

    • To investigate the occurrence and potential causes of fetal death after a reactive nonstress test (NST).
    • To evaluate the reliability of the NST in high-risk pregnancies.
    • To identify specific NST findings that might predict adverse outcomes.

    Main Methods:

    • Retrospective analysis of 4,500 nonstress tests (NSTs) performed on 2,226 high-risk pregnancies.
    • Focused review of cases involving fetal death within 7 days of a reactive NST.

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  • Examination of presumed etiologies for fetal demise.

    • Main Results:

    • Four fetal deaths (0.026%) occurred within 7 days of a reactive NST in 1,564 deliveries.
    • Presumed causes included cord accidents (3 cases) and abruptio placentae (1 case).
    • False negative NSTs were associated with cord accidents, congenital anomalies, and abruptio placentae.

    Conclusions:

    • While a reactive NST is associated with a low risk of fetal death, it does not guarantee fetal well-being.
    • Identifying fetal heart rate decelerations during NST may help detect pregnancies at risk for cord accidents.
    • Current fetal well-being tests, including the NST, do not provide absolute reassurance against all adverse outcomes.