Fetal ecg analysis for intrapartum electronic fetal. Previous guidance has been mainly based on pattern recognition. Ifm may be required for monitoring uterine activity while inducing or augmenting labor for example, when the mother is obese or agitated. Intermediate fetal monitoring course cnecme contact hours.
Define fhr fetal heart rate patterns for visual interpretation that have been produced from either a direct fetal electrode. Intrapartum fetal heart rate monitoring a standardized approach to interpretation and management lecture objectives at the end of. Cd006066 d gibb and s arulkumaran 2017 fetal monitoring in practice. Therefore, we need a reliable noninvasive diagnostic method which improves the predictive value for congenital heart diseases early in pregnancy. Since the electronic fhr monitoring was introduced 40 years ago, it has been expected to be an innovative screening test to detect fetuses who are becoming hypoxic and who may benefit from cesarean delivery or operative vaginal delivery. Figo consensus guidelines on intrapartum fetal monitoring. It is generally accepted that intermittent auscultation ia is. Leading experts in the united states have been involved in development of the credentialing examination for fetal heart monitoring. Electronic fetal monitoring with and without pattern interpretation the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Intro to fetal monitoring strip interpretation bundle. Jun 20, 2015 the primary goal of fhr monitoring is to identify hypoxemic and acidotic fetuses in whom timely intervention will prevent death. Using nichd nomenclature, the essentials of fetal monitoring.
Fetal electrode placement should also preferably be avoided in very preterm fetuses under 32 weeks of gestation. Fetal assessment is a key aspect of perinatal patient safety. Nomenclature, interpretation, and general management principles in the most recent year for which data are available, approximately 3. It is indisputable that monitoring of the fetal heart is an essential part of the care of the fetus in labour. When the dream is shattered case study in fetal monitoring. Nonreassuring fhr patterns are common and quite nonspecific. Ctg is used during pregnancy to monitor the fetal heart and contractions of the uterus. The impact of electronic fetal monitoring on obstetric safety has become a high priority, with documentation being essential to evaluating care quality. Ctg interpretation and response the royal womens hospital. Interpretation of the electronic fetal heart rate during labor amir sweha, m. Child health and human development workshop report on electronic fetal monitoring.
Comparison of five classification systems for interpreting. University of california, davis, school of medicine davis, california electronic fetal heart rate monitoring is commonly used to assess fetal wellbeing during labor. Fetal heart rate tracings are presented with a full explanation of their interpretations. The purpose of fetal heart rate fhr monitoring is to a. Poor reliability for fhr interpretation failure to show the validity of fhr monitoring in detecting fetal asphyxia benefit not realized. The choice of technique is based on various factors, including the resources available. The ctg monitor records both fetal heart rate cardio and maternal uterine contractions toco. For as long as we have had electronic fetal monitoring clinicians have asked what. Determine if the fetus is well oxygenated related searches for fetal monitoring strip test related searches fetal monitor strips test quiz fetal monitoring test questions fetal monitoring competency. The book uses case studies and highquality tracings accompanied by detailed teaching diagrams usually found only in anatomical and surgical atlases. Electronic fetal heart rate monitoring ceconnection for nursing. To provide a systematic approach to interpreting the electronic fetal monitor. Essential characteristics for tracing interpretation.
Jun 22, 2016 history of fetal monitoring dt is somewhat surprising that something as potentially accessible as the fetal heart was neither heard nor described until the 17th century when phillipe legaust first depicted fetal heart tones in his poetry in an ancient french dialect. Electronic fetal heart monitoring made easy duration. This fetal monitoring system is the best thing apple has ever done for women. Comparison of five classification systems for interpreting electronic fetal monitoring in predicting neonatal status at birth mariarosaria di tommaso, viola seravalli, adalgisa cordisco, giada. Fetal physiology in relation to electronic fetal monitoring efm. Elsevier e chandrahan, s evans, d krueger, s pereira, s skivens, a zaima physiological ctg interpretation 2018 intrapartum fetal monitoring. A secondary goal is to avoid fetal neurologic injury, if possible. Fhr interpretation in 20 or so slides university of utah health. Either of these factors may lead to a decrease in the maternal fetal oxygen transfer. Electronic fetal monitoring with and without pattern. Continuous electronic fetal monitoring is commonly performed by cardiotocography ctg. Courses in fetal monitoring offer an opportunity for medical professionals to learn to use equipment to monitor the heart rate of inutero babies. This is the first fetal monitoring guideline that solely relies on physiologybased interpretation for the assessment of fetal wellbeing.
At times, the discussion may lead to the care decisions made based on efm interpretation. Completion of basic fhm education and use of fetal monitoring in the intrapartum setting for a least 6 months. Approximate mean fhr rounded to 5 bpm during a 10 min segment c. Intro to fetal monitoring interpretation pdf concise 20 p. Prepared by editors of international renown, the latest edition of fetal monitoring in practice has been fully updated throughout and now presents the latest information in colour. Why the nichd terminology was developed a lack of consensus was identified in the definitions and nomenclature related to fetal heart rate monitoring and the clinical interpretation of fetal. The perinatal quality foundation examination allows participants to demonstrate knowledge and judgment of fetal heart rate monitoring principles defined by national consensus. It equips midwives and obstetricians with the knowledge and skills to interpret cardiotocographs ctgs correctly. The content is relevant to practitioners anywhere in the world. Identify the purpose of fetal monitoring describe the various methods of monitoring. 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. Gl863 in addition, continuous electronic monitoring should be performed at.
Electronic fetal heart rate monitoring ge healthcare. Fetal ecg analysis for intrapartum electronic fetal monitoring. Standardized guidelines for the interpretation of the fetal heart rate have been suggested by the national institute of child health and human development 3and are adopted in the following discussion. Many attempts to introduce methods of automatic signal processing and evaluation have appeared during the last 20 years, however still no significant progress similar to that in the domain of adult heart rate variability, where open. Any of these causes may eventually lead to fetal hypoxemia and eventually myocardial depression. Open access intrapartum ctg database bmc pregnancy and. Electronic fetal monitoring training efm eintegrity. Despite its widespread use, there is controversy about the efficacy of efm, interobserver and intraobserver variability.
Learn vocabulary, terms, and more with flashcards, games, and other study tools. Guidelines for interpretation kathryn welch, md objectives history of fetal monitoring definitions limitations practice introduction goal of electronic fetal monitoring efm is to detect fetal hypoxia and signal to the clinician that an intervention is needed to. The guide provides a structured approach to ctg interpretation e. Neither i, nor any member of my immediate family, have a significant. Task learning objectives fetal monitor basics 20 min content outline evaluation methods defining characteristics baseline fetal heart rate normal, bradycardia, tachycardia baseline variability absent, minimal, moderate, marked accelerations decelerations early, late, variable. Jan, 2014 cardiotocography ctg is a monitoring of fetal heart rate and uterine contractions. Ceufast fetal monitoring interpretation essentials. The quizzes emphasize a systematic approach to interpreting tracings and use of the appropriate nomenclature.
Internal fetal monitoring ifm requires that the membranes be ruptured and the cervix be sufficiently dilated to insert an intrauterine catheter and apply a fetal scalp electrode. Pdf use of continuous electronic fetal monitoring in a. Use of continuous electronic fetal monitoring in a preterm fetus. Fetal heart rate monitoring, number 62, may 2005, pages, 11611169. The avoidance of adverse fetal outcomes is the objective of intrapartum fetal monitoring. Guideline working party, updated by working party written. Pdf intrapartum fetal heart monitoring interpretation in labour.
Absence of induced accelerations after fetal stimulation. Intrapartum care and fetal heart rate trust reference. Eileen vdoi bsn,rncob luann beacom msn, mph, cns, fnp karen harmon msn, cns, rnc anamaria gallo phd, cns, rnc objectives by the end of this presentation the participant shall. 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. Centralized fetal heart rate monitoring introduces new risks. Interpretation of the electronic fetal heart rate during labor. The two commonly used modalities for intrapartum fhr monitoring are continuous electronic fhr monitoring and intermittent auscultation. Intrapartum care and fetal heart rate monitoring in labour uhl obstetric guideline page 3 of 65 author. Acog fetal heart rate monitoring information minnesota hospital. Macones ga, hankins gd, spong cy, hauth j, moore t. Intrapartum fetal monitoring american family physician. Ctg training for midwives and obstetricians across the world. Dr c bravado, to assist in the systematic interpretation of fetal monitoring.
An understanding of the principles of ctg monitoring and a systematic approach to ctg analysis may enable anaesthetists to better appreciate why. The discussion will focus on interpretation of the electronic fetal monitoring efm tracings for the purpose of education. Jan 28, 2015 as more hospitals turn to centralized fetal heart rate monitoring, they should be aware of the unanticipated, and sometimes problematic, consequences that can occur, says a case study of an event that went undetected with centralized monitoring. Fetal heart monitoring journal of obstetric, gynecologic. The following interactive quizzes test your basic knowledge of fetal heart tracing interpretation. Eugene bailey, md, suny upstate medical university, syracuse. This fetal monitoring system is the best thing apple has ever. External fhr monitoring is the recommended initial method for routine intrapartum monitoring, provided that a recording of acceptable quality is obtained, i.
Threetiered fetal heart rate interpretation system category i category i fhr tracings include all of the following. Normal ranges for fetal electrocardiogram values for the. By understanding the physiologic and pathophysiologic basis of fhr monitoring, as well as its capabilities and limitations, the clinician can reduce the need for interventions. Basic electronic fetal monitoring by beth flege on prezi. 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. This module provides concepts for nursing process interpretation of the fhr fetal heart rate characteristics. The 2008 national institute of child health and human. The fetal nonstress test is a simple, noninvasive test performed in pregnancies over 28 weeks gestation. Pdf electronic fetal monitoring efm has been introduced in the obstetrics practice as a test to identify the first signs of fetal deterioration. Continuous electronic intrapartum fetal heart monitoring 3. Definitions, interpretation, and management this program has taken online efm education to a new level. Electronic fetal heart rate monitoring efm continues to. We aim to encompass a pathophysiological approach to explain how a. Intrapartum fetal heart rate monitoring obstetricsgynecology.
Quizlet flashcards, activities and games help you improve your grades. Over several decades, electronic fetal monitoring documentation has reached a higher level of precision because paper is being replaced with health information technology that incor. The 2008 national institute of child health and human development workshop report on electronic fetal monitoring. External participants, please purchase the fetal heart monitoring principles and practices print book 5th edition through kendall hunt publishing if you would like your own personal copy. Apply nichd terminology to fetal heart rate pattern recognition, interpretation and assessment. Definitions, interpretation, and management recent consensus publications have reshaped the landscape in fetal heart rate monitoring, making it simpler and more practical than it has ever been. Thoroughly updated for its second edition, fetal monitoring interpretation describes and illustrates the full range of patterns revealed by fetal monitoring and explains their clinical significance. Update on definitions, interpretation, and research guidelines. Update on definitions, interpretations, and research guidelines. Interpretation of cardiotocograph traces use tables 1 and 2 to define and interpret cardiotocograph traces and to guide the management of labour for women who are having continuous cardiotocography.
Fetal heart rate interpretation university of rochester. The test is named nonstress because no stress is placed on the fetus during the test. The association of womens health, obstetric and neonatal nurses awhonn is a 501c3 nonprofit membership organization. Interactive, evidencebased, and filled with clinically applicable pearls, this is a perfect route for clinicians to enhance or reinforce their knowledge of efm in all aspects. Our mission is to empower and support nurses caring for women, newborns, and their families through research, education, and advocacy. Physiological ctg interpretation 2018 intrapartum fetal monitoring. Assess fetal wellbeing and response to stress labor a. Mercy healthcare sacramento sacramento, california jim nuovo, m. Cardiotocography ctg or electronic fetal monitoring efm is the most widely used technique for assessing fetal wellbeing in labour in the developed world. Guidelines for interpretation kathryn welch, md objectives history of fetal monitoring definitions limitations practice introduction 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.
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 data obtained to provide care to. Placental dysfunction, too, may lead to a decreased maternal fetal oxygen transfer, andor a smaller volume of placental reserve in proportion to fetal need. These tables include and summarise individual recommendations about fetal monitoring 1. The document provides background on electronic fetal heart rate monitoring efm, definitions of fhr features, criteria for. Standardized nomenclatureforelectronicfetalmonitoring. Participants included obstetric experts and representatives from relevant stakeholder groups and. Emphasis is placed on the physiologic basis of fhr characteristics found on electronic fetal monitoring tracings. Applying nichd terminology and other factors to electronic. Listing a study does not mean it has been evaluated by the u. The monitoring of fetal heart rate fhr status is an important method to check wellbeing of the baby during labor. Electronic fetal monitoring efm is the most common obstetric procedure goal of efm is to detect fetal hypoxia and signal to the clinician that an intervention is needed to correct the oxygen deficiency use common language to communicate and document findings. Interprofessional policies should support the rn in making decisions regarding fetal monitoring practice, intervening independently when appropriate to maternal andor fetal condition, and identifying appropriate mechanisms to use if there is a difference of opinion regarding the interpretation of fetal monitoring data or the womans plan of care.
This objective is the same for all hospitals providing maternity services. Some of these differences may be due to differing attitudes toward electronic fetal monitoring, differences in interpretation of electronic fetal monitoring tracings, and differences in the way. If the instructor shares details regarding actual or potential care decisions, please note those decisions do not necessarily. Fetal heart rate tone monitoring decelerations early, late, variable nclex ob maternity nursing. After completing the essentials of fetal monitoring program, the provider can complete the post test, which includes 11 clinical case studies each with fetal heart rate tracings for interpretation. Pdf one of the most important goals for the anesthesiologist caring for a pregnant woman should be to maintain the uteroplacental unit and fetus in. Intraobserver variability may play a major role in its interpretation. It might just be the most hated technology we cant live without. We aim to encompass a pathophysiological approach to explain how a fetus defends itself against intrapartum hypoxic. Since 1960 it is routinely used by obstetricians to assess fetal wellbeing. Maternity fetal heart rate monitoring summarythis guideline provides guidance for antenatal and intrapartum fetal heart rate fhr monitoring as a fetal welfare assessment tool.
Development workshop report on electronic fetal monitoring. Fetal monitoring practice strips pdf ten actual fetal monitoring strips to practice interpretation complete with. Interprofessional policies should support the rn in making decisions regarding fetal monitoring practice, intervening independently when appropriate to maternal andor fetal condition, and identifying appropriate mechanisms to use if there is a difference of opinion regarding interpretation of fetal monitoring data or a womans plan of care. The fetal monitoring during labour path for the intrapartum care pathway. Fetal heart rate tone monitoring decelerations early. Legaust was a colleague of marsac, a physician of the province of limousin. Patterns of fetal heart rate response at 30 weeks gestation. Clinical dilemmas and recommendations for practice. Development workshop report on electronic fetal monitoring published in obstetrics and gynecology, volume 112, issue 3, 6616663 and in the journal of obstetric, gynecologic and neonatal nursing, volume 37, issue 5, pages 510515. New features include an expanded international author team, the latest guidelines from nice and figo, updated information on clinical assessment and medical litigation, and a new chapter on competency testing in ctg. Indications for ctg in labour please use the trust labour risk assessment tool to identify all the pregnancies where continuous electronic fetal monitoring is clinically indicated or recommended. Intrapartum fetal monitoring guideline revision group. Interpretation includes the systematic analysis of collected assessment data necessary for collaborative diagnosis and intervention. Basic pattern recognition electronic fetal monitoring.780 39 739 434 115 4 185 103 1298 509 529 16 706 712 1055 404 47 801 1294 488 719 871 372 352 501 1032 651 329 1420 601 1127 22 353 375 451 554 169 377 431 158 691 1142