Prediction of abnormal umbilical cord position and intrapartum cord problems from the nonstress test

A prospective analysis of the nonstress test revealed a group of patients who demonstrate typical variable decelerations associated with fetal movement. Such variable decelerations were observed only in patients who had the test performed for suspected intrauterine growth retardation or for postdatism. Almost half of the suspected small-for-gestational-age fetuses and fetuses of a postdate gestation who demonstrated variable deceleration at nonstress testing also demonstrated an umbilical cord in an abnormal position at delivery. The position of the cord in utero of the remaining patients with variable deceleration at nonstress testing was not determined; however, 88% of this group demonstrated significant variable deceleration during labor. An abnormally positioned cord was noted in half of the patients undergoing cesarean section. It appears that patients with small-for-gestational-age fetuses and those with postdate gestation are at higher risk of intrapartum cord compression problems when variable decelerations are noted with fetal movements during a nonstress test.