A nonreactive positive contraction stress test in a pregnancy near term is an indication
for delivery. Such nonreassuring antepartum testing combined with severe prematurity
presents a management dilemma. Ideally, prolongation of selected pregnancies would
allow time for corticosteroid therapy and fetal maturation. Prior to 32 weeks' gestation,
we utilized the biophysical profile to select patients for continued intrauterine
management as an alternative to immediate delivery. Continued surveillance was undertaken
if the fetus had a reassuring biophysical profile score; immediate delivery by cesarean
section was undertaken if the biophysical profile score was nonreassuring. This approach
allowed a mean gain of 13 days in utero for the continued surveillance group. There
was no evidence of further fetal compromise in this group based on umbilical cord
pH or 5-minute Apgar scores. These data suggest that the biophysical profile can be
safely used to prolong selected preterm pregnancies with nonreactive positive contraction
stress tests without adversely affecting the initial neonatal metabolic status.
Contraction - stress test - biophysical profile - pregnancy - prematurity - heart
rate monitoring
