EVALUATION OF THE NONREACTIVE POSITIVE CONTRACTION STRESS TEST PRIOR TO 32 WEEKS - THE ROLE OF THE BIOPHYSICAL PROFILE

A nonreactive positive contraction stress test in a pregnancy near ter m is an indication for delivery. Such nonreassuring antepartum testing combined with severe prematurity presents a management dilemma. Ideal ly, prolongation of selected pregnancies would allow time for corticos teroid therapy and fetal maturation. Prior to 32 weeks' gestation, we utilized the biophysical profile to select patients for continued intr auterine 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 allo wed a mean gain of 13 days in utero for the continued surveillance gro up. There was no evidence of further fetal compromise in this group ba sed on umbilical cord pH or 5-minute Apgar scores. These data suggest that the biophysical profile can be safely used to prolong selected pr eterm pregnancies with nonreactive positive contraction stress tests w ithout adversely affecting the initial neonatal metabolic status.