This leads many hospitals and clinics to want to scan these fetal monitoring strips. External tocodynamometry provides no information regarding the strength or intensity of uterine contractions. Identify the baseline fetal heart rate and presence of variability. Fetal scalp pH determination or evoked fetal response to scalp stimulation or vibroacoustic stimulation may be helpful in the accurate assessment of fetal status in the face of nonreassuring FHR data. They tell the doctor that the baby has an adequate oxygen supply, which is critical. Uterine contractions are dealt with at the end of this section. Fixation of the transducer with elastic tape may be preferable because it allows signal detection and recording despite maternal movement.
ACI's 14th Annual Advanced Forum on Obstetric Malpractice Claims
Deviations from this normal baseline range are not necessarily indicative of fetal compromise. This FHR pattern must be present for at least 10 minutes to avoid overdiagnosing this rare pattern, which classically is associated with severe fetal anemia e. Fetal asphyxia an impaired exchange of oxygen and carbon dioxide is recognized as an important cause of stillbirth and neonatal death. Not surprisingly, most authors have reported that only under extreme circumstances e. Assess fetal pH fetal scalp stimulation, scalp pH, or acoustic stimulation. A nonreassuring deviation is, for example, a pattern that displays during a contraction as a slight downward deviation that returns to normal but may indicate compression of the umbilical cord and require a shift in your position.
Intrapartum Fetal Monitoring - - American Family Physician
Clearly, accurate assessment of the intrapartum fetal status requires an overview of the entire clinical scenario, not the simple categorization of isolated, perhaps even transient, FHR tracing characteristics. Accelerations Decelerations What to expect Overview. Coupling jelly is not required; in fact, its use may damage the transducer. Adapted from Bailey RE. During a contraction, the flow of oxygen from the mother through the placenta to the baby is temporarily blocked. For these and other reasons, the United States Preventive Services Task Force states that there is some evidence that using EFM on low-risk women in labor might not be indicated. Sleep cycles of 20 to 40 minutes or longer may cause a normal decrease in FHR variability, as can certain medications, including analgesics, anesthetics, barbiturates, and magnesium sulfate.
If the time is longer, there may be some injury that is reversible. Also, there are conditions where the technology such as M-mode or Doppler ultrasound or the expertise to exclude congenital heart block as a cause of fetal bradycardia are not available. The free-flowing blood is collected in preheparinized capillary tubes. If the interruption to the supply of oxygen is short, the baby may recover without any damage. I was having difficulty understanding. Fetal bradycardia is commonly associated with fetal hypoxemia. The frequency of use of internal monitors both the fetal scalp electrode and IUPC differs by centers, with some centers preferring to use external monitors when they are able to get reasonably good data and other centers preferring to use internal monitors more commonly.