Management of intrapartum fetal heart rate tracings acog. Management of intrapartum fetal heart rate tracings. Nomenclature, interpretation, and general management principles. Elliott, md, facog this module builds a framework for using the fetal heart rate pattern to determine the proper intervention in a given clinical situation. Auscultation of the fetal heart rate fhr is performed by external or internal means. The intent of intrapartum fetal surveillance is to assess uterine activity, fetal well. Compare reassuring and nonreassuring fetal heart rate patterns. Intrapartum electronic fetal monitoring efm is used for most women who give birth in the united states. Following is a summary of the terminology definitions and assumptions found in the 2008 nichd workshop report. Advanced fetal assessment and monitoring online program. Goal of electronic fetal monitoring efm is to detect fetal hypoxia and signal to the clinician that an intervention is needed to correct the oxygen deficiency efm is the most common obstetric procedure use common language to communicate and document findings a brief history fetal heart sounds were first reported in the 1600s.
Fetal heart rate fhr monitoring is important because it provides basic patterns that can be correlated to the acidbase status, circulatory volume, and oxygenation status of the fetus through brainstem detection and subsequent cardiac response. An examination of maternal and fetal responses to 26 yoga postures. Ppt fetal monitoring powerpoint presentation free to view. As of 2004, electronic fetal monitoring efm was employed in an estimated 89% of live births. 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 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. Standardisation of fetal heart rate monitoring fetal heart rate monitoring, whether by intermittent auscultation ia or electronic fetal monitoring efm, should be recommended to all women in labour. Cerclage for the management of cervical insufficiency. It is oftentimes detected through an abnormal fetal heart rate. Indications for induction of labor are not absolute but should take into account maternal and fetal conditions, gestational age, cervical status, and other factors.
Problems with intrapartum fetal heart rate monitoring. So if the heart rate goes as high as 160 bpm to 140 bpm in a. Nomenclature, interpretation, and general management principles this practice bulletin was developed by the acog. Thus, fetal heart rate fhr monitoring can be used to determine if a fetus is well oxygenated. Assessing the clinical use of a novel, mobile fetal monitoring device. Consensusbased recommendation all women should be offered intrapartum fetal heart rate monitoring see exceptions on page 9. Hobel cj intrapartum clinical assessment of fetal distress. Setting guidelines for documenting fhr enhances care for. Historically, the term fetal distress has been used to describe when the fetus does not receive adequate amounts of oxygen during pregnancy or labor.
Identification and evaluation of fetal heart rate monitoring. Acog guidelines on antepartum fetal surveillance practice. Today, the use of intrapartum fetal heart rate monitors is widespread. Fetal monitoring robin petersen, rn, msn valley medical center renton, wa learning objectives describe the components of a fetal heart rate pattern. Confusion between maternal and fetal heart rate during the second stage of labour. In striking a balance between responsibilities and obligations, nurses must play an active role in designing a charting system. It continues to be the predominant method for intrapartum fetal surveillance despite questions about its ef. General guidelines for fetal monitoring include the following. Freeman, md fetal heart rate fhr monitoring was introduced over 3 decades ago into clinical use and patient management. Fetal heart rate is noted to be 120 beats per minute when the external monitor is applied. Electronic fetal heart rate monitoring american academy. Fetal heart monitoring includes initial and ongoing assessments of the woman and fetus. The document provides background on electronic fetal heart rate monitoring efm, definitions of fhr features, criteria for. Fetal heart rate variability learning about electronics.
Otherwise, the baseline for that segment is described as indeterminate. Factors with varying degrees of influence on the fetal heart rate. Interpretation of the electronic fetal heart rate during labor. Paperwork, while essential, often takes time away from providing supportive care for laboring women and their families. Fetap with an internal fetal monitor, an iupc may give a more precise reading of the babys heart rate and the strength of contractions. The fetal heart rate is normal and the fetus is having accelerations of the fetal heart rate, also a reassuring finding. The mean fetal heart rate rounded to increments of five beats per minute during a tenminute segment, excluding accelerations, deceleration and periods of marked fhr variability. At a minimum, if the fetus is considered to be viable, simultaneous electronic fetal heart rate and contraction monitoring should be. Figo consensus guidelines on intrapartum fetal monitoring.
Heart rate variability is the amount in beats per minute bpm that the heart rate varies in a given period of time. In this article, were specifically talking about heart rate variability in terms of a fetus. A cardiotocograph recording fetal heart rate and uterine contractions. American college of obstetricians and gynecologists, society for maternalfetal medicine, caughey, a. As such, clinicians are faced daily with the management of fetal heart rate fhr tracings. As the recognized leader in fetal heart monitoring education, awhonns inperson and online formats are convenient, evidencebased and the essential tools for educating the entire team. Because of high interobserver and intraobserver variability in the interpretation of fetal heart rate fhr tracings, the american college of obstetricians and gynecologists acog, the society for maternalfetal medicine smfm, and the united states national institute of child health and human development nichd convened a workshop to standardize definitions and. The purpose of fetal heart rate monitoring is to identify evidence of fetal well being and oxygenation during labor and then appropriately intervene to reduce the incidence of poor neonatal outcomes. If the fetus is considered previable, it is generally sufficient to ascertain the fetal heart rate by doppler before and after the procedure. While both antenatal and intrapartum monitoring have come under criticism, antepartum fetal heart rate surveillance to assess the risk of fetal death and stillbirth is less controversial for the purpose for which it was. This practice bulletin was devel oped by the acog committee on. Monitoring the fetal heart rate the major risk associated with electronic fetal heart rate monitoring is a falsepositive test that may result in unnecessary surgical intervention. American college of obstetricians and gynecologists.
Problems with intrapartum fetal heart rate monitoring interpretation and patient management roger k. However, while the term fetal distress is commonly used, it is not well defined. Physiologic basis of fetal monitoring fetal heart rate monitoring is essentially an observation of ongoing human fetal physiology, most often during labor or prior to labor, in the assessment of patients with certain highrisk conditions for which antepartum fetal surveillance is indicated. The fetal heart rate may be monitored using continuous electronic fhr monitoring efm components external cardiotocography ctg or internal. Risk factors should be identified and recorded see table 1. These factors may evolve through the course of labour. Electronic fetal monitoring techniques for fetal surveillance in the united states today, efm is the routine method of fetal surveillance in most u. This patient appears to be having a normal labor at term. Jul 15, 2015 the intent of intrapartum fetal surveillance is to assess uterine activity, fetal well. American college of obstetricians and gynecologists 2010. The baseline must be for a minimum of 2 minutes in a tenminute segment. Maternal fetal physiology and acidbase assessment by john p.
Nurses working in intrapartum settings have many responsibilities to ensure a safe and satisfying birth experience for the families in their care. Management of intrapartum fetal heart rate tracings intrapartum electronic fetal monitoring efm is used for most women who give birth in the united states. Electronic fetal monitoring efm has been in clinical use for four decades despite evidence suggesting it is ineffectual, 1 5 prone to interpretive errors, 6, 7 has a 99% falsepositive prediction of fetal distress, 8 has increased the incidence of cesarean delivery, 9 11 has not reduced the rate of cerebral palsy cp, 4, 5, 10, 11 and has not produced better perinatal outcomes. Intrapartum electronic fetal heart rate monitoring and the prevention of perinatal brain injury. Acog practice bulletin minnesota hospital association. The goal of antepartum fetal surveillance is to prevent fetal death. Agreement and accuracy using the figo, acog and nice. Simultaneous monitoring of the maternal heart rate mhr can be useful in specific maternal health conditions and in cases where it is difficult to distinguish between maternal and fetal heart rates for example complete fetal heart block. Ppt fetal monitoring powerpoint presentation free to.
Electronic fetal heart rate monitoring american academy of. Fetal heart monitoring journal of obstetric, gynecologic. It was used among 45% of laboring women in 1980, 62% in 1988, 74% in 1992, and 85% in 2002 1. The fetal brain modulates the fetal heart rate through an interplay of sympathetic and parasympathetic forces. The goal of the framework is to avoid the simple see a pattern, interact model. Pregnant womens views about choice of intrapartum monitoring of the fetal heart rate.
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