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He says: "I believe there is no way this system can fail! Browse by Genre Available eBooks Show More. Archana Rajendran , M. D obstetrics and gynecology at Lady Hardinge Medical College. Carlos Wolff. Vat Nang Ben Them. Mahmuda Sumi. No Downloads. Views Total views. Actions Shares. Embeds 0 No embeds. No notes for slide. Macones, MD. Despite its widespread use, there is controversy about The information is designed to aid the efficacy of EFM, interobserver and intraobserver variability, nomenclature, practitioners in making decisions systems for interpretation, and management algorithms.

Moreover, there is evi- about appropriate obstetric and dence that the use of EFM increases the rate of cesarean deliveries and opera- gynecologic care. These guidelines tive vaginal deliveries. The purpose of this document is to review nomenclature should not be construed as dictating for fetal heart rate assessment, review the data on the efficacy of EFM, delin- an exclusive course of treatment or procedure.

Variations in practice eate the strengths and shortcomings of EFM, and describe a system for EFM may be warranted based on the classification. Background A complex interplay of antepartum complications, suboptimal uterine perfu- sion, placental dysfunction, and intrapartum events can result in adverse neona- tal outcome.

Known obstetric conditions, such as hypertensive disease, fetal growth restriction, and preterm birth, predispose fetuses to poor outcomes, but they account for a small proportion of asphyxial injury. Fetal heart rate monitoring may be performed exter-nally or internally. Internal FHR monitoring is accom- tions. The clinical response to tachy- systole may differ depending on whether contrac-Guidelines for Nomenclature and tions are spontaneous or stimulated. Deceler-of Child Health and Human Development partnered with ations are defined as recurrent if they occur with at leastthe American College of Obstetricians and Gynecolo- one half of the contractions.

This workshop gathered a diverse group of Rate Tracingsinvestigators with expertise and interest in the field toaccomplish three goals: 1 to review and update the def- A variety of systems for EFM interpretation have beeninitions for FHR pattern categorization from the prior used in the United States and worldwide 4—6.

Based onworkshop; 2 to assess existing classification systems for careful review of the available options, a three-tieredinterpreting specific FHR patterns and make recommen- system for the categorization of FHR patterns is recom-dations about a system for use in the United States; and mended see box.

It is important to recognize that FHR3 to make recommendations for research priorities for tracing patterns provide information only on the currentEFM. A complete clinical understanding of EFM neces- acid—base status of the fetus. Categorization of the FHRsitates discussion of uterine contractions, baseline FHR tracing evaluates the fetus at that point in time; tracingrate and variability, presence of accelerations, periodic patterns can and will change.

An FHR tracing may moveor episodic decelerations, and the changes in these char- back and forth between the categories depending on theacteristics over time.

A number of assumptions and fac- clinical situation and management strategies used. Category I FHRare central to the proposed system of nomenclature tracings are strongly predictive of normal fetal acid—baseand interpretation 3. Two such assumptions are of par- status at the time of observation. Category I FHR trac-ticular importance. First, the definitions are primarily ings may be monitored in a routine manner, and no spe-developed for visual interpretation of FHR patterns, but cific action is required.

Categoryintrapartum patterns, but also are applicable to antepar- II FHR tracings are not predictive of abnormal fetaltum observations. Contraction frequency alone is ued surveillance and reevaluation, taking into accounta partial assessment of uterine activity.

Other factors the entire associated clinical circumstances. In some cir-such as duration, intensity, and relaxation time between cumstances, either ancillary tests to ensure fetal well-contractions are equally important in clinical practice.

Category III Normal: five contractions or less in 10 minutes, tracings are associated with abnormal fetal acid—base averaged over a minute window status at the time of observation. Depending on the clini- utes, averaged over a minute window cal situation, efforts to expeditiously resolve theVOL. Table 1. In this case, one may refer to the prior minute window for determination of baseline.

Abbreviation: FHR, fetal heart rate. The National Institute of Child Health and Human Development workshop report on electronic fetal mon-itoring: update on definitions, interpretation, and research guidelines. Obstet Gynecol ;—6. Category II cations, the FHR tracing should be reviewed approxi- tracings may represent an appreciable fraction of those mately every 30 minutes in the first stage of labor and encountered in clinical care.

Examples of Category II every 15 minutes during the second stage. Thus, the benefits of EFM are gauged from reports comparing it with intermittent auscultation. The relative risk [RR], 1. Two months later,suring FHR tracing is predictive of cerebral palsy. In another study, fivebirth weights of 2, g or more is 0.

The obstetricians interpreted the tracingsonly one or two will develop cerebral palsy 9. The interpretation of cardiotocograms is more con- Available data, although limited in quantity, suggest sistent when the tracing is normal With retrospec-that the use of EFM does not result in a reduction in cere- tive reviews, the foreknowledge of neonatal outcome maybral palsy 8.

Given thethat the occurrence of cerebral palsy has been stable over same intrapartum tracing, a reviewer is more likely totime, despite the widespread introduction of EFM Given that the available data do not show a clear When should the very preterm fetus bebenefit for the use of EFM over intermittent auscultation, monitored? Logistically, it may not be feasible to adhere to The decision to monitor the very preterm fetus requiresguidelines for how frequently the heart rate should be a discussion between the obstetrician, pediatrician, andauscultated.

The most common estimated fetal weight, and other factors and issuesreasons for unsuccessful intermittent auscultation related to mode of delivery. If a patient undergoes aincluded the frequency of recording and the require- cesarean delivery for indications related to a pretermments for recording. The earliest gestational ageall pregnancies. Most of the clinical trials that compare that this will occur may vary. The labor of women with high-risk conditions followed by tachycardia and minimal or absent baseline eg, suspected fetal growth restriction, preeclampsia, and variability If FHR abnormalities are per- There are no comparative data indicating the opti- sistent, intrauterine resuscitation, ancillary tests tomal frequency at which intermittent auscultation should ensure fetal well-being, and possibly delivery should bebe performed in the absence of risk factors.

One method undertaken What medications can affect the fetal heart of magnesium on FHR patterns. Some show no inde- rate? In general, however, caution should be usedFetal heart rate patterns can be influenced by the med- in ascribing unfavorable findings on EFM to the use ofications administered in the intrapartum period.

Most magnesium alone. Parenteral narcotics did have frequent contractions even when labor wasalso may affect the FHR. A randomized trial comparing unstimulated As determined by computer analysisepidural anesthesia with 0. In antepartumregional analgesia A systematic review of accelerations Among twinsthose who did not receive epidural analgesia during labor 31 and singletons 32, 33 , the use of betamethasone


History of Fetal Monitoring

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Cardiotocography CTG is a technical means of recording the fetal heartbeat and the uterine contractions during pregnancy. The machine used to perform the monitoring is called a cardiotocograph , more commonly known as an electronic fetal monitor EFM. A refined antepartal, non-invasive, beat-to-beat version cardiotocograph was later developed for Hewlett Packard by Konrad Hammacher. CTG monitoring is widely used to assess fetal wellbeing.


Fetal Heart Rate Monitoring During Labor

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