Guideline working party, updated by working party written. Principles for intrapartum ctg trace interpretation. This guideline provides an update of the use of electronic fetal monitoring. Intrapartum fetal monitoring systems should accurately alarm for fetal hypoxia and the risk of developing severe acidosis. Intermittent auscultation for intrapartum fetal heart rate surveillance clinical bulletin no. In essence, you are free to copy and communicate the work in its current form for noncommercial purposes, as long as you attribute queensland clinical guidelines. Increasing number of preterm births and rising concerns of improved maternity care, with the speedy development of healthcare infrastructure globally, is leading towards the demand for technological advancement in intrapartum. Leveno kj, cunningham fg, nelson s, roark m, williams ml, guzick d, dowling s, rosenfeld cr, buckley a. 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. Magnesium sulfate in the management of acute intrapartum fetal distress. The purpose of intrapartum fetal heart rate monitoring is to detect episodes of hypoxia and prevent neonatal morbidity and mortality. This work is licensed under a creative commons attributionnoncommercialnoderivatives v4.
Intrapartum care and fetal heart rate monitoring in labour uhl obstetric guideline page 2 of 65 author. Eugene bailey, md, suny upstate medical university, syracuse, new york i ntrapartum fetal monitoring was. A nurse explains the purpose of effleurage to a client in early labor. Chapter 17 intrapartum fetal surveillance learning objectives after studying this chapter, you should be able to. Efm electronic fetal monitoring fbs fetal blood sample fhr fetal heart rate ia intermittent auscultation 9. It continues to be the predominant method for intrapartum fetal surveillance despite questions about its ef. Antepartum fetal monitoring two thirds of fetal deaths occur before the onset of labor, many of which are due to uteroplacental insufficiency. Fetal assessment is a key aspect of perinatal patient safety. Low ja, victory r, derrick ejpredictive value of electronic fetal monitoring for intrapartum fetal asphyxia with metabolic. Problems with intrapartum fetal heart rate monitoring interpretation and patient management roger k. Intermittent auscultation was used as early as the 1800s for evaluating fetal wellbeing, and the criteria for fetal distress were established by the mid. Intrapartum monitoring devices market size industry. Purpose and scope the purpose of this guideline is to reduce adverse perinatal outcomes related to inappropriate or inadequate intrapartum fetal surveillance.
In the igroup the fetal heart rate was recorded with electronic fetal monitoring for 10 to 30 min every 2 to 2. Electronic fetal monitoring efm provides graphic and numeric information on fetal heart rate fhr and maternal uterine activity ua to help clinicians assess fetal wellbeing before and during labor. Pdf figo consensus guidelines on intrapartum fetal monitoring. Intrapartum care and fetal heart rate trust reference. Thus, although no method of intrapartum fetal surveillance clearly is superior to all others, a substantial body of literature confirms that intrapartum fetal monitoring intermittent or continuous, although a relatively poor diagnostic test, is a reliable screening test for the confirmation of fetal wellbeing. This is a learning in 10 voice annotated presentation vap on intrapartum fetal monitoring to learn more about learning in 10 lit, please visit.
It has been developed by the editorial board based on the experience gained from maternity units where a reduction in the. Check out each question carefully and pick the best answer. Goal the timely identification and rescue of the fetus at risk of neonatal and. Fetal heart monitoring journal of obstetric, gynecologic. This guideline is intended for healthcare professionals, particularly those in training, who are working in hse. The goal of intrapartum fetal monitoring is to recognize changes in fetal oxygenation that could result in adverse outcomes.
Identify the purposes of fetal surveillance before birth. Fetal heart rate changes environment lungs heart vasculature uterus placenta cord fetus hypoxemia hypoxia metabolic acidosis metabolic acidemia potential injury 1. What are the periodic changes that occur in the fht. Figo news the guidelines are available at the links below, in the special ijgo free to view section and on the figo committee and working group publications page.
As such, clinicians are faced daily with the management of fetal heart rate fhr tracings. Intrapartum fetal monitoring american family physician. Intrapartum fetal heart rate monitoring obstetricsgynecology. In freeman rk, garite tj, nageotte mp, fetal heart rate monitoring, 3rd ed. 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. Thirty years of electronic intrapartum fetal heart rate. A prospective comparison of selective and universal electronic fetal monitoring in 34,995 pregnancies. It is currently not recommended as standard by nice or the royal college of obstetricians and gynaecologists rcog. History and rationale of intrapartum fetal assessment. Intrapartum fetal monitoring chapter 4 best practice. Inherited clinical guideline c will be withdrawn upon publication of this new guideline. The document provides background on electronic fetal heart rate monitoring efm, definitions of fhr features, criteria for.
These tables include and summarise individual recommendations about fetal monitoring 1. Explain the normal and pathologic mechanisms that influence fetal heart rate fhr. Electronic fetal monitoring is performed externally using a doppler technology with computerized processing that interprets and counts 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.
All professionals providing intrapartum care will attend an annual whole day or equivalent to 6 hours teaching seminar on fetal physiology in labour, discussion of the principles underlying intermittent auscultation, ctg interpretation and stan together with an. Electronic fetal heart rate monitoring american academy. Intrapartum fetal monitoring was developed in the 1960s to identify events that. Pdf the purpose of this chapter is to assist in the use and interpretation of intrapartum cardiotocography ctg, as well as in the clinical. Identify the advantages and limitations of each method of fetal surveillance. 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 purpose of intrapartum fetal heart rate monitoring. Little is written in the first edition of this textbook concerning monitoring of the fetus during labor. Fetal electrode placement should also preferably be avoided in very preterm fetuses under 32 weeks gestation. Management of intrapartum fetal heart rate tracings acog. Overview intrapartum care for healthy women and babies. Professor declan devane is professor of midwifery and holds a joint post between nui galway and the west, northwest hospitals group. It also aims to reduce variation in areas of care such as fetal monitoring during labour and management of the third stage of labour. What are the commonly used methods of intrapartum fetal monitoring.
This is the part 1 of the nclex practice questions. A 26item examination with concerns obgyn intrapartum. Intrapartum electronic fetal monitoring efm is used for most women who give birth in the united states. Intrapartum fetal monitoring a disappointing story nejm. Nomenclature, interpretation, and general management principles in the most recent year for which data are available, approximately 3. The guidelines are available at the links below, in the special ijgo free to view section and on the figo committee and. Figo consensus guidelines on intrapartum fetal monitoring ncbi. Intrapartum fetal monitoring guideline revision group. Much later, periodic auscultation of the fetal heartbeat with a fetoscope was adopted. Intrapartum assessment of fetal wellbeing bja education. Intrapartum fhr monitoring management decision model. Ensure that the focus of care remains on the woman rather than the ctg. Acog fetal heart rate monitoring information minnesota hospital. Figo consensus guidelines on intrapartum fetal monitoring.
However, the need for fbs during labour was lower in the stan. For nearly 4 decades, fetal heart monitoring fhr has been used to assess antenatal and intrapartum fetal wellbeing. Declan is an associate editor with the cochrane pregnancy and childbirth group, an associate senior lecturer with the uk cochrane centre and an author. Awhonnendorsed and incorporated in fetal monitoring curriculum american college of nurse midwives american academy of family practice american college of obstetricians and gynecologists 2009, july. Communication and information during pregnancy, women should be offered information on intrapartum fetal surveillance. 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. The dublin randomized controlled trial of intrapartum fetal heart rate monitoring.
St analysis for intrapartum fetal monitoring sacco. St analysis is a relatively new adjunct to ctg monitoring. External fhr monitoring is the recommended initial method for routine intrapartum monitoring, provided that a recording of acceptable quality is obtained, i. This guideline is an update of the use of electronic fetal monitoring. Standardized guidelines for the interpretation of the fetal heart rate have been suggested by the national institute of child health and human development. Essential to achieving the benefits of the stan method in any obstetric unit is the implementation of structured training programmes and the attainment of a high rate of stan usage. Intrapartum fetal monitoring by means of automatic stan did not improve the neonatal outcome or decrease the caesarean section rate. Maternity fetal heart rate monitoring summarythis guideline provides guidance for antenatal and intrapartum fetal heart rate fhr monitoring as a fetal welfare assessment tool.
An information leaflet is available for download from the nice website. Despite its widespread use, there is controversy about the efficacy of efm, interobserver and intraobserver variability. Which nursing action indicates the proper evaluation of this situation. Intrapartum care and fetal heart rate monitoring in labour uhl obstetric guideline page 1 of 65 author. Decelerations late, variable or prolonged signal interruption of the. Nomenclature, interpretation, and general management principles. Acog practice bulletin minnesota hospital association. No single test can detect abn with 100% accuracy ideal detection. Fetal electrode placement should also preferably be avoided in very preterm fetuses under 32 weeks of gestation. What is the physiology, and what interventions, if any, would be appropriate. The global intrapartum monitoring devices market size was valued at usd 1. 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. Association of womens health, obstetric and neonatal nurses. Problems with intrapartum fetal heart rate monitoring.
These practices were eclipsed in the late 1960s and early 1970s by the development of electronic fetal monitoring. Intrapartum fetal monitoring guideline published february 2018 disclaimer this guideline describes fetal monitoring using physiologybased ctg interpretation. An alternative approach is to provide intermittent ctg monitoring alternating with fetal heart rate fhr auscultation. Intrapartum fetal surveillance test bank multiple choice 1. The use and interpretation of cardiotocography in intrapartum fetal surveillance inherited clinical guideline c issued in 2001. Fhr often exhibits decelerations and accelerations in response to uterine contractions or fetal movements. What is the most important aspect in the evaluation of any fetal heart. Freeman, md fetal heart rate fhr monitoring was introduced over 3 decades ago into clinical use and patient management.
1024 1459 1159 661 1152 1167 678 1528 983 1585 662 1334 1345 1402 429 540 1030 1587 1164 285 182 548 1006 606 242 1488 427 239 154