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Non-Stress Test (NST) - OB/GYN and Midwives-East/West (12.07)

Non-Stress Test (NST) - OB/GYN and Midwives-East/West (12.07) - Policies, Clinical, UWHC Clinical, Department Specific, Ambulatory, Clinic Specific

12.07

12.07 Non‐Stress Test (NST) ‐ OB/GYN and Midwives‐East/West  
Category:  UWHC Departmental Policy   
Policy Number:  12.07    
Effective Date:  August 27, 2014   
Version:  Revision    
Manual:  Ambulatory    
Section:  Clinic Specific (Ambulatory)   
  
I. PURPOSE

To outline clinical responsibilities in performance of a non-stress test (NST).

II. DEFINITIONS

A NST provides fetal surveillance during a pregnancy in which the fetus may be at risk and is also utilized to
monitor uterine activity. Clinical indications for fetal surveillance may include: Diabetes, hypertension, heart
disease, anemia, sickle cell disease, hyperthyroidism, collagen vascular disease, postdates, intrauterine growth
retardation, decreased fetal movement, history of previous stillbirth, poly/oligohydramnios, multiple gestation, post
external version, RH isoimmunization.

III. POLICY

The clinical staff will utilize the following procedure to perform a NST.

IV. PROCEDURE
A. Obtain written test order from provider.
B. Place the patient in semi-fowlers position.
C. Explain procedure and equipment to patient. Instruct patient to press the remote button each time she
feels the fetus move.
D. Apply toco (belt) and ultrasonic transducer on the uterus to obtain recording. Label monitor strip with
patient’s name, date of birth, medical record number, date, time, provider's name, and pertinent OB
history (gravida, parity, estimated due date, and reason for test).
E. Obtain initial maternal blood pressure, pulse, and respiratory rate (include temperature if concerns for
maternal infection); record on strip.
F. Determine baseline fetal heart rate (FHR) reactivity and uterine activity. Normal FHR is between 110 to
160.
G. Continue monitoring for minimum of 20 minutes.
1. If there are 2 or more FHR accelerations in a 20-minute period, the test is reactive, and the test
is completed. (Accelerations are defined as an increase of at least 15 beats per minute above
baseline, and lasting at least 15 seconds.)
2. If above criteria is not met due to fetal inactivity, change maternal position. Note maternal
movement on monitor strip. Continue monitoring for 10 minutes; if test is still non-reactive, may
repeat change in maternal position and continue monitoring for 10 minutes; or pending provider
preference, offer patient four ounces of juice and continue monitoring for 10 minutes (a total of
40 minutes or as directed by provider).
3. If test remains non-reactive, notify the provider.
4. In all cases, have the NST read by the provider.
H. The test will be recorded, stating the reason for the NST, and the provider will read the NST, signing the
electronic medical record, reactive or non-reactive.


V. REFERENCES

OB/GYN Peds Notes Nurse's Clinical Pocket Guide, Brenda Walters Holloway and Cheryl Moredich, F. A. Davis
Company, 2nd Edition, 2011
The American College of Obstetricians and Gynecologists, Clinical Practice Guidelines; Number 106; July 2009.

VI. WRITTEN BY

Clinic Manager, Womens Health Center
Clinic Coordinator, OB/GYN-West

VII. REVIEWED AND APPROVED BY

Gregory Bills, MD, Medical Director
Ambulatory Policy and Procedure Committee
Clinics Administration

SIGNED BY

Karen Leimkuehler, RN, MS, Clinic Operations Director