The NST involves 20 minutes of monitoring the FHR while assessing the number, amplitude, and duration of accelerations that usually correlate with fetal movement. A normal test result, as defined by the American College of Obstetrics and Gynecologist, is one in which two or more accelerations peak at 15 bpm or more above baseline, each lasting 15 seconds or more, and all occurring within 20 minutes of beginning the test. It is important to note that an abnormal stress test is not always ominous and can occur with a sleeping fetus. If a test is not reactive, FHR should be monitored for at least 40 minutes to account for the fetus sleep cycle, and vibroacoustic stimulation can be used to stimulate fetal movement. Continuous nonreactive NST can indicate central nervous system depression, but further evaluation is necessary, usually in the form of a biophysical profile or contraction stress test. The diagnostic value of NSTs before 32 weeks varies and has high false-positive rates due to the immaturity of the fetal heart. An NST before 24 weeks gestation is nonreactive. A nonreactive NST is one that lacks sufficient fetal heart rate accelerations over 40 minutes. The NST of most preterm fetuses are frequently nonreactive: From 24 weeks, up to 50 percent of NSTs may be nonreactive, and from 28 to 32 weeks of gestation, 15 percent of NSTs are not reactive. For preterm fetuses between 24 weeks and 32 weeks, the predictive value of NSTs has its basis on a lower threshold of acceleration (at least 10 beats per minute from baseline) and has been evaluated and found to sufficiently predict fetal wellbeing. ...
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