Freeman, md fetal heart rate fhr monitoring was introduced over 3 decades ago into clinical use and patient management. Which nursing action indicates the proper evaluation of this situation. It continues to be the predominant method for intrapartum fetal surveillance despite questions about its ef. Therefore, the midwife has a powerful role to play in balancing the benefits and risk ratios applicable to fetal heart rate monitoring. Intrapartum fetal heart rate monitoring case presentation. Nomenclature, interpretation, and general management principles, july 2009.
Fetal bradycardia is defined as a baseline heart rate less than 110 bpm for at least 10 minutes table 1. Decelerations late, variable or prolonged signal interruption of the. Scaleup of doppler to improve intrapartum fetal heart rate. New zealand research intrapartum fetal heart rate monitoring. Thus, fetal heart rate fhr monitoring can be used to determine if a fetus is well oxygenated. They are designed to measure, record, and display fhr, uterine contractions, andor maternal blood pressure and heart rate before and during childbirth.
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. Pdf persistent challenge of intrapartum fetal heart rate. There are no randomized trials of intrapartum fetal monitoring versus no intrapartum fetal monitoring. 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. You can move this window by clicking on the headline. Thirty years of electronic intrapartum fetal heart rate.
The fetal heart rate fhr tracings of 1,996 fetuses were analyzed to assess the prognostic value of accelerations in early labor and just prior to delivery. Fetal heart rate fhr monitoring is one of the most important procedures for. A continuously plotted fetal heart rate recordingwas shown toyield more information than the 30s average usually obtained by auscultation. Internal fetal heart rate monitoring at 1 cmmin top graph, 2. To determine the quality of fetal heart rate fhr recordings during the first and second stage of labor by quantifying the amount of fetal signal loss in relation to the method of monitoring.
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. Pdf intrapartum fetal heart monitoring interpretation in labour. The fetal heart rate can be evaluated using intermittent auscultation or electronic fetal monitoring. Prolonged decelerations are defined as fhr decreases of at least 15 bpm below baseline that last at least 2 minutes but less than 10 minutes. Intrapartum fetal monitoring guideline published february 2018 disclaimer this guideline describes fetal monitoring using physiologybased ctg interpretation. Intermittent auscultation may be used for low risk women and electronic fetal monitoring efm for. Electronic fetal heart rate monitoring ceconnection for nursing. Early in gestation the fetal heart rate is predominately under the control of the sympathetic nervous system and arterial chemoreceptors 1. Because abnormal fhr is a potential predicator of newborn asphyxia, fhr monitoring is important for quality intrapartum care. Compared predictive values of pulse oximetry and fetal blood analysis. This practice bulletin was devel oped by the acog committee on. Standardized nomenclatureforelectronicfetalmonitoring. Intrapartum fetal monitoring guideline revision group. Pdf intrapartum fetal heart monitoring interpretation in.
The fetal heart rate tracing shows all of the following. Baseline fhr 110160 bpm, moderate fhr variability, accelerations may be present or absent, no late or variable decelerations, may have early decelerations. For nearly 4 decades, fetal heart monitoring fhr has been used to assess antenatal and intrapartum fetal wellbeing. As the fetus develops its heart rate decreases in response to parasympathetic vagal stimulation nervous system maturation and variability becomes more pronounced. Intermittent auscultation for intrapartum fetal heart rate. 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. Acog practice bulletin 120, use of prophylactic antibiotics in labor and delivery, june 2011 acog practice bulletin 116, management of intrapartum fetal heart rate tracings, november 2010. 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. Problems with intrapartum fetal heart rate monitoring.
It monitors uterine and fetal activity including fetal heart rate, and has enhanced maternal. Fetal monitors are bedside units that consist of a monitoring unit, cables, and electrodes. What are the periodic changes that occur in the fht. Normal baseline fetal heart rate fhr, shown at 5 beats per minute bpm. Normal fetal heart rate pattern in the braindamaged infant. Intrapartum assessment of fetal wellbeing bja education. Maternity fetal heart rate monitoring summarythis guideline provides guidance for antenatal and intrapartum fetal heart rate fhr monitoring as a fetal welfare assessment tool.
Otherwise, the baseline for that segment is described as indeterminate. Continuous electronic monitoring of the fetal heart rate electronic fetal monitoring, efm and uterine contractions cardiotocography, ctg during labour was introduced in the 1960s70s1 as an alternative to intermittent auscultation. Electronic fetal heart rate monitoring efm continues to be the primary. 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. The national institutes of health have helped standardize fetal heart rate monitoring terminology with their 1997 task force report, which will aid clinicians and scientists in their. 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. Neurological control of fetal heart rate in 20 cases of anencephalic fetuses. Offer intermittent auscultation of the fetal heart rate to women at low risk of complications in.
Intrapartum fetal heart rate monitoring obstetricsgynecology. Moreover, there is evidence that the use of efm increases the rate of cesarean deliveries and operative vaginal deliveries. The dublin randomized controlled trial of intrapartum fetal heart rate monitoring. Despite metaanalyses reporting a 59% fall in intrapartum deaths attributable to intrapartum hypox. Intrapartum fetal heart rate monitoring ariz exams. 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. Internal fetal heart rate monitoring at 1 cmmin top graph, 2 cmmin middle graph, and 3 cmmin bottom graph.
Fetal monitoring during labour nice pathways bring together everything nice says on a topic in an interactive flowchart. Monitoring of lactate in blood is identified as a potential alternative for intrapartum fetal monitoring due to its ability to distinguish between different types of acidosis. An audit methodology was chosen to determine the current state of practice in relation to the dhb intrapartum fetal heart rate monitoring policy, to discover where the major gaps. By comparing intrapartum fhr patterns with fetal outcome using apgar scores, hondeterminedthe normalfurpattern,andalsoattemptedtodefinethe. It was used among 45% of laboring women in 1980, 62% in 1988, 74. Handheld doppler devices have been investigated in several lowresource countries as an alternative to pinard stethoscope and are more sensitive to.
Fetal monitoring antepartum surveillance intrapartum surveillance intrapartum fetal resuscitation key points antepartum and intrapartum surveillance techniques provide an opportunity to monitor fetal well being. Effects of electronic fetal heart rate monitoring on perinatal outcome and obstetric practices. Freeman, one of the pioneers of fetal assessment with heart rate monitoring both antepartum and intrapartum, lamented, clearly, the hopedfor benefit from intrapartum continuous electronic fetal monitoring has not been realized. Figo consensus guidelines on intrapartum fetal monitoring. 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. What is the physiology, and what interventions, if any, would be appropriate.
Intermittent auscultation for intrapartum fetal heart rate surveillance americancollegeofnursemidwives fetal heart rate surveillance is a standard component of intrapartum care. 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. Fetal heart monitoring is recommended for all women in labour. 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.
As such, clinicians are faced daily with the management of fetal heart rate fhr tracings. Murray electronic fetal monitoring technology is capable of monitoring and recording maternal heart rate mhr patterns that mimic fetal heart rate fhr patterns. Problems with intrapartum fetal heart rate monitoring interpretation and patient management roger k. Normal baseline rate ranges from 110 to 160 bpm for a 10minute. The baseline must be for a minimum of 2 minutes in a tenminute segment. Interpreting continuous fetal heart rate fhr monitoring is one of the most common tasks obstetricians perform during the course of intrapartum care. What is the most important aspect in the evaluation of any fetal heart. Intrapartum fetal surveillance test bank multiple choice 1. The interpretation of the fetal heart rate tracing should follow a systematic. Intrapartum fetal heart rate monitoring case presentation david a. Nice pathways are interactive and designed to be used online. Nomenclature, interpretation, and general management principles this practice bulletin was developed by the acog. The basic purpose of continuous intrapartum ctg monitor ing is to reduce fatal. For last four decades, intrapartum monitoring of fetuses has been commonly performed by either intermittent auscultation ia or electronic fetal heart rate monitoring efm.
Intrapartum fetal heart rate monitoring a standardized approach to interpretation and management lecture objectives at the end of. Factors with varying degrees of influence on the fetal heart rate. Intrapartum care and fetal heart rate monitoring in labour uhl obstetric guideline page 2 of 65 author. Intrapartum fetal monitoring american family physician. Threetier fetal heart rate interpretation system 41 category i. Identification, assessment and management of fetal. Fetal heart rate changes environment lungs heart vasculature uterus placenta cord fetus hypoxemia hypoxia metabolic acidosis metabolic acidemia potential injury 1.
Nomenclature, interpretation, and general management principles in the most recent year for which data are available, approximately 3. 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. Participants included obstetric experts and representatives from relevant stakeholder groups and. Intrapartum electronic fetal monitoring efm is used for most women who give birth in the united states.
Pdf electronic fetal monitoring efm has been introduced in the obstetrics. Guideline working party, updated by working party written. Acog practice bulletin 106, intrapartum fetal heart rate monitoring. Intrapartum fetal heart monitoring interpretation in labour.
Abnormal fetal heart rate fhr in the intrapartum period can indicate a hypoxic state in a fetus resulting from interruption of placental blood. What is the purpose of intrapartum fetal heart rate monitoring. Management of intrapartum fetal heart rate tracings acog. For both low and highrisk pregnancies, continuous electronic fhr monitoring is not clearly superior to intermittent auscultation with respect to. Intrapartum fetal abnormal fetal heart rate on auscultation or admission tracing 20minute strip meconiumstained amniotic fluid. Electronic fetal monitoring is performed externally using a doppler. Fetal heart rate response to vibratory acoustic stimulation predicts fetal ph in labor. The nurse sees a pattern on the fetal monitor that looks similar to early decelerations, but the deceleration begins near the acme of the contraction and continues well beyond the end of the contraction. Nomenclature, interpretation, and general management principles. The quality of intrapartum fetal heart rate monitoring. College of obstetricians and gynecologists, and the society for maternal fetal medicine partnered to sponsor a 2day workshop to revisit nomenclature, interpretation, and research recommendations for intrapartum electronic fetal heart rate monitoring. The baseline is affected by contractions causing decreases in fetal heart rate that are close to fulfilling the criteria for decelerations, but the bandwidth remains reduced. Intrapartum fetal heart rate monitoring early in gestation the fetal heart rate is predominately under the control of the sympathetic nervous system and arterial chemoreceptors.
The ability to distinguish one from the other requires knowledge of fhr and mhr characteristics. Intrapartum care and fetal heart rate monitoring in labour uhl obstetric guideline page 1 of 65 author. Fetal fever infection medications anemia arrhythmia heart block congenital anomaly extreme prematurity preexisting neurologic injury sleep cycle other causes of fetal heart rate changes environment lungs heart vasculature uterus placenta cord fetus hypoxemia hypoxia metabolic acidosis metabolic acidemia potential injury 1. The current gold standard, continuous fetal heart rate monitoring allows for identification of the compromised fetus. As the fetus develops its heart rate decreases in response to parasympathetic vagal stimulation nervous system maturation and variability becomes more pronounced 2. Article pdf available in minerva ginecologica 671 november 2014 with 1,681 reads how we measure reads. The document provides background on electronic fetal heart rate monitoring efm, definitions of fhr features, criteria for. The goal of intrapartum fetal monitoring is to recognize changes in fetal oxygenation that could result in adverse outcomes. What are the commonly used methods of intrapartum fetal monitoring. Management of intrapartum fetal heart rate tracings intrapartum electronic fetal monitoring efm is used for most women who give birth in the united states. Intrapartum fetal heart rate monitoring american journal of. The purpose of this document is to provide obstetric care providers with a framework for. Computerised analysis of intrapartum fetal heart rate.
Intrapartum care and fetal heart rate trust reference. Intrapartum fetal monitoring in labour with risk factors. It has been developed by the editorial board based on the experience gained from maternity units where a reduction in the. 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. English midwives views and experiences of intrapartum fetal heart rate monitoring in women at low obstetric risk. A total of 1,996 fetal heart rate fhr tracings were analyzed to assess the prognostic significance of variable decelerations.
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