Intrapartum fetal heart rate monitoring obstetricsgynecology. 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. Fetal heart rate monitoring 4th edition pdf for free. Obstetrics and gynecology attending and resident physicians 3. Doppler ultrasound fetal heart rate monitors are recommended but only 1 %. It is generally advised that the fetal heart rate be monitored during labor by a competent clinician. 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. Clinical practice guideline intrapartum fetal heart rate monitoring 3 key recommendations 1.
The relationship between fhr patterns and newborn acidemia. Electronic fetal heart monitoring is not a substitute for appropriate, professional, nursing care and support of women in labor. Intermittent auscultation may be used for low risk women and electronic fetal monitoring efm for women when an increase in risk has been identified. Standard nomenclature for intrapartum fetal heart rate.
As such, clinicians are faced daily with the management of fetal heart rate fhr tracings. Electronic fetal heart rate monitoring efm is widely used in nearly every modern labor and delivery unit in the developed world, and was initially introduced for clinical use in the late 1960s as an alternative to the very laborintensive auscultation of the fetal heart. For nearly 4 decades, fetal heart monitoring fhr has been used to assess antenatal and intrapartum fetal wellbeing. We will evaluate the fetal heart rate, segment intervals, normalised amplitude and the fetal heart axis. Also, with a 99% false positive rate for cerebral palsy, i wonder about the rate of uterine rupture false positives. Acog fetal heart rate monitoring information minnesota hospital. Moreover, there is evidence that the use of efm increases the rate of cesarean deliveries and operative vaginal deliveries. It is important to stress that fetal monitoring is only part of the overall clinical assessment of both mother and fetus, aimed mainly at. Fetal heart rate monitoring professional educational center. The guidelines for healthy women with uncomplicated pregnancies do not recommend continuous monitoring acog, 2009. Fetal heart rate monitoring can be performed internally or externally. The threetiered fetal heart rate interpretation system should be used to assist in determining fetal status 1. Nomenclature, interpretation, and general management principles.
This video, uploaded with permission, contains indepth information about fetal heart tracings. Electronic fetal heart rate monitoring and its relationship to neonatal and infant mortality in. Fetal heart monitoring is recommended for all women in labour. Normal human labor is characterized by regular uterine contractions and repeated episodes of transient interruption of fetal oxygenation.
They do tell us about intrapartum events such as cord compresssion, head compression, fetal hypoxia, and fetal acidbase status. Kergaradec further suggested that fetal heart sounds could be used to determine fetal viability and life. Womens health care physicians background in 2008, a workshop sponsored by the american college. Management of intrapartum fetal heart rate tracings. King cnm, mph october 26, 2016 disclosure i have no financial disclosures related to this presentation objectives 3 a quick history the category ii chasm. 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.
See nonstress test and contraction stress test, section on physiologic basis of fetal heart rate changes. Describe components of a fetal heart rate fhr tracing. Fetal heart rate monitoring anesthesia and the fetus. Fetal heart rate tracings do have a lot of meaning. Whether this information is useful in a low risk labor is up to some debate, but that information is. Interpreting continuous fetal heart rate fhr monitoring is one of the most common tasks obstetricians perform during the course of intrapartum care. Describe periodic and nonperiodic fhr changes as they relate to accelerations and. Why is fetal heart rate monitoring done during labor and delivery. Management after confirmation of the diagnosis of prom is dependent primarily on gestational age and is discussed in more detail in the following paragraphs. Used by all members of the obstetric team nurses, students, midwives, and physicians it is the primary method to assess fetal oxygenation in both the antepartum and intrapartum setting.
Prior to its implementation, intrapartum fetal death rates were between 3 and 4 per. This website provides free medical books this website provides over 0 free medical books and more for all students and doctors this website the best choice for medical students during and after learning medicine. The fetal brain modulates the fetal heart rate through an interplay of sympathetic and parasympathetic forces. Acog and the association of womens health, obstetric, and neonatal nurses awhonn. Fetal heart rate monitoring is the process of checking the condition of your fetus during labor and delivery by monitoring your fetuss heart rate with special equipment. Consensusbased recommendation all women should be offered intrapartum fetal heart rate monitoring see exceptions on page 9. The accuracy of the pinard is without much evidence indicating improved outcomes in situations of fetal distress. Normal ranges for fetal electrocardiogram values for the. A multicenter controlled trial of fetal pulse oximetry in the intrapartum management of nonreassuring fetal heart rate patterns. Continuous intrapartum monitoring of fetal heart rate fhr patterns began in the 1960s in an effort to decrease birth asphyxia and cerebral palsy.
By 1833, evory kennedy, an english physician, published guidelines for fetal distress and recommended auscultation of the fetal heart rate as a tool of intrapartum monitoring. Fetal heart rate monitoring may help detect changes in the normal. There are two methods of fetal heart rate monitoring in labor. The video is useful for practitioners in labor and delivery units looking to. Fetal heart rate monitoring affects the lives of millions of women and infants every year in the united states alone. Current recommended management algorithms research findings. Fetal monitoring is used to assess the adequacy of fetal oxygenation during labor acog, 2009 with. A normal tracing reliably predicts a welloxygenated fetus.
Nurses, midwives, and physicians must have a shared understanding of 1 how fhr tracings are interpreted, 2 which fhr patterns are associated with actual or impending fetal acidemia, 3 when and within what time frame the physician or the midwife should be notified of. Intermittent auscultation of the fetal heart rate purpose scope a. Normal ranges for fetal electrocardiogram values for the healthy fetus of 1824 weeks of gestation. Yet while continuous fetal monitoring has been shown not to decrease cerebral palsy, it continues to be used in a majority of labor suites. Are we misguided by current guidelines on intrapartum. Most fetuses tolerate this process well, but some do not. 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. Fetal heart monitoring journal of obstetric, gynecologic. Auscultation is a method of periodically listening to the fetal heartbeat.
Your healthcare provider may do fetal heart monitoring during late pregnancy and labor. This lets your healthcare provider see how your baby is doing. Qcom fetal heart monitoring basic pattern recognition. Electronic fetal heart rate monitoring american academy. Acog refines guidelines for fetal monitoring in labor. The average fetal heart rate is between 110 and 160 beats per minute. Intrapartum electronic fetal heart rate fhr monitoring is widely practiced in the uk, the usa and in many other developed countries.
The role of interpretation acog refines fetal heart rate. In addition to monitoring fetal heart rate patterns, information about the effects of labor on the fetus can also be learned by observing the pattern of uterine contractions. The fetal heart rate fhr pattern helps to distinguish the former from the latter as it is an indirect marker of fetal cardiac and central nervous. Management of intrapartum category i, ii, and iii fetal. Fetal heart rate monitoring measures the heart rate and rhythm of your baby fetus. Here is the link, acog refines fetal heart rate monitoring guidelines. Thus, fetal heart rate fhr monitoring can be used to determine if a fetus is well oxygenated. As such, clinicians are faced daily with the management of fetal heart rate fhr. Management of intrapartum fetal heart rate tracings acog. Effective intrapartum fetal heart rate fhr monitoring requires ongoing collaboration among health care providers. The fetal heart rate fhr pattern helps to distinguish the former from the latter as it is an indirect marker of fetal cardiac and central nervous system responses to changes in blood pressure, blood gases, and acidbase status.
Fetal heart rate monitoring allows maternalfetal medicine experts and obgyns to monitor the health of a baby in late stages of pregnancy and during labor, helping to determine conditions in the uterus and how the baby is doing. Fetal heart rate patterns in the second stage of labor. Perinatal rns are responsible for fhm, and this responsibility may not be delegated to personnel without requisite assessment skills and scope of practice. Note that vbac is not listed under highrisk conditions that should be monitored continuously during labor. Compared to other techniques for fetal monitoring, the development of the fetal ecg lagged behind. Acog monitoria fetal pdf intrapartum fetal heart rate monitoring. Acog recommendations for fetal heart rate monitoring. According to the acog committee, the falsepositive rate of electronic fetal monitoring for predicting adverse outcomes is. Acog members, please click log in here to access content. It was used among 45% of laboring women in 1980, 62% in 1988, 74% in 1992, and 85% in 2002 1.
Acog practice bulletin minnesota hospital association. We would like to show you a description here but the site wont allow us. The fetal heart rate may be monitored using continuous electronic fhr monitoring efm components external cardiotocography ctg or internal device or auscultated intermittently. Intrapartum fetal heart rate monitoring acog practice bulletin no. Continuous cardiocartography as a form of electronic fetal monitoring efm for fetal assessment during labour.