This practice bulletin was devel oped by the acog committee on. By reading this page you agree to acogs terms and conditions. The goal of antepartum fetal surveillance is to prevent fetal death. Highquality intrapartum care, including intermittent monitoring of fetal heart rates fhr to detect and manage abnormalities, is recommended by who and the government of tanzania got and creates potential to save newborn lives in tanzania.
Electronic fetal heart rate monitoring american academy of. Electronic fetal monitoring is performed externally using a doppler. Nomenclature, interpretation, and general management principles in the most recent year for which data are available, approximately 3. In striking a balance between responsibilities and obligations, nurses must play an active role in designing a charting system.
Freeman, one of the pioneers of fetal assessment with heart rate monitoring both antepartum and intrapartum, lamented, clearly, the hopedfor benefit from intrapartum continuous electronic fetal monitoring has not been realized. Fetal heart monitoring journal of obstetric, gynecologic. Intrapartum fetal heart rate monitoring a standardized approach to interpretation and management lecture objectives at the end of. Nomenclature, interpretation and general management principles. Clinical management guidelines for obstetrician gynecologists.
For nearly 4 decades, fetal heart monitoring fhr has been used to assess antenatal and intrapartum fetal wellbeing. The intent of intrapartum fetal surveillance is to assess uterine activity, fetal well. Nomenclature, interpretation, and general management principles. Intrapartum care and fetal heart rate monitoring in labour uhl obstetric guideline page 1 of 65 author. Acog, american college of obstetrics and gynecology. The existing classification systems for fhr patterns were assessed and new recommendations for use in the united states were made 32. Intrapartum fetal monitoring guideline published february 2018 disclaimer this guideline describes fetal monitoring using physiologybased ctg interpretation. Participants included obstetric experts and representatives from relevant stakeholder groups and. It is generally advised that the fetal heart rate be monitored during labor by a competent clinician. The minimum baseline duration must be at least 2 minutes. Electronic fetal heart monitoring is not a substitute for appropriate professional nursing care and support of women in labor. Intrapartum care and fetal heart rate trust reference. The goal of intrapartum fetal monitoring is to recognize changes in fetal oxygenation that could result in adverse outcomes.
The fetal heart rate may be monitored using continuous electronic fhr monitoring efm components external cardiotocography ctg or internal device or auscultated intermittently. The baseline fhr is the heart rate during a 10 minute segment rounded to the nearest 5 beat per minute increment excluding periods of marked fhr variability, periodic or episodic changes, and segments of baseline that differ by more than 25 beats per minute. Acog practice bulletin 106, intrapartum fetal heart rate monitoring. Clinical management guidelines for obstetriciangynecologists, number 70, december 2005 replaces practice bulletin number 62, may 2005. Intrapartum fetal monitoring in labour with risk factors. It has been developed by the editorial board based on the experience gained from maternity units where a reduction in the. Fetap with an internal fetal monitor, an iupc may give a more precise reading of the babys heart rate and the strength of contractions. Thus, fetal heart rate fhr monitoring can be used to determine if a fetus is well oxygenated.
The purpose of this document is to provide obstetric care providers with a framework for. A doppler ultrasound transducer and pressure transducer are placed on the maternal abdomen, which monitor fetal heart rate and the frequency and strength of uterine contractions, respectively. Intrapartum category i, ii, and iii fetal heart rate tracings uptodate. Fetal heart monitoring includes initial and ongoing assessments of the woman and fetus. Nomenclature, interpretation, and general management principles, july 2009. However, one of its limitations is the modest interobserver agreement in ctg interpretation 15. Internal monitoring provides a more accurate and consistent transmission of the fetal heart rate than external monitoring because factors such monigoria movement do not affect it. The document provides background on electronic fetal heart rate monitoring efm, definitions of fhr features, criteria for. Scaleup of doppler to improve intrapartum fetal heart. Intrapartum care and fetal heart rate monitoring in labour uhl obstetric guideline page 2 of 65 author.
Intrapartum assessment of fetal wellbeing bja education. The fetal brain modulates the fetal heart rate through an interplay of sympathetic and parasympathetic forces. Prolonged decelerations are defined as fhr decreases of at least 15 bpm below baseline that last at least 2 minutes but less than 10 minutes. It was used among 45% of laboring women in 1980, 62% in 1988, 74% in 1992, and 85% in 2002 1. Sep 12, 2017 prior to its implementation, intrapartum fetal death rates were between 3 and 4 per. 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. Management of intrapartum fetal heart rate tracings intrapartum electronic fetal monitoring efm is used for most women who give birth in the united states.
Management of intrapartum fetal heart rate tracings. Get new journal tables of contents sent right to your email inbox get new issue alerts. It continues to be the predominant method for intrapartum fetal surveillance despite questions about its ef. Nurses working in intrapartum settings have many responsibilities to ensure a safe and satisfying birth experience for the families in their care. As such, clinicians are faced daily with the management of fetal heart rate fhr tracings. Intrapartum monitoring is designed to detect fetal metabolic acidosis and to prevent hypoxia. Decelerations, tachycardia, and decreased variability american. Intrapartum fetal monitoring chapter obstetric care. Fetal bradycardia is defined as a baseline heart rate less than 110 bpm for at least 10 minutes table 1. A cardiotocograph recording fetal heart rate and uterine contractions. Continuous cardiotocography ctg as a form of electronic fetal monitoring efm for fetal assessment during labour. Provides essential ctg knowledge required for mrcog examination as well as serves as an update for obstetricians of all grades. Intrapartum electronic fetal heart rate monitoring and the prevention of perinatal brain injury. Guideline working party, updated by working party written.
Simultaneous monitoring of the maternal heart rate simultaneous monitoring of the maternal heart rate mhr can be useful in specific maternal health conditions and in cases where it is difficult to distinguish between maternal and fetal heart rates 9 for example complete fetal heart block. A multicenter controlled trial of fetal pulse oximetry in the intrapartum management of nonreassuring fetal heart rate patterns. Intrapartum fetal heart rate monitoring obstetricsgynecology. Acog practice bulletin 120, use of prophylactic antibiotics in labor and delivery, june 2011. Nomenclature fetal heart rate interpretation categories provided framework for evaluation and management of intrapartum patterns based on categories assessment algorithm for fetal heart rate patterns intrapartum resuscitative measures. For both low and highrisk pregnancies, continuous electronic fhr monitoring is not clearly superior to intermittent auscultation with respect to preventing death or poor longterm neurologic outcome and has a high falsepositive rate 24. Factors with varying degrees of influence on the fetal heart rate. Determine the role of additional tests of fetal wellbeing such as fetal scalp blood sampling and fetal ecg stanalyser or stan appreciate the medicolegal aspects of intrapartum fetal heart rate monitoring. Moreover, there is evidence that the use of efm increases the rate of cesarean deliveries and operative vaginal deliveries. Acog practice bulletin 49, dystocia and augmentation of labor, december 2003. Intrapartum fetal abnormal fetal heart rate on auscultation or admission tracing 20minute strip. Mar 14, 2019 intrapartum fetal heart rate monitoring. Aetna considers inoffice and inhospital antepartum fetal surveillance with nonstress tests nst, contraction stress tests cst, biophysical profile bpp, modified bpp, and umbilical artery doppler velocimetry medically necessary according to the american college of obstetricians and gynecologists acog clinical guideline on antepartum fetal surveillance.
Intrapartum electronic fetal monitoring efm is used for most women who give. Buderus gb202 pdf an abrupt increase is defined as an increase from the onset of acceleration to the peak in less than or equal to 30 seconds. University of california, davis, school of medicine davis, california electronic fetal heart rate monitoring is commonly used to assess fetal wellbeing during labor. Guidelines on fetal monitoring aim to codify normal. Soncini e1, paganelli s, vezzani c, gargano g, giovanni battista ls. In the most recent year for which data are available, approximately 3. Many national scientific organizations have also published guidelines on the subject, but perhaps. Utility of intrapartum fetal heart rate monitoring in a. A device to continuously monitor and record the fetal heart rate fhr and uterine contractions by using an external or internal mode, sometimes referred as indirect and direct methods.
Freeman, md fetal heart rate fhr monitoring was introduced over 3 decades ago into clinical use and patient management. Acog practice bulletin minnesota hospital association. A normal tracing reliably predicts a welloxygenated fetus. What are the commonly used methods of intrapartum fetal monitoring. The type and level of monitoring chosen by the woman and her care providers will depend on the antenatal and intrapartum circumstances, perceived risks and patient preference. Agreement and accuracy using the figo, acog and nice.
Acog guidelines on antepartum fetal surveillance practice. Problems with intrapartum fetal heart rate monitoring interpretation and patient management roger k. Clinical practice guideline intrapartum fetal heart rate monitoring 6 intrapartum events that may affect the fhr, for example, the siting of an epidural or the commencement of oxytocin should be noted comprehensively in the maternal notes, signed, dated and timed. No randomized trials have compared intrapartum fetal monitoring with no intrapartum fetal monitoring. College of obstetricians and gynecologists, and the society for maternal fetal medicine partnered to sponsor a 2day workshop to revisit nomenclature, interpretation, and research recommendations for intrapartum electronic fetal heart rate monitoring. Maternity fetal heart rate monitoring summarythis guideline provides guidance for antenatal and intrapartum fetal heart rate fhr monitoring as a fetal welfare assessment tool. Practice bulletins authored by the american college of obstetricians and gynecologists acog are evidencebased documents that summarize current information on techniques and clinical management issues for the practice of obstetrics and gynecology. Setting guidelines for documenting fhr enhances care for. Intrapartum fetal monitoring guideline published february 2018 disclaimer. The art and science of tracing interpretation session 4.
Antepartum fetal surveillance medical clinical policy. This is a retrospective study of 16,980 term, singleton deliveries at a single hospital from 202014. Sep 01, 2000 the american college of obstetricians and gynecologists acog has developed guidelines on antepartum fetal surveillance. These variables are then plotted against time on graph paper. Intrapartum fetal heart rate monitoring home reference fetal monitoring intrapartum fetal monitoring early in gestation the fetal heart rate is predominately under the control of the sympathetic nervous system and arterial chemoreceptors 1. Interpretation of the electronic fetal heart rate during labor. Jul 15, 2015 health care facilities should ensure rn staffing levels meet the changing needs and acuity of the laboring woman and her fetus throughout the intrapartum period. The threetiered fetal heart rate interpretation system should be used to assist in determining fetal status 1. Nov 21, 2016 the international federation of gynecology and obstetrics figo published its first guidelines on fetal heart rate fhr monitoring in 1987 6 and established the only international consensus available at the time the present study was undertaken. American college of obstetricians and gynecologists 2009, july. The international federation of gynecology and obstetrics figo published its first guidelines on fetal heart rate fhr monitoring in 1987 6 and established the only international.
The fetal brain modulates the fetal heart rate through an interplay of sym pathetic and parasympathetic forces. Electronic fetal heart rate monitoring american academy. To determine the quality of fetal heart rate fhr recordings during the first and second stage of labor by quantifying the amount of fetal signal loss in relation to the method of monitoring. Acog fetal heart rate monitoring information minnesota hospital. Interpretation of the electronic fetal heart rate during labor amir sweha, m. Management of intrapartum fetal heart rate tracings acog. American college of obstetricians and gynecologists. Measures of acidosis with repetitive umbilical cord occlusions leading to fetal asphyxia in the near. Paperwork, while essential, often takes time away from providing supportive care for laboring women and their families.
Nomenclature, interpretation, and general management principles this practice bulletin was developed by the acog. Problems with intrapartum fetal heart rate monitoring. The quality of intrapartum fetal heart rate monitoring. Handheld doppler devices have been investigated in several lowresource countries as an alternative to pinard stethoscope and are more sensitive to.
Prior to its implementation, intrapartum fetal death rates were between 3 and 4 per. What is the purpose of intrapartum fetal heart rate monitoring. Cardiotocography ctg is an integral part of intrapartum care in most high. Mercy healthcare sacramento sacramento, california jim nuovo, m. Intrapartum electronic fetal monitoring efm is used for most women who give birth in the united states. 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. The mean fetal heart rate rounded to increments of five beats per minute during a tenminute segment, excluding accelerations, deceleration and periods of marked fhr variability. To evaluate the use of intrapartum electronic fetal heart rate monitoring efm as a screening tool for adverse neonatal outcomes.