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. Electronic monitoring is linked with higher rates of caesarean deliveries, with their higher risks and costs. Review the nomenclature standardized terminology for interpretation category development for research definitions for uterine activity. Monitoring for perinatal safetyelectronic fetal monitoring. The monitoring of fetal heart rate fhr status is an important method to check wellbeing of the baby during labor. Efm spawned a birth injury litigation crisis centered on the myth that it predicts cerebral palsy cp. Development workshop report on electronic fetal monitoring. It also checks the duration of the contractions of your uterus. 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. Electronic fetal heart monitoring kaiser permanente. In order to accurately assess a fhr pattern, a description of the pattern should include qualitative and quantitative information in the following five areas. 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 well.
Nonetheless, electronic fetal monitoring has proved so useful in so many ways that it has become a prominent feature of intrapartum care, and indispensable for high risk patients. Monitoring is carried out using an ultrasonic heart rate detector, doppler ultrasound or electronic monitoring, using transducers placed on the abdomen or electrodes applied to the bony part of the fetal skull. Insufficient knowledge and interpretations regarding efm will. Nageotte miller childrens and womens hospital, long beach, 2801 atlantic avenue, long beach, ca 90801, usa s u m m a r y keywords. When the dream is shattered case study in fetal monitoring.
Intrapartum fetal heart rate monitoring obstetricsgynecology. Fetal assessment is a key aspect of perinatal patient safety. Comparison of intrapartum electronic fetal heart rate monitoring versus intermittent auscultation in detecting fetal acidemia at birth. A refined antepartal, noninvasive, beattobeat version. Fluctuations in the baseline fhr of 2 cycles per minute or greater.
The results of electronic fetal heart monitoring are usually available immediately. Fetal heart monitoring is part of every pregnancy checkup. Basic education, staff development, and quality assurance activities involving staff nurses and managers are. Application to electronic fetal monitoring interpretation ncc. 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. Electronic fetal heart rate monitoring american academy. Randomised trials and time trends in population based data establish that it has not done so.
Electronic fetal monitoring during labour was introduced with an expectation that it would reduce cerebral palsy. Understanding how the fetal heart reacts to labor is essential knowledge for clinicians who are responsible for the interpretation of heart rate tracings. As such, clinicians are faced daily with the management of fetal heart rate fhr tracings. 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. A marked change to the individual fetal heart pattern is significant and may be a sign of fetal distress. Basic pattern recognition electronic fetal monitoring. 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. Ahrq safety program for perinatal care electronic fetal monitoring 2.
Electronic fetal monitoring assesses fetal health during the prenatal and intrapartum process. With the use of efm categories and definitions from the american college of obstetricians and gynecologists, the national institutes of health, and the society for maternal fetal medicine, clinicians can now better define and communicate tracing assessments. This article highlights a community hospitals program for efm. For as long as we have had electronic fetal monitoring clinicians have. Webmd explains how and why doctors may take these readings at office checkups or while you.
Electronic fetal heart monitoring wellspan health library. Monitoring fetal heart rate, or fhr, and contractions during labor, whether done intermittently or continuously, is a commonly used practice on labor and delivery. The history of efm basic equipment for fetal monitoring the physiological. Outline the management of fhr information obtained from auditory andor electronic fetal monitoring assessments. Jun 16, 2001 electronic fetal monitoring with the cardiotocograph is standard practice during labour in most obstetric units in the united kingdom. Unlike other fetal heart rate monitoring education. Intrapartum electronic fetal monitoring a disappointing story. Electronic fetal monitoring, cerebral palsy, and caesarean.
Neither i, nor any member of my immediate family, have a significant. Electronic fetal monitoring basic and advanced study. Standardized nomenclatureforelectronicfetalmonitoring. Fhr often exhibits decelerations and accelerations in response to uterine contractions or fetal movements. Electronic fetal monitoring it is crucial for st12 trainees to appreciate the role of electronic fetal monitoring efm in pregnancy and labour, particularly its advantages and limitations. Fetal heart monitoring is recommended for all women in labour. When youre pregnant, your doctor can check on your babys health with a fetal heart rate monitor. Clinical practice guideline intrapartum fetal heart rate monitoring 3 key recommendations 1. Update on definitions, interpretations, and research. Monitoring fetal heart rate, or fhr, and contractions during labor, whether done intermittently or continuously, is a commonly used practice on. Ch 17 evaluating electronic fetal monitoring strips youtube. Sound waves detect fetal heart movement assess fetal heart baseline rate, rhythm, variability. Fetal heart rate monitoring principles and practices 4th ed. Jonie johnson, rnc history of fhm commercially available.
National institute of child health and human development nichd society for maternal fetal medicine. The brookside associates videos obstetrics electronic fetal monitoring video efm pattern recognition electronic fetal monitors continuously record the instantaneous fetal heart rate on the upper channel and uterine contractions on the lower channel. 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 pregnancies. Management of intrapartum fetal heart rate tracings acog. Electronic fetal heart rate monitoring ge healthcare. Two forms of continuous electronic fetal heart monitoring are used, internal and external. The electronic fetal heart rate monitoring program introduces a comprehensive, systematic, evidencebased approach to standardized intrapartum fetal heart rate interpretation and management that reflects consensus in the medical literature, is practical, and teachable. Electronic fetal heart monitoring is not a substitute for appropriate, professional, nursing care and support of women in labor. 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.
Maternity fetal heart rate monitoring summarythis guideline provides guidance for antenatal and intrapartum fetal heart rate fhr monitoring as a fetal welfare assessment tool. It is generally advised that the fetal heart rate be monitored during labor by a competent clinician. Interpretation of the electronic fetal heart rate during labor may 1, 1999 american academy of family physicians. Electronic fetal monitoring efm is obstetric technology helps to record any changes in fetal heart rate fhr and uterine activity. They do this by attaching, either externally and noninvasively or internally, to detect the fetal heart and each uterine.
Continuous electronic fetal heart rate monitoring efm is used in the vast majority of all labors in the united states. Interpretation of electronic fetal heart rate monitoring. Dec 01, 2016 electronic fetal monitoring during labour was introduced with an expectation that it would reduce cerebral palsy. Perinatal rns are responsible for fhm, and this responsibility may not be delegated to personnel without requisite assessment skills and scope of practice. The fetal brain is responsible for modulating the fetal heart rate fhr through sympathetic and parasympathetic pathways. Electronic fetal monitoring is intended to detect abnormalities in the fetal heart rate that indicate. 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 efm is the most common obstetric procedure use common language to communicate and document findings a brief history fetal heart sounds were first reported in the 1600s. Electronic fetal heart monitoring is done during pregnancy, labour, and delivery.
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. Sep 07, 2018 electronic fetal heart monitoring made easy duration. Fetal heart monitoring journal of obstetric, gynecologic. National institute of child health and human development research planning workshop. Fetal heart rate tone monitoring decelerations early. Sep, 2019 electronic fetal monitoring can limit your ability to get up and move about freely to cope with contractions during labor and delivery. Objectives to use a metaanalysis of all published randomlized trials to determine whether the use of continuous electronic fetal heart rate monitoring efm as the main method of intrapartum fetal surveillance is associated with improved pregnancy outcome compared to intermittent auscultation. Electronic fetal heart monitoring is done during pregnancy, labour, and delivery to keep track of the heart rate of your baby fetus and the strength and duration of the contractions of your uterus.
In this section, you can learn more about the history of electronic fetal monitoring, its physiologic basis, and contextual details about reading fetal tracings. Monitoring for perinatal safety electronic fetal monitoring. Electronic fetal monitoring training efm eintegrity. It is essential that maternity professionals know how to interpret ctg readings so that timely care can be offered. Classify fetal heart rate patterns according to nichd. Some research has suggested that continuous electronic fetal monitoring may increase the risk of csection and other labor interventions compared with intermittent monitoring. The monograph also addresses related electronic fetal monitoring efm. This technology has been in use since the 1950s, and it is the most commonly used medical intervention in obstetrics. How to differentiate maternal from fetal heart rate. Gagnon r, campbell k, hunse c, patrick j patterns of human fetal heart rate accelerations from 26 weeks to term.
Intermittent auscultation may be used for low risk women and electronic fetal monitoring efm for women when an increase in risk has been identified. Intrapartum electronic fetal monitoring efm is used for most women who give birth in the united states. Electronic fetal monitoring category i, ii and iii fetal tracings late decelerations variable decelerations sinusoidal. The workshops express purpose was to develop a standardized and rigorously, unambiguously described set of definitions that can be quantitated for electronic fetal heart monitoring, with the ultimate goal of producing a common language that would facilitate further investigational research examining the predictive value of electronic. Cd006066 d gibb and s arulkumaran 2017 fetal monitoring in practice. 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. Its combined with other tests for a closer look if you have diabetes, high blood pressure, or other conditions that could cause. Auscultationgenerally involves intermittent assessment of the fhr and may be accomplished by doppler, ultrasound transducer, or fetoscope. 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. Electronic fetal monitoring video the brookside associates. The training materials and tool for this bundle offer key safety elements for the use of efm. Electronic fetal heart rate monitoring ceconnection. Cefm continuous electronic fetal monitoring cqc commission of quality control cs caesarean section csf cerebrospinal fluid ctg cardiotocograph dob date of birth fbs fetal scalp blood sample fh fetal heart fhr fetal heart rate figo international federation of gynaecology and obstetrics fse fetal. Introduction electronic fetal monitoring efm began with the early devices and seminal studies of hon et al.
Electronic fetal heart monitoring is done during pregnancy, labor, and delivery. Electronic fetal monitoring efm has been used for four decades, after its introduction without clinical trials. American journal of obstetrics and gynecology, 1776, 8590. Cardiotocography ctg is a technical means of recording the fetal heartbeat and the uterine contractions during pregnancy. Electronic fetal heart rate monitoring request pdf. The fetal heart rate may be monitored using continuous electronic fhr monitoring efm components external cardiotocography ctg or internal device or auscultated intermittently. Joint publication in 2008 on electronic fetal heart monitoring. Intermittent auscultation does not detect key elements of fetal risk, such as beattobeat variability. Your babys heart rate is a good way to tell if your baby is doing well or may have some problems. 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. This video explains fetal heart rate tone decelerations early decelerations, late decelerations, variable decelerations that you have. Elsevier e chandrahan, s evans, d krueger, s pereira, s skivens, a zaima physiological ctg interpretation 2018 intrapartum fetal monitoring. Interpretation of the electronic fetal heart rate during labor. Intrapartum electronic fetal monitoringa disappointing story.
The machine used to perform the monitoring is called a cardiotocograph, more commonly known as an electronic fetal monitor efm fetal monitoring was invented by doctors alan bradfield, orvan hess and edward hon. Eileen vdoi bsn,rncob luann beacom msn, mph, cns, fnp. Basic pattern recognition accurate fetal heart rate fhr assessment may help in determining the status of the fetus and indicate management steps for a particular condition. It keeps track of the heart rate of your baby fetus. How do scientists discover how the fetal heart rate is regulated during labor. The future of electronic fetal monitoring sciencedirect. Vintzileos am, nochimson dj, antsaklis a, varvarigos i, guzman er, knuppel ra.
1011 374 924 995 277 394 212 1493 1311 1307 724 924 698 845 511 837 568 1222 311 93 554 1152 130 1351 926 552 966 278 205 13 557 1275 1014 1227 1485 909 92 317 834 5 1081