CONTRACTION STRESS TEST (OXYTOCIN CHALLENGE TEST)

DOCUMENT TYPE: PROCEDURE

POLICY
Obstetricians order a Contraction Stress Test (CST) for an atypical Nonstress Test (NST) and/or for
concerns about fetal well-being and assessment of fetal ability to tolerate labour. The contraction stress
test should be considered in the presence of an atypical non-stress test as a proxy for the adequacy of
intrapartum uteroplacental function and, together with the clinical circumstances, will aid in decision making
about timing and mode of delivery. A CST should NOT be performed when a vaginal delivery is
contraindicated.
Registered Nurses (RN) certified in fetal health assessment perform and interpret electronic fetal
monitoring tracings and report the results to the obstetrician.
The CST may be performed using an oxytocin infusion (Oxytocin Challenge Test, or OCT), or by maternal
nipple stimulation
Applicability: CST’s occur in Labour & Delivery area in the Maternal Newborn Program.

PROCEDURE

1.1 Gather Materials

For CST using nipple stimulation only: For OCT, also gather:
 Fetal monitor and attachments  Infusion pump
 Intravenous (IV) administration sets,
intravenous catheter #18
 Oxytocin, 30 International Units (IU)
 Syringe with needle, 3 millilitres (mL)
 500 mL IV solution
 1000 mL normal saline mainline

1.2 Procedure Preparation

Monitor baseline vital signs and perform ongoing assessments, hourly or more frequently, as required.
Initiate NST for a minimum 20 minutes.
 Note: If contractions spontaneously occur, the response may be interpreted as a test result.

1.3 Contraction Stress Test (CST)

Establish a primary IV line (usually with normal saline).
 Prepare a secondary IV with oxytocin 30 IU diluted in 500 mL IV solution. Connect the IV with the
oxytocin solution into the port closest to the insertion site.
 Attach the IV oxytocin line to the infusion pump.
 Start the oxytocin infusion at 1 mU/ minute.
 Increase the oxytocin infusion rate by 1 mU/minute every 30 minutes up to 16 mU/min or until three
contractions lasting one minute each within a 10 minute period occur
 If unable to achieve the required pattern of contractions at 16 mU/ minute of oxytocin, obtain further
orders.

The test is complete when this uterine contraction pattern (3 contractions lasting one minute each within a
10 minutes period) is achieved. It is not necessary to increase this frequency.

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 CONTRACTION STRESS TEST (OXYTOCIN CHALLENGE TEST)

DOCUMENT TYPE: PROCEDURE

Using nipple stimulation:

Instruct the woman to rub one nipple through her clothing with the palmar surface of her fingers rapidly, but
gently, for two minutes.
 Stop for five minutes and assess uterine activity.
 If the desired contraction pattern is not achieved, instruct the woman to proceed with a second cycle of
two minutes of stimulation.
 If contractions remain insufficient, bilateral nipple stimulation may be considered.
 Should nipple stimulation fail to induce contractions that meet the test criteria, oxytocin infusion should
be considered.
Note: Nipple stimulation is associated with no greater risk of uterine hyperstimulation and has a shorter
average testing time than oxytocin infusion.

1.4 CST/ OCT Interpretation and Monitoring

The purpose of the Contraction Stress Test (CST) is to determine how the fetus responds to reduced
oxygen (O2) delivery during contractions. It indirectly determines placental function and fetal oxygen
reserves.

Check the fetal heart rate (FHR) tracing and uterine activity recording is interpretable and is continuous on
both channels.

Interpretation of the Contraction Stress Test or Oxytocin Challenge Test

Negative Positive Equivocal
Late or complicated Late decelerations  Suspicious: At least one late deceleration, but
variable follow more than pattern not repetitive.
decelerations are 50% of the induced  Hyperstimulation: Uterine contractions lasting at
not present. Is contractions. This least 90 seconds or occurring more frequently
associated with fetal is associated with than every 2 minutes accompanied by late
well-being for up to poor fetal outcome decelerations.
1 week after the and therefore
test. delivery should be  Unsatisfactory: desired number and length of
expedited. contractions not achieved or poor quality tracing.

1.5 Post Procedure Actions

Registered Nurse

Discontinue the oxytocin infusion and notify the physician if:

 Bleeding and/or continuous abdominal pain occurs.
 The fetal heart tracing is abnormal.

Notify physician when test complete.

 When physician orders the CST/ OCT discontinued, continue primary IV infusion, and FHR and uterine
monitoring until contractions subside.

WW.04.05 Published Date: 30-Jul-2018

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 CONTRACTION STRESS TEST (OXYTOCIN CHALLENGE TEST)

DOCUMENT TYPE: PROCEDURE

Physician - Interpret the CST/ OCT as positive, negative or equivocal and determine the next steps in
care.
Negative Positive Equivocal
Plan for further fetal surveillance Plan to proceed with delivery Plan to repeat CST within 24
as indicated by maternal/ fetal by: hours, if appropriate
condition  Induction of labour Or
Or Or use other methods of fetal
Order induction of labour  Cesarean delivery* assessment

*Note: A fetus demonstrating an atypical/ abnormal NST and a positive CST/OCT is less likely to tolerate
labour and will require careful intrapartum observation.

DOCUMENTATION
Fetal Monitor Label and Fetal Heart Tracing
Fluid Balance Record – 12 Hour
Labour Partogram
Medication Added Label
Physician’s Orders

REFERENCES
Kavanagh, J. Thomas, J (2005) Breast stimulation for cervical ripening and induction of labour (review)
Cochrane Database of Systematic Reviews Issue 3

Liston, R., Sawchuk, D., Young, D., (2007, September). Fetal Health Surveillance: Antepartum and
Intrapartum Consensus Guideline No.197. SOGC. JOGC Vol 29(9) Supplement 4.
http://www.sogc.org/guidelines/documents/gui197CPG0709r_000.pdf
Miller, D (2018) Nonstress test and contraction stress test UpToDate Accessed June 20 2018
www.uptodate.com/contents/nonstress-test-and-contraction-stress-test Last updated Jan 2018

VERSION HISTORY
DATE DOCUMENT NUMBER and TITLE ACTION TAKEN
26-June- WW.04.05 Contraction Stress Test Approved at: BC Women’s Hospital Acute Perinatal Program
2018 (Oxytocin Challenge Test) Best Practice Committee
DISCLAIMER
This document is intended for use within BC Children’s and BC Women’s Hospitals only. Any other use or reliance is
at your sole risk. The content does not constitute and is not in substitution of professional medical advice. Provincial
Health Services Authority (PHSA) assumes no liability arising from use or reliance on this document. This document is
protected by copyright and may only be reprinted in whole or in part with the prior written approval of PHSA.
WW.04.05 Published Date: 30-Jul-2018
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This is a controlled document for BCCH& BCW internal use. Refer to online version. Print copy may not be current. See Disclaimer at the end of the document.