There are no randomized trials of intrapartum fetal monitoring versus no intrapartum fetal monitoring. Intrapartum fetal heart rate monitoring a standardized approach to interpretation and management lecture objectives at the end of. Intrapartum fetal heart monitoring study guide by jgautam includes 37 questions covering vocabulary, terms and more. Are we misguided by current guidelines on intrapartum. Nomenclature, interpretation, and general management principles. Notably, use these expert tips to anticipate and address the common challenges of intrapartum fhr monitoring to improve care of the mother and baby and reduce potential liability. An example of the method of fetal heart rate processing employed when a scalp electrode is used is shown in figure 242. The fetal heart rate and the activity of the uterine muscle are detected by two transducers placed on the mothers abdomen one above the fetal heart, to monitor heart rate and the other at the fundus of the uterus to.
Pdf intrapartum fetal surveillance case based learning. Thirty years of electronic intrapartum fetal heart rate. The dublin randomized controlled trial of intrapartum fetal heart rate monitoring. The document provides background on electronic fetal heart rate monitoring efm, definitions of fhr features, criteria for. These variables are then plotted against time on graph paper. Declan is an associate editor with the cochrane pregnancy and childbirth group, an associate senior lecturer with the uk cochrane centre and an author of numerous cochrane systematic. Fetal heart monitoring journal of obstetric, gynecologic. Intrapartum fetal monitoring professor declan devane is professor of midwifery and holds a joint post between nui galway and the west, northwest hospitals group. Abnormal fetal heart rate fhr in the intrapartum period can indicate a hypoxic state in a fetus resulting from interruption of placental blood. External cardiotocography can be used for continuous or intermittent monitoring.
Subjects1255 women who were 37 weeks or more pregnant with singleton cephalic presentation and normal fetal heart rate before entry into. Objectiveto compare effectiveness of different methods of monitoring intrapartum fetal heart rate. Obstetrics and gynecology attending and resident physicians 3. The incidence of maternal artefact during intrapartum fetal heart rate monitoring. As such, clinicians are faced daily with the management of fetal heart rate fhr tracings. Intermittent auscultation for intrapartum fetal heart rate. Summary intrapartum fetal heart rate monitoring was developed in the mid 1960s after patterns of heart rate change in relation to uterine contractions had been described by hon, caldero. The purpose of this document is to provide obstetric care providers with a framework for evaluation and management of intrapartum efm patterns based on the new threetiered categorization. Interpreting continuous fetal heart rate fhr monitoring is one of the most common tasks obstetricians perform during the course of intrapartum care.
Transmission of the maternal electrocardiograph via a fetal scalp electrode in the presence of intrauterine death. Continuous electronic monitoring of the fetal heart rate electronic fetal monitoring, efm and uterine contractions cardiotocography, ctg during labour was introduced in the 1960s70s 1 as an alternative to intermittent auscultation. It is important to stress that fetal monitoring is only part of the overall clinical assessment of both mother and fetus, aimed mainly at the detection of fetal hypoxia. Cardiotocography ctg is a monitoring of fetal heart rate and uterine contractions. Quizlet flashcards, activities and games help you improve your grades. Intrapartum fetal monitoring a disappointing story nejm. As a result, fetal scalp blood sampling was introduced in order to improve the specificity of fhr monitoring alone. Individual units should develop a system for recording relevant intrapartum events for example, vaginal examination, fetal blood sampling and siting of an epidural in standard notes andor on. Cervix needs to be 45cm dilated and vx at 1 st or below ph 7. Article pdf available in minerva ginecologica 671 november 2014 with 1,681 reads how we measure reads. Intrapartum fetal heart monitoring flashcards quizlet. Intrapartum electronic fetalheartrate monitoring was introduced in the united states in the early 1970s after studies supported the existence of a correlation between patterns of fetal heart rate.
Time t in milliseconds between fetal r waves is fed into a cardiotachometer, where a new fetal heart rate is set with the arrival of each new r wave. Instead of picking up this distress, the fetal heart rate monitor made a smooth transition to the maternal heart rate, confusing the healthcare providers into believing the babys heart rate was fine the strip chart indicated the maternal heart rate and fetal heart rate actually overlapped 5 times during the monitoring session, as. Pdf intrapartum fetal heart monitoring interpretation in. Scaleup of doppler to improve intrapartum fetal heart. The type and level of monitoring chosen by the woman and her care providers will depend on the antenatal and intrapartum circumstances, perceived risks and patient preference.
Despite the questions about its efficacy and controversy regarding. Offer intermittent auscultation of the fetal heart rate to women at low risk of complications in. Intermittent auscultation for intrapartum fetal heart rate surveillance americancollegeofnursemidwives fetal heart rate surveillance is a standard component of intrapartum care. Fetal scalp ph in women with abnormal fetal heart rate tracings. Intermittent auscultation of the fetal heart rate purpose scope a. A doppler ultrasound transducer and pressure transducer are placed on the maternal abdomen, which monitor fetal heart rate and the frequency and strength of uterine contractions, respectively. Intrapartum fetal monitoring guideline published february 2018 disclaimer this guideline describes fetal monitoring using physiologybased ctg interpretation. Macdonald d, grant a, sheridanpereira m, boylan p, chalmers i. Open access intrapartum ctg database bmc pregnancy and.
Randomised controlled trial of intrapartum fetal heart. The fetal heart rate can be evaluated using intermittent auscultation or electronic fetal monitoring. Intrapartum fetal monitoring in labour with risk factors. There is no evidence to support the use of routine antenatal or intrapartum ctg in. Settingreferral maternity hospital, harare, zimbabwe. Highquality intrapartum care, including intermittent monitoring of fetal heart rates fhr to detect and manage abnormalities, is recommended by who and the government of tanzania got and creates potential to save newborn lives in tanzania. This is a learning in 10 voice annotated presentation vap on intrapartum fetal monitoring to learn more about learning in 10 lit, please visit. Intrapartum fetal heart monitoring interpretation in labour. Maternity fetal heart rate monitoring summarythis guideline provides guidance for antenatal and intrapartum fetal heart rate fhr monitoring as a fetal welfare assessment tool. The initial description of the fetal heart rate fhr apparently dates to marsacs report in 1650 1. Factors with varying degrees of influence on the fetal heart rate. Intrapartum fetal heart rate monitoring acog practice bulletin no. Since 1960 it is routinely used by obstetricians to assess fetal wellbeing.
Intrapartum assessment of fetal wellbeing bja education. Baseline variability is defined as fluctuations in the fetal heart rate of more than 2 cycles per minute. Handheld doppler devices have been investigated in several lowresource countries as an alternative to pinard stethoscope and are more sensitive to. For both low and highrisk pregnancies, continuous electronic fhr monitoring is not clearly superior to intermittent auscultation with respect to. Effects of electronic fetal heart rate monitoring on perinatal outcome and obstetric practices. Utility of intrapartum fetal heart rate monitoring in a. Electronic fetal monitoring efm is the recommended method of intrapartum fetal surveillance for high risk pregnancies. Intrapartum fetal surveillance by intermittent auscultation of the fhr continued to evolve early in the 20th century and, in fact, had become.
Intrapartum electronic fetal heart rate fhr monitoring is widely practiced in the uk, the usa and in many other developed countries. To evaluate the use of intrapartum electronic fetal heart rate monitoring efm as a screening tool for adverse neonatal outcomes. Clinical practice guideline intrapartum fetal heart rate monitoring 6 intrapartum events that may affect the fhr, for example, the siting of an epidural or the commencement of oxytocin should be noted comprehensively in the maternal notes, signed, dated and. Nomenclature, interpretation, and general management principles practice bulletin no. Acog monitoria fetal pdf intrapartum fetal heart rate monitoring. Fetap with an internal fetal monitor, an iupc may give a more precise reading of the babys heart rate and the strength of contractions. Unrecognized maternal heart rate artefact in cases of. Indications for performing a cardiotocograph ctg 1.
Moreover, there is evidence that the use of efm increases the rate of cesarean deliveries and operative vaginal deliveries. Intrapartum electronic fetal monitoring efm is used for most women who give birth in the united states. Intrapartum fetal heart rate monitoring is commonly used to evaluate fetal status in labor, despite a lack of convincing randomized studies to support its use. Computerised analysis of intrapartum fetal heart rate. Premature rupture of membranes the 2008 national institute of child health and human development workshop report on electronic fetal monitoring. Structured intermittent auscultation is a technique that employs the systematic use of a doppler assessment of fetal heart rate fhr during labor at defined timed intervals table 1.
The widespread use of fetal heart rate fhr monitoring in labour resulted in an increase in the number of operative deliveries, frequently delivering a neonate without any sign of asphyxia. Clinical practice guideline intrapartum fetal heart rate monitoring 6 intrapartum events that may affect the fhr, for example, the siting of an epidural or the commencement of oxytocin should be noted comprehensively in the maternal notes, signed, dated and timed. It has been developed by the editorial board based on the experience gained from maternity units where a reduction in the. Continuous cardiocartography as a form of electronic fetal monitoring efm for fetal assessment during labour. Management of intrapartum fetal heart rate tracings acog. Many attempts to introduce methods of automatic signal processing and evaluation have appeared during the last 20 years, however still no significant progress similar to that in the domain of adult heart rate variability, where open. Because abnormal fhr is a potential predicator of newborn asphyxia, fhr monitoring is important for quality intrapartum care. Fhr fetal heart rate fse fetal scalp electrode gtn glyceryl trinitrate hb haemoglobin ia intermittent auscultation ifs intrapartum fetal surveillance iv intravenous mom multiples of median pappa pregnancy associated plasma proteina ranzcog royal australian and new zealand college of obstetricians and gynaecologists. Nomenclature, interpretation, and general management principles in the most recent year for which data are available, approximately 3. A cardiotocograph recording fetal heart rate and uterine contractions. Standard nomenclature for intrapartum fetal heart rate.