Fetal Heart Tracings M3 Clerkship Orientation


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FETAL HEART TRACINGS M3 OB/GYN CLERKSHIP
ORIENTATION

Department of Obstetrics and Gynecology

MOST LAYPERSONS THINK WE CAN DO …

GOALS FOR TODAY
WHO – gets monitored WHY – is this important enough to warrant a whole separate lecture WHEN – are fetuses monitored WHERE – can this be done
WHAT is it and HOW do I interpret it??

WHO?
Intrapartum - Women in labor (but not all)
 There are alternatives  Some women choose not to be monitored
Antepartum monitoring
 Pregnant women with maternal or fetal concerns  Known fetal problems

WHO – IS IT REQUIRED?
How did all this start?
 -FHT monitoring is nearly 60 years old
 Was developed in 1968 (Miller,
et.al)
• -Use has only increased since then and is now standard of care
It is the most common obstetric procedure done and 85% of fetus have had external fetal monitoring (ACOG practice
bulletin number 70)

THEN WHY?
oResearch has shown that not shown that monitoring leads to better outcomes (reduction of neurologic problems in neonates) o“The goal of fetal monitoring is to prevent fetal injury resulting from interruption of fetal oxygenation during labor or the antepartum period” oPossible decrease in neonatal seizures, cerebral palsy, and intrapartum death –resultant from neurologic response to lack of oxygenation oGives information about fetal status in the moment only and has poor positive predictive value
MILLER ET. AL

WHEN AND WHERE
ANTEPARTUM AND INTRAPARTUM
Maternal indications:
 Labor  Hypertensive disorders  Diabetes
Fetal indications
 Growth restriction  Decreased movement
In the ambulatory setting or
Labor and delivery

WHAT AND HOW?
The National Institute of Child Health and Human Development (NICHD) guidelines were created to standardize the nomenclature
 For appropriate patient management  For standardized communication and documentation  To assist with decisions about delivery and advising our pediatric colleagues about expected outcomes

WHAT AND HOW
External monitoring (EFM) Internal monitoring (FSE) – fetal scalp electrode

HOW DO WE DO IT?
Fetoscope

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Fetal Heart Tracings M3 Clerkship Orientation