A non-stress test (NST) monitors and records the fetal heart rate and movement during pregnancy. It is usually performed after 28 weeks of gestation if the pregnancy is high-risk or if the baby's movement seems less active. During the NST, belts are placed on the mother's abdomen to measure the fetal heart rate and contractions while the mother pushes a button when feeling movement. The test looks for an increase in heart rate in response to fetal movement, indicating the baby is receiving enough oxygen.

1. ULTRASOUND
& NST

2. ULTRASOUND
What is General Ultrasound Imaging?
Ultrasound imaging = ultrasound
scanning=sonography adalah pemeriksaan
bagian tubuh tertentu dengan memaparkan
gelombang suara frekuensi tinggi untuk
menghasilkan gambar didalam tubuh.
Pemeriksan Ultrasound  (-) ionizing
radiation (x-ray).
Gambar yang dihasilkan :real-time
captured, menunjukkan structur & gerakan
organ dalam tubuh misal aliran darah.

3. Ultrasound imaging is usually a painless
medical test that helps physicians
diagnose and treat medical conditions.
Conventional ultrasound displays the
images in thin, flat sections of the body.
Advancements in ultrasound technology
include three-dimensional (3-D)
ultrasound that formats the sound wave
data into 3-D images. Four-dimensional
(4-D) ultrasound is 3-D ultrasound in
motion.

4. Ultrasound sends high-frequency sound waves
through your breast and converts them into
images on a viewing screen. Ultrasound
complements other tests. If an abnormality is
seen on mammography or felt by physical
exam, ultrasound is the best way to find out if
the abnormality is solid (such as a benign
fibroadenoma, or cancer) or fluid-filled (such as
a benign cyst). It cannot determine whether a
solid lump is cancerous, nor can it detect
calcifications.

5. Doppler ultrasound is a special ultrasound technique that
evaluates blood as it flows through a blood vessel, including
the body's major arteries and veins in the abdomen, arms,
legs and neck.
There are three types of Doppler ultrasound:
Color Doppler uses a computer to convert Doppler
measurements into an array of colors to visualize the speed
and direction of blood flow through a blood vessel.
Power Doppler is a newer technique that is more sensitive
than color Doppler and capable of providing greater detail of
blood flow, especially in vessels that are located inside organs.
Power Doppler, however, does not help the radiologist
determine the direction of flow, which may be important in
some situations.
Spectral Doppler. Instead of displaying Doppler measurements
visually, Spectral Doppler displays blood flow measurements
graphically, in terms of the distance traveled per unit of time.

6. What are some common
uses of the procedure?
Ultrasound examinations can help to
diagnose a variety of conditions and to
assess organ damage following illness.
Ultrasound is used to help physicians
diagnose symptoms such as:
pain
swelling
infection

7. Ultrasound is a useful way of examining many of the
body's internal organs, including but not limited to the:
heart and blood vessels, including the abdominal aorta
and its major branches
liver
gallbladder
spleen
pancreas
kidneys
bladder
uterus, ovaries, and unborn child (fetus) in pregnant
patients
eyes
thyroid and parathyroid glands
scrotum (testicles)

8. Ultrasound is also used to:
guide procedures such as needle biopsies, in which
needles are used to extract sample cells from an
abnormal area for laboratory testing.
image the breasts and to guide biopsy of breast cancer
(see the Ultrasound-Guided Breast Biopsy page).
diagnose a variety of heart conditions and to assess
damage after a heart attack or other illness.
Doppler ultrasound images can help the physician to see
and evaluate:
blockages to blood flow (such as clots)
narrowing of vessels (which may be caused by plaque)
tumors and congenital malformation
With knowledge about the speed and volume of blood
flow gained from a Doppler ultrasound image, the
physician can often determine whether a patient is a
good candidate for a procedure like angioplasty.

9. How should I prepare
for the procedure?
You should wear comfortable, loose-fitting clothing for
your ultrasound exam. You will need to remove all
clothing and jewelry in the area to be examined.
You may be asked to wear a gown during the
procedure.
Other preparation depends on the type of examination
you will have. For some scans your doctor may instruct
you not to eat or drink for as many as 12 hours before
your appointment. For others you may be asked to
drink up to six glasses of water two hours prior to your
exam and avoid urinating so that your bladder is full
when the scan begins.

10. What does the
equipment look like?
Ultrasound scanners consist of a console containing a
computer and electronics, a video display screen and a
transducer that is used to scan the body. The transducer is a
small hand-held device that resembles a microphone, attached
to the scanner by a cord. The transducer sends out a high
frequency sound wave and then listens for a returning sound
wave or "echo".
The ultrasound image is immediately visible on a nearby
screen that looks much like a computer or television monitor.
The image is created based on the amplitude (strength),
frequency and time it takes for the sound signal to return from
the patient to the transducer.

11. How does the
procedure work?
Ultrasound imaging is based on the same
principles involved in the sonar used by bats,
ships and fishermen. When a sound wave
strikes an object, it bounces backward, or
echoes. By measuring these echo waves it is
possible to determine how far away the object
is and its size, shape, consistency (whether
the object is solid, filled with fluid, or both)
and uniformity.
In medicine, ultrasound is used to detect
changes in appearance and function of organs,
tissues, or abnormal masses, such as tumors.

12. In an ultrasound examination, a transducer both sends the
sound waves and records the echoing waves. When the
transducer is pressed against the skin, it directs a stream of
inaudible, high-frequency sound waves into the body. As
the sound waves bounce off of internal organs, fluids and
tissues, the sensitive microphone in the transducer records
tiny changes in the sound's pitch and direction. These
signature waves are instantly measured and displayed by a
computer, which in turn creates a real-time picture on the
monitor. These live images are usually recorded on
videotape and one or more frames of the moving pictures
are typically captured as still images.
Doppler ultrasound, a special application of ultrasound,
measures the direction and speed of blood cells as they
move through vessels. The movement of blood cells causes
a change in pitch of the reflected sound waves (Doppler
effect). A computer collects and processes the sounds and
creates graphs or pictures that represent the flow of blood
through the blood vessels.

13. How is the procedure
performed?
For most ultrasound exams, the patient is positioned lying
face-up on an examination table that can be tilted or moved.
A clear gel is applied to the area of the body being studied to
help the transducer make secure contact with the body and
eliminate air pockets between the transducer and the skin.
The sonographer (ultrasound technologist) or radiologist then
presses the transducer firmly against the skin and sweeps it
back and forth over the area of interest.
Doppler sonography is performed using the same transducer.
When the examination is complete, the patient may be asked
to dress and wait while the ultrasound images are reviewed.
However, the sonographer or radiologist is often able to
review the ultrasound images in real-time as they are
acquired and the patient can be released immediately.

14. In some ultrasound studies, the transducer is
attached to a probe and inserted into a natural
opening in the body. These exams include:
Transesophageal echocardiogram. The
transducer is inserted into the esophagus to
obtain images of the heart.
Transrectal ultrasound. The transducer is
inserted into a man's rectum to view the
prostate.
Transvaginal ultrasound. The transducer is
inserted into a woman's vagina to view the
uterus and ovaries.
Most ultrasound examinations are completed
within 30 minutes to an hour.

15. What will I experience during
and after the procedure?
Most ultrasound examinations are painless, fast and easy.
After you are positioned on the examination table, the radiologist or
sonographer will spread some warm gel on your skin and then press
the transducer firmly against your body, moving it back and forth over
the area of interest until the desired images are captured. There may
be varying degrees of discomfort from pressure as the transducer is
pressed against the area being examined.
If scanning is performed over an area of tenderness, you may feel
pressure or minor pain from the procedure.
Ultrasound exams in which the transducer is attached to probe and
inserted into an opening of the body may produce minimal discomfort.
If a Doppler ultrasound study is performed, you may actually hear
pulse-like sounds that change in pitch as the blood flow is monitored
and measured.
Once the imaging is complete, the gel will be wiped off your skin.
After an ultrasound exam, you should be able to resume your normal
activities.

16. Who interprets the results
and how do I get them?
A radiologist, a physician specifically
trained to supervise and interpret
radiology examinations, will analyze the
images and send a signed report to
your primary care or referring
physician, who will share the results
with you. In some cases the radiologist
may discuss preliminary results with
you at the conclusion of your
examination.

17. Benefits
Ultrasound scanning is noninvasive (no needles or
injections) and is usually painless.
Ultrasound is widely available, easy-to-use and less
expensive than other imaging methods.
Ultrasound imaging uses no ionizing radiation.
Ultrasound scanning gives a clear picture of soft tissues
that do not show up well on x-ray images.
Ultrasound causes no health problems and may be
repeated as often as is necessary if medically indicated.
Ultrasound is the preferred imaging modality for the
diagnosis and monitoring of pregnant women and their
unborn infants.
Ultrasound provides real-time imaging, making it a good
tool for guiding minimally invasive procedures such as
needle biopsies and needle aspiration of fluid in joints or
elsewhere.

18. Risks
For standard diagnostic ultrasound there are
no known harmful effects on humans.
If you're under age 30, your doctor may recommend ultrasound
before mammography to evaluate a palpable breast lump.
Mammograms can be difficult to interpret in young women because
their breasts tend to be dense and full of milk glands. (Older
women's breasts tend to be more fatty and are easier to evaluate). In
mammograms, this glandular tissue looks dense and white—much
like a cancerous tumor. Some doctors say that locating an
abnormality in the midst of dense gland tissue can be like finding a
polar bear in a snowstorm. Most breast lumps in young women are
benign cysts, or clumps of normal glandular tissue.

19. What are the limitations of
General Ultrasound Imaging?
Ultrasound waves are reflected by air or gas; therefore
ultrasound is not an ideal imaging technique for the
bowel. Barium exams and CT scanning are the methods
of choice for bowel-related problems.
Ultrasound waves do not pass through air; therefore an
evaluation of the stomach, small intestine and large
intestine may be limited. Intestinal gas may also
prevent visualization of deeper structures such as the
pancreas and aorta. Patients who are obese are more
difficult to image because tissue attenuates (weakens)
the sound waves as they pass deeper into the body.
Ultrasound has difficulty penetrating bone and therefore
can only see the outer surface of bony structures and
not what lies within. For visualizing internal structure of
bones or certain joints, other imaging modalities such
as MRI are typically used.

20. Nonstress test

21. What is a non-stress test?
Non-stress test (NST) measures the fetal heart rate in response to
the fetus' movements. Generally, the heart rate of a healthy
fetus increases when the fetus moves. The NST is usually
performed in the last trimester of pregnancy.
The Fetal Non-Stress test is a simple, non-invasive
test performed in pregnancies over 28 weeks
gestation. The test is named “non-stress” because
no stress is placed on the fetus during the test.

22. What is a non-stress test?
(con’t)
This simple, painless procedure is done during pregnancy to
evaluate your baby's condition. During the test, your
healthcare practitioner or a technician monitors your baby's
heartbeat, first while the baby is resting and then while he's
moving. Just as your heart beats faster when you're active,
your baby's heart rate should go up while he's moving or
kicking.
The test is typically done if you've gone past your due date, or
in the month leading up to your due date if you're having a
high-risk pregnancy. Here are some reasons you might
have a nonstress test:

23. What is a non-stress test? (Con’t)
You have diabetes that's treated with insulin, high blood pressure, or some
other medical condition that could affect your pregnancy.
• You have gestational hypertension.
• Your baby appears to be small or not growing properly.
• Your baby is less active than normal.
• You have too much or too little amniotic fluid.
• You've had a procedure such as an external cephalic version (to turn a
breech baby) or third trimester amniocentesis (to determine whether your
baby's lungs are mature enough for birth or to rule out a uterine infection).
Afterward, your practitioner will order a non-stress test to make sure that
your baby's doing well.
You're past your due date and your practitioner wants to see how your baby
is holding up during his extended stay in the womb.
You've previously lost a baby in the second half of pregnancy, for an
unknown reason or because of a problem that might happen again in this
pregnancy. In this case, non-stress testing may start as early as 28 weeks.

24. How is a non-stress test
performed?
The test involves attaching one belt to the mother’s abdomen to measure fetal heart
rate and another belt to measure contractions. Movement, heart rate and
“reactivity” of heart rate to movement is measured for 20-30 minutes. If the baby
does not move, it does not necessarily indicate that there is a problem; the baby
could just be asleep. A nurse may use a small “buzzer” to wake the baby for the
remainder of the test.
The actual procedure for a NST may vary, but, generally, the procedure is as follows:
The test is often performed in a special prenatal testing area of the hospital, or in your physician's
office.
The mother lies down and has a belt placed around her abdomen with a transducer positioned over
the fetal heartbeat, called an external fetal heart rate monitor.
The fetal heart rate is recorded on the monitor and on a paper printout.
The mother pushes a button on the monitor each time she feels fetal movement. This places a mark
on the paper printout.
Testing usually lasts for 20 to 40 minutes.
Sometimes, the testing occurs during a fetal sleep cycle, when there is little fetal movement. A
special acoustic (sound) device is sometimes used to awaken the fetus. It is placed against the
mother's abdomen and makes a noise like a buzzer. This is not harmful to the fetus but may help a
sleepy fetus become more active. Having the mother eat or drink may also awaken the fetus.

25. Why would a NST be
performed?
A NST may be performed if:
You sense that the baby is not moving as
frequently as usual
You are overdue
There is any reason to suspect that the placenta
is not functioning adequately
You are high risk for any other reason
The test can indicate if the baby is not receiving
enough oxygen because of placental or
umbilical cord problems; it can also indicate
other types of fetal distress.

26. What does the NST look for?
The primary goal of the test is to measure
the heart rate of the fetus in response to its own
movements. Healthy babies will respond with an
increased heart rate during times of movement,
and the heart rate will decrease at rest. The
concept behind a non-stress test is that
adequate oxygen is required for fetal activity
and heart rate to be within normal ranges. When
oxygen levels are low, the fetus may not
respond normally. Low oxygen levels can often
be caused by problems with the placenta or
umbilical cord.

27. What's the procedure like?
You may be advised to eat a meal just before the test in the hope that
eating will stimulate your baby to move around more. Although there's
no hard evidence that this works, it can't hurt. It's also a good idea to
use the bathroom before the test, because you'll be lying strapped to a
monitor for up to an hour.
During the procedure, you lie on your left side, possibly with a wedge
under your back that allows you to lean back. A technician straps two
devices to your belly: One monitors your baby's heartbeat and
movement; the other records contractions in your uterus. The
technician listens to and watches your baby's heartbeat on an electronic
screen while your contractions are recorded on paper.
If your baby's not moving, he could be asleep. You might be asked to
drink some water, juice, or soda to get him going, or the technician
may nudge him gently through your abdomen or try to wake him with
a buzzer. In some cases, you'll be asked to press a button when you
feel the baby move. The test usually takes 20 to 60 minutes.

28. What do the results mean?
Test results of the NST may be:
reactive (normal) - two or more fetal heart rate increases in the testing period
(usually 20 minutes).
Non-reactive - there is no change in the fetal heart rate when the fetus moves.
This may indicate a problem that requires further testing.
A non-reactive NST does not always mean there is a problem with the fetus. The
fetus may simply be asleep. Or, it may be non-reactive because of fetal
immaturity. It is common for pre-term fetuses, especially those before 28
weeks, to have non-reactive non-stress tests. Additional prenatal testing may
be necessary.

29. What do the results mean?
(con’t)
If your baby's heart beats faster (at least 15 beats per minute over his resting
rate) while he's moving for at least 15 seconds on two separate occasions
during a 20-minute span, the result is normal, or "reactive." A normal result
means that your baby is probably doing fine for now. Your practitioner may
want to repeat the test every week (or more often) until your baby's born.
If your baby's heart doesn't beat faster while he's moving or your baby doesn't
move after about 90 minutes, the result is "nonreactive." A nonreactive result
doesn't necessarily mean something is wrong. It just means that the test didn't
provide enough information and you may need to take it again in an hour or
take other tests such as a biophysical profile or contraction stress test.
However, a nonreactive result could indicate that your baby isn't getting
enough oxygen or that there are problems with the placenta. If your
practitioner thinks that your baby's no longer doing well in the womb, she'll
probably decide to induce labor.

30. Why does the test measure contractions,
and why would I be having them?
For several reasons. First, you may or may not be having contractions at
this point in your pregnancy. If you are, they could be Braxton-Hicks
contractions, which are usually mild, irregular, and sporadic. These are
harmless and common during the third trimester. But if you're less than
37 weeks pregnant and you're having continuous, repetitive, regular
contractions, it could be a sign of preterm labor, and your practitioner
will want to evaluate your cervix to see if it's dilated.
Another reason to monitor contractions is to see whether your baby's heart
rate changes when you're having them. That's what's measured during
a contraction stress test. If the heart rate drops during a contraction, it
may be a sign that that there's a problem with your placenta and that
your baby's oxygen supply is compromised.

31. What are the risks and side
effects to the mother or baby?
A NST is a noninvasive test that poses no
known risks or side effects to mother or
baby.
When is a NST performed?
NSTs are generally performed after 28 weeks of gestation.
Before 28 weeks, the fetus is not developed enough to
respond to the test protocol.

32. What do the NST results mean and what are
the reasons for further testing?
A reactive non-stress result indicates
that blood flow (and oxygen) to the fetus
is adequate. A non-reactive non-stress
result requires additional testing to
determine whether the result is truly due
to poor oxygenation, or whether there
are other reasons for fetal non-reactivity
(i.e. sleep patterns, certain maternal
prescription or nonprescription drugs).

33. High-Risk Pregnancy
Biophysical Profile

34. A biophysical profile (BPP) is a test that combines a nonstress test with
ultrasound. A non-stress test (NST) measures the fetal heart rate in
response to the movements of the fetus. An ultrasound is a diagnostic
technique that uses high-frequency sound waves to create an image of
the internal organs. Biophysical profile testing is usually performed in
the last trimester of pregnancy.
There are five parts to a biophysical profile:
 the nonstress test
plus four areas assessed by ultrasound:
 fetal breathing movements
 fetal movements
 fetal tone
 amniotic fluid volume
What is a biophysical profile (BPP)?

35. How is a biophysical profile performed?
Each of the five areas of the biophysical profile has a
possible total score of two points, for a total of 10
points. A score of:
•eight to ten is usually considered normal.
•six is considered equivocal (uncertain).
•four or less is considered abnormal.
If the score is questionable or abnormal, or if the
amniotic fluid volume is too low, additional testing
may be needed.

36. What is a modified biophysical
profile?
Another type of BPP is sometimes performed.
The modified BPP combines the non-stress test
and an evaluation of the amount of amniotic fluid
called the amniotic fluid index (AFI). A pocket of
amniotic fluid is measured using ultrasound, then
the total amount of amniotic fluid is estimated.

37. Pregnancy: Prenatal
Ultrasound

38. What Happens During the
Test?
You may be asked to change into a hospital gown.
You will lie on a padded examining table during the test and a small
amount of water-soluble gel is applied to the skin over your abdomen.
The gel does not harm your skin or stain your clothes.
A small device, called a transducer, is gently applied against the skin on
your abdomen. The transducer sends high-frequency sound waves into
the body, which reflect off internal structures, including your baby. The
sound waves or echoes that reflect back are received by the transducer
and transformed into a picture on a screen. These pictures can be
printed out or sometimes recorded on a videotape.
There is virtually no discomfort during the test. If a full bladder is
required for the test, you may feel some discomfort when the probe is
applied over the bladder.
You may be asked to hold your breath briefly several times.
The ultrasound test takes about 30 minutes to complete.

39. What Happens After the
Test?
Will Insurance Pay For the
Ultrasound?
The gel will be wiped off your skin and your health care
provider will discuss the test results with you.
Insurance will pay for the ultrasound if it is deemed
medically necessary. If you have an ultrasound that is not
medically necessary (for example, to simply see the baby
or find out the baby's sex), your insurance company may
not pay for the ultrasound.