Medicolegal issues concerning the use of electronic fetal monitoring 66. The stress of uterine contractions may affect the fetus adversely especially if the fetus is already compromised, when the placental reserves are suboptimal. Method of fetal heart rate assessment, either auscultation or electronic fetal monitoring, is dependent on risk factors and clinician preference. Identify ways to apply key safety elements to your unit policies, procedures, and practices related to electronic fetal monitoring. Interpretation of the electronic fetal heart rate during labor. Development workshop report on electronic fetal monitoring. Evidence based clinical guideline on the use and interpretation of cardiotocography in intrapartum fetal surveillance. If you read our article evidence on birthing positions, you know that most people in hospital settings give birth in a lying or semisitting position. Cardiotocography ctg or electronic fetal monitoring efm is the most widely used technique for assessing fetal wellbeing in labour in the developed world. 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. Essential characteristics for tracing interpretation.
Paperwork, while essential, often takes time away from providing supportive care for laboring women and their families. Basic pattern recognition electronic fetal monitoring. National institute of child health and human development partnered with the american college of obstetricians and gynecologists and the society for maternalfetal medicine to sponsor a workshop focused on electronic fhr monitoring 3. Although electronic fetal monitoring efm has been widely used in clinical practice for more than two decades, educational standards and competency validation for efm use in hospitals have been developed only recently. Electronic fetal heart rate monitoring is commonly used to assess fetal wellbeing during labor. It has been developed by the editorial board based on the experience gained from maternity units where a reduction in the. Electronic fetal monitoring during labour was introduced with an expectation that it would reduce cerebral palsy. Deciphering fetal heart rate patterns entails making observations over time.
Assess and manage is based on the resource listed below. Figo consensus guidelines on intrapartum fetal monitoring icarectg. Fetal monitoring subspecialty certification is to provide a competency. If the instructor shares details regarding actual or potential care decisions, please note those decisions do not necessarily. Continuous electronic fetal monitoring was developed in the 1960s to assist in the diagnosis of fetal hypoxia during labor. Cypher, msn, pnnp abstract contemporaneous, complete, and objective documentation is the foundation for continuity of patient care and facilitates communication between all levels of healthcare clinicians. Safe care for mothers and babies during labor and birth is the goal of all health care professionals and is an expectation of childbearing women and their families. Internal fhr monitoring is accomplished with a fetal electrode, which is a spiral wire placed directly on the fetal scalp or other presenting part. Many patterns acquire increased significance when there is a trend toward persistent, significant departures from baseline with decreased variability, loss of. The discussion will focus on interpretation of the electronic fetal monitoring efm tracings for the purpose of education. Causes changes during periods of fetal activity and sleep, and is effected by medication medulla oblongata vasomotor centers increases or decreases in fhr oscillatory changes of fhr variability respond to changes in fetal blood pressure, oxygen, co2 levels, and hormone levels. Concepts and applications, 3rd edition, is an invaluable guide for clinicians nurses, nursemidwives, physicians responsible for ordering, initiating, performing, and interpreting electronic fetal monitoring efm. E chandrahan, s evans, d krueger, s pereira, s skivens, a zaima.
Monitoring for perinatal safety electronic fetal monitoring. Electronic fetal heart rate monitoring research guidelines for interpretation from the national institute of child health and human development research planning workshop published in the journal of obstetric, gynecologic and neonatal nursing jognn, volume 26, issue 6, novemberdecember 1997 pages 635640 and in the american journal of. Improving consistency in interpretation of electronic. Monitoring for perinatal safetyelectronic fetal monitoring. The purpose of the ncc electronic fetal monitoring subspecialty certification is to provide a competencybased examination that tests specialty knowledge and the application of that knowledge for licensed health care professionals in the us and canada, who utilize the application of electronic fetal monitoring and interpretation of data. It is essential that maternity professionals know how to interpret ctg readings so that timely care can be offered. In 1997, the national institute of child health and human development nichd research planning workshop published guidelines for interpretation of fetal tracings. Intrapartum electronic fetal monitoringa disappointing story. Monitoring fetal heart rate, or fhr, and contractions during labor, whether done intermittently or continuously, is a commonly used practice on. External fetal heart rate monitoring at 1 cmmin top graph, 2 cmmin middle graph, and 3 cmmin bottom graph. Electronic fetal heart monitoring made easy duration. Fetal heart rate monitoring may be performed externally or internally.
Physiological ctg interpretation 2018 intrapartum fetal monitoring. If high risk, determine, assess and document fetal heart rate every 15 minutes in. Applying nichd terminology and other factors to electronic. The technique was introduced as a screening test in the 1970s in the belief that it would improve the detection of fetal hypoxaemia and reduce cerebral palsy and perinatal mortality, particularly in high risk. Absence of induced accelerations after fetal stimulation periodic or episodic decelerations. Electronic fetal monitoring vs intermittent ausculation there is no rct to document that efm is superior therefore it is acceptable that an uncomplicated patient could opt for ia however, this is hospital and staff dependent, as ia is very labor intensive acog recommends. Interpretation of the electronic fetal heart rate during labor amir sweha, m. Although detection of fetal compromise is one benefit of fetal monitoring, there are also risks, including falsepositive tests that may result in unnecessary surgical intervention. Cardiotocography ctg is a technical means of recording the fetal heartbeat and the uterine contractions during pregnancy. This self guided tutorial is the place to start and is adequate for most beginner students. Additionally, it examines how electronic fetal monitoring contributes to the construction and meaning of evidence in hospital obstetrics. Neither i, nor any member of my immediate family, have a significant. Traditional written tests may be useful in determining whether the nurse has the appropriate knowledge about a specific clinical practice area but.
Chapter 35 intrapartum fetal surveillance, creasy and resniks maternal fetal medicine, creasy, et al. The machine used to perform the monitoring is called a cardiotocograph, more commonly known as an electronic fetal monitor efm. Electronic fetal monitoring usually requires that a mother wear two monitoring belts around her abdomen during labor, which restricts movement and may even require bed rest. Electronic fetal monitoring documentation awhonn utah. Electronic fetal monitoring efm is the most common obstetric procedure goal of efm is to detect fetal hypoxia and signal to the clinician that an intervention is needed to correct the oxygen deficiency use common language to communicate and document findings. Standardized nomenclatureforelectronicfetalmonitoring. Cd006066 d gibb and s arulkumaran 2017 fetal monitoring in practice. In striking a balance between responsibilities and obligations, nurses must play an active role in designing a charting system. Spong, md, john hauth, md, and thomas moore, md in april 2008, the eunice kennedy shriver national institute of child health and human development, the american college of obstetricians. Intrapartum fetal monitoring guideline published february 2018 disclaimer this guideline describes fetal monitoring using physiologybased ctg interpretation. In the most recent year for which data are available, approximately 3.
Request pdf on jan 31, 2014, shravya govindappagari and others published 539. Electronic fetal monitoring basic and advanced study. This guideline is used to assist staff in use of electronic fetal monitoring. Apply knowledge of fetal heart rate regulation to the interpretation of electronic fetal monitoring data. Electronic fetal heart rate monitoring ceconnection for nursing. Nurses working in intrapartum settings have many responsibilities to ensure a safe and satisfying birth experience for the families in their care. Electronic fetal monitoring training efm eintegrity. Maternity fetal heart rate monitoring summarythis guideline provides guidance for antenatal and intrapartum fetal heart rate fhr monitoring as a fetal welfare assessment tool. Fetal physiology in relation to electronic fetal monitoring efm.
Fetal heart rate monitoring, number 62, may 2005, pages, 11611169. American college of obstetricians and gynecologists. The purpose of this chapter is to assist in the use and interpretation. Thoroughly updated for its second edition, fetal monitoring interpretation describes and illustrates the full range of patterns revealed by fetal monitoring and explains their clinical significance. Threetiered fetal heart rate interpretation system category i. Interpretation of electronic fetal heart rate monitoring. Electronic fetal monitoring efm or cardiotocography ctg was introduced in 1957 and has been in common use to determine fetal wellbeing during the intrapartum period since the 1970s 1,2. Electronic fetal monitoring assesses fetal health during the prenatal and intrapartum process.
Use knowledge of the advantages and disadvantages of electronic fetal monitoring to provide information to the pregnant woman and her support persons. The format for the conference consisted of a detailed examination of the research topic by a task force composed of representatives from medicine, nursing, epidemiology, basic science, and the public interest. All changes are therefore, based on a deviation from that fetus resting norm. Fetal monitoring was invented by doctors alan bradfield, orvan hess and edward hon. University of california, davis, school of medicine davis, california electronic fetal heart rate monitoring is commonly used to assess fetal wellbeing during labor. The 2008 national institute of child health and human. Despite its widespread use, there is controversy about the efficacy of efm, interobserver and intraobserver variability. Electronic fetal monitoring efm, also called cardiotocography ctg, is when the babys heart rate is monitored with an ultrasound machine while the mothers contractions are monitored with a pressure sensor alfirevic et al. Fhr interpretation in 20 or so slides university of utah health. A copy of the resource is included with the module. Vintzileos am, nochimson dj, antsaklis a, varvarigos i, guzman er, knuppel ra. The book uses case studies and highquality tracings accompanied by detailed teaching diagrams usually found only in anatomical and surgical atlases. The technique was introduced as a screening test in the 1970s in the belief that it would improve the detection of fetal hypoxaemia and reduce cerebral palsy and.
Standardized guidelines for the interpretation of the fetal heart rate have been suggested by the national institute of child health and human development 3and are adopted in the following discussion. Fetal assessment is a key aspect of perinatal patient safety. Most external monitors use a doppler device with computerized logic to interpret and count the doppler signals. Update on definitions, interpretations, and research guidelines. This article highlights a community hospitals program for efm. Dec 01, 2016 electronic fetal monitoring during labour was introduced with an expectation that it would reduce cerebral palsy. Current commentary the 2008 national institute of child. Correlation of intra partum electronic fetal monitoring. Fetal heart monitoring includes initial and ongoing assessments of the woman and fetus. Intermittent auscultation does not detect key elements of fetal risk, such as beattobeat variability. Why the nichd terminology was developed a lack of consensus was identified in the definitions and nomenclature related to fetal heart rate monitoring and the clinical interpretation of fetal.
These tables include and summarise individual recommendations about fetal monitoring 1. Gynecologists and the society for maternalfetal medicine. The history of efm basic equipment for fetal monitoring the physiological. Electronic monitoring is linked with higher rates of caesarean deliveries, with their higher risks and costs. Participants included obstetric experts and representatives from relevant stakeholder groups and. Learn vocabulary, terms, and more with flashcards, games, and other study tools. The purpose of the ncc electronic fetal monitoring subspecialty certification is to provide a competencybased examination that tests specialty knowledge and the application of that knowledge for licensed health care professionals in the us and canada, who utilize the application of electronic fetal monitoring and interpretation of. The fetal brain is responsible for modulating the fetal heart rate fhr through sympathetic and. Jun 16, 2001 electronic fetal monitoring with the cardiotocograph is standard practice during labour in most obstetric units in the united kingdom.
Electronic fetal monitoring, cerebral palsy, and caesarean. Guidelines for interpretation kathryn welch, md objectives history of fetal monitoring definitions limitations practice introduction 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. National institute of child health and human development research planning workshop. Electronic fetal monitoring with the cardiotocograph is standard practice during labour in most obstetric units in the united kingdom. Randomised trials and time trends in population based data establish that it has not done so. The nichd definitions and classifications in the the 2008 national institute of child health and human development workshop report on electronic fetal monitoring were published in. Electronic fetal monitoring competence validation obgyn key. 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.
Basic education, staff development, and quality assurance activities involving staff nurses and managers are. Elsevier e chandrahan, s evans, d krueger, s pereira, s skivens, a zaima physiological ctg interpretation 2018 intrapartum fetal monitoring. The 2008 national institute of child health and human development workshop report on electronic fetal monitoring. Mercy healthcare sacramento sacramento, california jim nuovo, m.
Define fhr fetal heart rate patterns for visual interpretation that have been produced from either a direct fetal electrode. The association of womens health, obstetric and neonatal nurses awhonn asserts that the availability of registered nurses rns and other health care professionals who are skilled in fetal heart monitoring fhm techniques, including auscultation and electronic fetal monitoring efm, is essential to maternal and fetal wellbeing during antepartum care, labor, and birth. Despite its widespread use, there is controversy about the efficacy of efm. Setting guidelines for documenting fhr enhances care for. Produced by the clinical clinical effectiveness support unit of the royal college of obstetricians and gynaecologists.
I would encourage all my labour ward colleagues to complete efm. Monitoring, interpretation and management, and the society of obstetricians and gynaecologists of canada has issued a policy statement on fetal health surveillance in labour j soc obstet gynaecol can 1995. Electronic fetal heart rate monitoring efm continues to. In this section, you can learn more about the history of electronic fetal monitoring, its physiologic basis, and contextual details about reading fetal tracings. Ahrq safety program for perinatal care electronic fetal monitoring 2. At times, the discussion may lead to the care decisions made based on efm interpretation. To outline the nursing management of antepartum and intrapartum patients during external and internal fetal monitoring, intermittent fetal heart rate fhr auscultation, as well as.
Fetal heart monitoring journal of obstetric, gynecologic. Figure 11 from interpretation of the electronic fetal heart. Electronic fetal monitoring efm is a popular technology used to establish fetal wellbeing. Interpretation of the electronic fetal heart rate during labor may 1, 1999 american academy of family physicians. For as long as we have had electronic fetal monitoring clinicians have asked what. Guidelines for interpretation kathryn welch, md objectives history of fetal monitoring definitions limitations practice introduction goal of electronic fetal monitoring efm is to detect fetal hypoxia and signal to the clinician that an intervention. The role of electronic fetal monitoring october 1979, the nurses association of the american college of obstetricians and gynecologists technical bulletin no. Overview of nichd terminology and interpretation of electronic fetal monitoring tracings. When the dream is shattered case study in fetal monitoring. Ctg interpretation and response the royal womens hospital.
The document provides background on electronic fetal heart rate monitoring efm, definitions of fhr features, criteria for. A relationship between fetal heart rate changes, fetal status, fetal oxygenation and fetal acidbase status exists, and can be influenced by maternal, fetal, or placental factors fetal heart rate the product of numerous factors that may be loosely divided into fetal intrinsic mechanisms and maternalplacental extrinsic mechanisms. The baseline must be for a minimum of 2 min in any 10min segment nichd in order to determine whether there are changes in the fetus physiologic status, a baseline heart rate must first be determined as a reference. Both of these sensors are linked to a recording machine. Comparison of intrapartum electronic fetal heart rate monitoring versus intermittent auscultation in detecting fetal acidemia at birth. The future of electronic fetal monitoring sciencedirect. External monitoring of uterine contractions using a tocodynamometer toco evaluates. The importance of fetal monitoring during labour has been realized since long.
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