Volunteer studies of experimental, low-velocity rear-end collisions have shown a percentage of subjects to report short-lived symptoms, but the cause of these symptoms remains unknown. It is unclear whether the symptoms arise from biomechanical stress causing injury or from psychological stress causing symptom expectation and anxiety. Similarly, the cause of symptoms remains obscure in virtually all "whiplash" patients because it is impossible to identify acute pathology in many cases. In this study subjects were exposed to placebo collisions that almost completely lacked biomechanical stress. It was highly probable that if the symptoms reported following low-velocity collisions were not due to injury but to other factors (including misattribution of symptoms from other sources), then the proportion of subjects reporting symptoms would be similiar to that reported for volunteers in true (experimental) low-velocity, rear-end collisions. A total of 51 volunteers (33 males and 18 females, mean age 32.4 years) were recruited through local newspaper advertisements. An experimental set-up for a placebo collision was constructed using two standard European cars. At time T0, prior to the placebo collision, a history and physical examination was performed, including a psychological analysis (Freiburger Personality Inventory). A symptom history and physical examination were also performed at time T1, immediately after the placebo collision, and the subjects completed symptom questionnaires 3 days (time T2) and 4 weeks (time T3) after the placebo collision. Data analysis included a determination of the predictive value of psychological data for the presence of symptoms following exposure to a placebo collision. At time T1, 9 out 51 participants (17.6%) indicated symptoms. Within 3 days (time T2) after the placebo collision, 10 (19.6%) of the subjects had symptoms, and within 4 weeks (time T3) 5 subjects (9.8%) had symptoms. Of the last group, two of the five did not relate these symptoms to the "collision". Subjects who endorsed symptoms at time T1 had significantly higher scores on the psychological scale of psychosomatic disorders (measured at time T0). Subjects endorsing symptoms at time T2 had significantly higher scores on emotional instability. There was also a tendency to higher scores on this sub-scale for subjects with whiplash-associated disorders (WAD) at time T3. A discriminant analysis using all four psychological scales from time T0 had a power of 87%, 83% and 92% for correct classification of subjects as asymptomatic times T1, T2 and T3, respectively. Approximately 20% of subjects exposed to placebo, low-velocity rear-end collisions will thus indicate WAD, even though no biochemical potential for injury exists. Certain psychological profiles place an individual at higher risk for phenomenon.
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Prenatal non-stress test, popularly known as NST, is a method used to test fetal wellbeing before the onset of labor. A prenatal non-stress test functions in overall antepartum surveillance with ultrasound as a part or component of the biophysical profile. The presence of fetal movements and fetal heart rate acceleration is the most critical feature of the non-stress test. It is a non-invasive test used for the surveillance of high-risk pregnancies when the fetus is judged clinically to be at risk for hypoxemia or increased risk of death. This activity reviews the prenatal non stress test, its indications, clinical relevance, and highlights the role of the interprofessional team in the management of the pregnant patient.
Objectives:Identify the indications for a prenatal non stress testDescribe how a perenatal non-stress test is conducted.Review the clinical significance of a prenatal non stress test.Outline the importance of improving care coordination amongst interprofessional team members to improve outcomes for patients undergoing the prenatal non stress test.Access free multiple choice questions on this topic.
Prenatal non-stress test, popularly known as NST, is a method used to test fetal wellbeing before the onset of labor. A prenatal non-stress test functions in overall antepartum surveillance with ultrasound as a part or component of the biophysical profile. The presence of fetal movements and fetal heart rate acceleration is the most critical feature of the non-stress test. It is a non-invasive test used for the surveillance of high-risk pregnancies when the fetus is judged clinically to be at risk for hypoxemia or increased risk of death. Trained and certified nurses, midwives and physicians should read and interpret the non-stress test. The NST readings are as reactive and none reactive. The non-stress tests can initiate at 26 to 28 weeks. The NST is reactive from 32 weeks.
The presence of fetal heart rate acceleration with fetal movement is the principle behind the non-stress test. The NST recognizes the coupling of fetal neurological status to cardiovascular reflex responses. It is one of the factors that tends to disappear earliest during progressive fetal compromise. Interpretation of the nonstress test follows a systematic approach to include: the baseline fetal heart rate, baseline fetal heart rate variability, presence of accelerations, decelerations, and contractions.
The non-stress test is not useful in predicting outcomes or determination of fetal wellbeing in patients with acute events such as evolving placental abruption and cord prolapse. Such acute events require prompt clinical evaluation and delivery of fetus as indicated.
The electronic fetal monitor (called the cardiotocogram in the United Kingdom and other countries) is the equipment used for the prenatal nonstress test. The modern equipment records fetal heart rate pattern, contractions, fetal cardiac activity, maternal blood pressure and heart rate on a graph. It has a Doppler transducer for fetal heart rate monitoring and a pressure transducer for monitoring of uterine contractions and fetal movement. The transducers are placed on the pregnant abdomen using belts. The equipment is portable and can be placed in small rooms in the office setting and the hospital as needed. Computerized storage and interpretation of FHR records are obtainable with conventional monitors. Computerized cardiotocography provides a more detailed analysis of the fetal heart rate pattern but has not proved superior to the conventional nonstress test.
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 non-stress test is one of the most widely used techniques for antepartum fetal evaluation. Antepartum fetal surveillance techniques are used to assess the risk of fetal death in pregnancies complicated by preexisting maternal conditions (e.g., diabetes mellitus) as well as those in which complications have developed (e.g., fetal growth restriction).. The presence of fetal heart rate acceleration with fetal movement is the principle behind the none stress test. The NST recognizes the coupling of fetal neurological status to cardiovascular reflex responses. It is one of the factors that tends to disappear earliest during the progressive fetal compromise..
The interpretation of the non-stress test is as reactive or none reactive. The criteria for a reactive NST are at least two FHR accelerations lasting at least 15 seconds and rising at least 15 beats/minute above the established baseline heart rate. Most term fetuses have many of these accelerations in each 20- to 30- minute period of active sleep, and the term fetus seldom goes more than 60 minutes, and certainly not more than 100 minutes without meeting these criteria. When the non-stress test is not reactive, It should be extended to another 20 minutes in an attempt to separate the fetus in a period of prolonged quiet sleep from those who are hypoxemic or asphyxiated.
The prenatal nonstress test has utility in isolation in post-term pregnancies and patients with decreased fetal movement. When the non-stress test is not reactive, the testing period should extend another 20 minutes in an attempt to delineate between the fetus in a period of prolonged quiet sleep from those who are hypoxemic or asphyxiated. Vibroacoustic stimulation (VAS) may be used to change fetal state from quiet to active sleep and shorten the length of the NST. If the NST remains nonreactive after 60 minutes. The fetus should undergo evaluation with an ultrasound biophysical profile. 041b061a72