Nonstress test prediction of fetal status

Eighty-six patients were selected from the high-risk group delivered at Lincoln Hospital in New York City, constituting 22% of the total of 3,500 patients delivered. All of them underwent a nonstress test (NST) and oxytocin challenge test (OCT) antepartally and were also monitored during labor. Sixty-six of them had reactive nonstress patterns, all associated with a negative OCT. Three of them who had reduced variability developed late decelerations in labor; only one had a low Apgar score. Nineteen patients had absence of unequivocal accelerations, five associated with a negative OCT. Of these, only one developed late decelerations in labor. Of 14 others with nonreactive or combined positive OCT patterns, 9 developed late decelerations in labor. Two of them who also had reduced variability developed severe late decelerations in early labor, were delivered by cesarean section and had severe perinatal asphyxia. One case of baseline bradycardia was observed, and the patient did well. When reactive, NST appears to be as reliable as a negative OCT as an indicator of antepartum fetal well-being. Labor may be a life-threatening stress for fetuses displaying nonreactive positive OCT patterns with diminished variability.