New zealand research intrapartum fetal heart rate monitoring. Internal fetal heart rate monitoring at 1 cmmin top graph, 2 cmmin middle graph, and 3 cmmin bottom graph. 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. The quality of intrapartum fetal heart rate monitoring. 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. The document provides background on electronic fetal heart rate monitoring efm, definitions of fhr features, criteria for. Pdf intrapartum fetal heart monitoring interpretation in. Intrapartum fetal monitoring american family physician. 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. Neurological control of fetal heart rate in 20 cases of anencephalic fetuses. Murray electronic fetal monitoring technology is capable of monitoring and recording maternal heart rate mhr patterns that mimic fetal heart rate fhr patterns. Acog practice bulletin 106, intrapartum fetal heart rate monitoring.
By comparing intrapartum fhr patterns with fetal outcome using apgar scores, hondeterminedthe normalfurpattern,andalsoattemptedtodefinethe. Maternity fetal heart rate monitoring summarythis guideline provides guidance for antenatal and intrapartum fetal heart rate fhr monitoring as a fetal welfare assessment tool. Standardized nomenclatureforelectronicfetalmonitoring. 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 electronic fetal monitoring efm is used for most women who give birth in the united states. Nomenclature, interpretation, and general management principles this practice bulletin was developed by the acog. Fetal heart rate changes environment lungs heart vasculature uterus placenta cord fetus hypoxemia hypoxia metabolic acidosis metabolic acidemia potential injury 1.
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. Fetal monitoring during labour nice pathways bring together everything nice says on a topic in an interactive flowchart. Computerised analysis of intrapartum fetal heart rate. 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. Abnormal fetal heart rate fhr in the intrapartum period can indicate a hypoxic state in a fetus resulting from interruption of placental blood. Intrapartum fetal monitoring guideline published february 2018 disclaimer this guideline describes fetal monitoring using physiologybased ctg interpretation.
Electronic fetal heart rate monitoring efm continues to be the primary. Intrapartum fetal monitoring guideline revision group. English midwives views and experiences of intrapartum fetal heart rate monitoring in women at low obstetric risk. Compared predictive values of pulse oximetry and fetal blood analysis. Therefore, the midwife has a powerful role to play in balancing the benefits and risk ratios applicable to fetal heart rate monitoring. 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 ability to distinguish one from the other requires knowledge of fhr and mhr characteristics. 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. 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 fetal heart rate can be evaluated using intermittent auscultation or electronic fetal monitoring. Intrapartum fetal heart rate monitoring obstetricsgynecology. 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. Guideline working party, updated by working party written. 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. Thus, fetal heart rate fhr monitoring can be used to determine if a fetus is well oxygenated. Intrapartum care and fetal heart rate trust reference. Problems with intrapartum fetal heart rate monitoring interpretation and patient management roger k. Nice pathways are interactive and designed to be used online. Fetal heart rate fhr monitoring is one of the most important procedures for. Decelerations late, variable or prolonged signal interruption of the. Current clinical practices that include fetal heart rate monitoring and fetal scalp blood sampling are shown to be either inadequate or timeconsuming. A continuously plotted fetal heart rate recordingwas shown toyield more information than the 30s average usually obtained by auscultation.
It continues to be the predominant method for intrapartum fetal surveillance despite questions about its ef. It monitors uterine and fetal activity including fetal heart rate, and has enhanced maternal. As the fetus develops its heart rate decreases in response to parasympathetic vagal stimulation nervous system maturation and variability becomes more pronounced 2. Intrapartum care and fetal heart rate monitoring in labour uhl obstetric guideline page 1 of 65 author. As the fetus develops its heart rate decreases in response to parasympathetic vagal stimulation nervous system maturation and variability becomes more pronounced. Intrapartum fetal heart rate monitoring case presentation. Management of intrapartum fetal heart rate tracings acog. Problems with intrapartum fetal heart rate monitoring. Intrapartum fetal heart rate monitoring american journal of obstetrics. Baseline fhr 110160 bpm, moderate fhr variability, accelerations may be present or absent, no late or variable decelerations, may have early decelerations. Pdf persistent challenge of intrapartum fetal heart rate. What are the commonly used methods of intrapartum fetal monitoring. The dublin randomized controlled trial of intrapartum fetal heart rate monitoring.
There are no randomized trials of intrapartum fetal monitoring versus no intrapartum fetal monitoring. The fetal heart rate tracing shows all of the following. Intrapartum fetal abnormal fetal heart rate on auscultation or admission tracing 20minute strip meconiumstained amniotic fluid. Interpreting continuous fetal heart rate fhr monitoring is one of the most common tasks obstetricians perform during the course of intrapartum care. Despite metaanalyses reporting a 59% fall in intrapartum deaths attributable to intrapartum hypox. Offer intermittent auscultation of the fetal heart rate to women at low risk of complications in. This practice bulletin was devel oped by the acog committee on.
For nearly 4 decades, fetal heart monitoring fhr has been used to assess antenatal and intrapartum fetal wellbeing. 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 heart rate monitoring early in gestation the fetal heart rate is predominately under the control of the sympathetic nervous system and arterial chemoreceptors. What is the purpose of intrapartum fetal heart rate monitoring. 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. Intrapartum fetal surveillance test bank multiple choice 1. It has been developed by the editorial board based on the experience gained from maternity units where a reduction in the. The interpretation of the fetal heart rate tracing should follow a systematic. What is the most important aspect in the evaluation of any fetal heart. Fetal monitors are bedside units that consist of a monitoring unit, cables, and electrodes. Which nursing action indicates the proper evaluation of this situation. Scaleup of doppler to improve intrapartum fetal heart rate.
Fetal heart monitoring is recommended for all women in labour. Fetal bradycardia is defined as a baseline heart rate less than 110 bpm for at least 10 minutes table 1. Article pdf available in minerva ginecologica 671 november 2014 with 1,681 reads how we measure reads. What is the physiology, and what interventions, if any, would be appropriate. These variables are then plotted against time on graph paper. Intrapartum fetal heart monitoring interpretation in labour. 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. Pdf electronic fetal monitoring efm has been introduced in the obstetrics. Electronic fetal heart rate monitoring ceconnection for nursing. 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. Pdf intrapartum fetal heart monitoring interpretation in labour. What are the periodic changes that occur in the fht. 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.
Nomenclature, interpretation, and general management principles. 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. Electronic fetal monitoring is performed externally using a doppler. Handheld doppler devices have been investigated in several lowresource countries as an alternative to pinard stethoscope and are more sensitive to. Intrapartum care and fetal heart rate monitoring in labour uhl obstetric guideline page 2 of 65 author. For both low and highrisk pregnancies, continuous electronic fhr monitoring is not clearly superior to intermittent auscultation with respect to.
Because abnormal fhr is a potential predicator of newborn asphyxia, fhr monitoring is important for quality intrapartum care. 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. The basic purpose of continuous intrapartum ctg monitor ing is to reduce fatal. As such, clinicians are faced daily with the management of fetal heart rate fhr tracings. Intrapartum fetal monitoring professor declan devane is professor of midwifery and holds a joint post between nui galway and the west, northwest hospitals group. For last four decades, intrapartum monitoring of fetuses has been commonly performed by either intermittent auscultation ia or electronic fetal heart rate monitoring efm. Fetal heart rate response to vibratory acoustic stimulation predicts fetal ph in labor. 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. It was used among 45% of laboring women in 1980, 62% in 1988, 74. Moreover, there is evidence that the use of efm increases the rate of cesarean deliveries and operative vaginal deliveries.
Intrapartum fetal heart rate monitoring american journal of. Otherwise, the baseline for that segment is described as indeterminate. A total of 1,996 fetal heart rate fhr tracings were analyzed to assess the prognostic significance of variable decelerations. 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. Macdonald d, grant a, sheridanpereira m, boylan p, chalmers i. Intrapartum fetal heart rate monitoring case presentation david a. The baseline must be for a minimum of 2 minutes in a tenminute segment. Normal baseline fetal heart rate fhr, shown at 5 beats per minute bpm. 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. Effects of electronic fetal heart rate monitoring on perinatal outcome and obstetric practices. 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.
Nomenclature, interpretation, and general management principles in the most recent year for which data are available, approximately 3. Fetal monitoring antepartum surveillance intrapartum surveillance intrapartum fetal resuscitation key points antepartum and intrapartum surveillance techniques provide an opportunity to monitor fetal well being. Threetier fetal heart rate interpretation system 41 category i. Identification, assessment and management of fetal. The goal of intrapartum fetal monitoring is to recognize changes in fetal oxygenation that could result in adverse outcomes. Intrapartum fetal monitoring in labour with risk factors. 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. Figo consensus guidelines on intrapartum fetal monitoring. Intermittent auscultation for intrapartum fetal heart rate. 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. Intrapartum fhr monitoring management decision model. Intrapartum fetal heart rate monitoring a standardized approach to interpretation and management lecture objectives at the end of. Internal fetal heart rate monitoring at 1 cmmin top graph, 2. 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.
Normal baseline rate ranges from 110 to 160 bpm for a 10minute. They are designed to measure, record, and display fhr, uterine contractions, andor maternal blood pressure and heart rate before and during childbirth. Nomenclature, interpretation, and general management principles, july 2009. Intrapartum assessment of fetal wellbeing bja education. Intrapartum fetal heart rate monitoring ariz exams. 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. Early in gestation the fetal heart rate is predominately under the control of the sympathetic nervous system and arterial chemoreceptors 1. The current gold standard, continuous fetal heart rate monitoring allows for identification of the compromised fetus. You can move this window by clicking on the headline. The purpose of this document is to provide obstetric care providers with a framework for. Freeman, md fetal heart rate fhr monitoring was introduced over 3 decades ago into clinical use and patient management.
Participants included obstetric experts and representatives from relevant stakeholder groups and. Intermittent auscultation for intrapartum fetal heart rate surveillance americancollegeofnursemidwives fetal heart rate surveillance is a standard component of intrapartum care. Thirty years of electronic intrapartum fetal heart rate. Intermittent auscultation may be used for low risk women and electronic fetal monitoring efm for.
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