1 A Brief History of Fetal Monitoring, 1
Historical Overview, 1
Randomized Trials of Electronic Fetal Monitoring, 3
Research at the End of the 20th Century, 3
Fetal Monitoring in the 21st Century, 4
Summary, 6
2 Physiologic Basis for Electronic Fetal Heart
Rate Monitoring, 10
Transfer of Oxygen from the Environment
to the Fetus, 10
External Environment, 12
Maternal Lungs, 12
Maternal Blood, 12
Maternal Heart, 14
Maternal Vasculature, 15
Uterus, 15
Placenta, 16
Fetal Blood, 21
Umbilical Cord, 22
Fetal Response to Interrupted Oxygen Transfer, 22
Mechanisms of Injury, 24
Injury Threshold, 24
Summary, 26
3 Methods and Instrumentation, 28
Intermittent Auscultation of Fetal Heart Rate, 28
Description, 28
Leopold’s Maneuvers, 31
Utilization, Procedure, and Frequency of Intermittent
Auscultation, 33
Documentation of Auscultated Fetal Heart Rate, 36
Benefits and Limitations of Auscultation, 37
Electronic Fetal Monitoring, 38
Overview, 38
Converting Raw Data Into a Visual Display of Fetal
Heart Rate, 40
External Mode of Monitoring, 42
Ultrasound Transducer, 42
Tocotransducer, 45
Advantages and Limitations of External Transducers, 46
Internal Mode of Monitoring, 49
Fetal Spiral Electrode, 49
Contraindications, 50
Situations Requiring Caution, 50
Intrauterine Pressure Catheter, 51
Advantages and Limitations of Internal Monitoring, 53
Display of Fetal Heart Rate, Uterine Activity, and Other
Information, 54
Monitor Tracing Scale, 54
Monitoring Multiple Gestations, 57
Artifact Detection and Signal Ambiguity (Coincidence)
With Maternal Heart Rate, 59
Telemetry, 64
Electronic Fetal Monitoring Troubleshooting, 65
Troubleshooting Actions, 65
Computerized Perinatal Data Systems, 67
Computer Decision Analysis of the Fetal Heart Rate, 71
Data-Input Devices, 71
Summary, 72
4 Uterine Activity Evaluation and Management, 77
Assessment Methods: Palpation and Electronic
Monitoring, 77
Manual Palpation, 78
Electronic Monitoring of Uterine Activity, 79
Parameters for Normal Labor, 81
Defining Adequate Uterine Activity, 83
Defining Excessive Uterine Activity, 88
Common Underlying Causes of Excessive Uterine
Activity, 91
Corrective Measures to Decrease Excessive Uterine
Activity, 92
Current Trends in Labor Support and Management, 92
Latent Phase Abnormalities, 93
Active Phase Abnormalities, 94
Second-Stage Abnormalities, 95
Uterine Activity and Oxytocin Use, 95
Summary, 99
5 Pattern Recognition and Interpretation, 104
The Evolution of Standardized Fetal Heart
Rate Definitions, 104
The 2008 National Institute of Child Health and Human
Development Consensus Report, 104
Evidence-Based Interpretation of Fetal Heart Rate
Patterns, 107
National Institute of Child Health and Human
Development Definitions: General Considerations, 109
Five Essential Components of a Fetal Heart Rate
Tracing, 110
Definitions, Physiology, and Interpretation of Specific
Fetal Heart Rate Patterns, 110
Baseline Rate, 110
Categories of Baseline Rate, 112
Tachycardia, 112
Bradycardia, 114
Baseline Fetal Heart Rate Variability, 115
Categories of Baseline Variability, 118
Absent Variability, 118
Minimal Variability, 120
Moderate Variability, 120
Marked Variability, 121
Sinusoidal Pattern, 121
Acceleration, 122
Decelerations, 123
Types of Decelerations, 124
Early Deceleration, 124
Late Deceleration, 125
Variable Deceleration, 127
Prolonged Deceleration, 130
Fetal Cardiac Arrhythmias, 132
Terms and Concepts Not Supported by Evidence
or Consensus, 133
Wandering Baseline, 133
Lambda Pattern, 133
Shoulder, 133
Checkmark Pattern, 134
End-Stage Bradycardia and Terminal Bradycardia, 134
Uniform Accelerations, 134
Atypical Variable Decelerations, 135
Variable Deceleration With a Late Component, 135
Mild, Moderate, and Severe Variable Decelerations, 136
V-Shaped Variables and W-Shaped Variables, 136
Good Variability Within the Deceleration, 137
Other Mechanisms That Lack Scientific Basis, 137
Summary, 139
6 Intrapartum Management of the Fetal Heart
Rate Tracing, 145
Fundamental Principles, 145
Standard of Care, 146
Confirm Fetal Heart Rate and Uterine Activity, 147
Evaluate Fetal Heart Rate Components, 147
A Standardized “ABCD” Approach to Fetal Heart Rate
Management, 149
A: Assess the Oxygen Pathway and Consider Other
Causes of Fetal Heart Rate Changes, 152
B: Begin Corrective Measures as Indicated, 153
C: Clear Obstacles to Rapid Delivery, 156
D: Delivery Plan, 157
Expectant Management Versus Delivery, 157
Other Methods of Fetal Monitoring, 160
Intrapartum Fetal Scalp pH and Lactate Determination, 160
Fetal Scalp Stimulation and Vibroacoustic
Stimulation, 160
Computer Analysis of Fetal Heart Rate, 161
Fetal Pulse Oximetry, 161
ST Segment Analysis, 161
Umbilical Cord Blood Gas Analysis, 163
Summary, 165
7 Influence of Gestational Age on Fetal
Heart Rate, 170
The Preterm Fetus, 170
Baseline Fetal Heart Rate in the Preterm Fetus, 172
Baseline Variability in the Preterm Fetus, 173
Periodic and Episodic Heart Rate Changes in the Preterm
Fetus, 173
Behavioral States in the Preterm Fetus, 175
Preterm Uterine Activity, 177
Short-Term Tocolytic Therapy and Effect on Fetal Heart
Rate, 178
Monitoring the Preterm Fetus, 184
The Late-Term and Postterm Fetus, 185
Fetal Assessment, 186
Risks Associated with Postterm Pregnancy, 186
Management of Postterm Pregnancy, 188
Summary, 188
8 Fetal Assessment in Non-Obstetric Settings, 197
Maternal Trauma Algorithm, 197
A Culture of Patient Safety, 197
Pregnancy Anatomy and Physiology, 198
Obstetric Patients in the Emergency Department, 198
Federal Law and Emergency Medical Treatment and
Active Labor Act, 203
Pregnant Trauma Victim Assessment and Care, 203
Primary and Secondary Survey in the
Emergency Department, 205
Emergent Cesarean Birth and Resuscitative
Hysterotomy, 210
Stabilization and Discharge, 210
Non-Obstetric Surgical Procedures: Maternal–Fetal
Assessment and Care, 212
Intraoperative Maternal–Fetal Assessment, 213
Tocolytic Agents and Antenatal Corticosteroids, 216
Fundamentals of Non-Obstetric Surgery, 216
Summary, 216
9 Antepartum Fetal Assessment, 221
Comparing Antepartum Testing Methods, 221
Methods of Testing, 225
Contraction Stress Test and Oxytocin Challenge
Test, 225
The Nonstress Test, 228
The Biophysical Profile, 230
The Modified Biophysical Profile, 232
Fetal Movement Counts, 234
Doppler Velocimetry of Maternal and Fetal Blood
Vessels, 235
Biochemical Assessment, 237
Summary, 239
10 Patient Safety, Risk Management, and
Documentation, 243
Risk Management, 243
The Decision-Making Process in Electronic Fetal
Monitoring and Intermittent Auscultation, 244
Central Concepts in Liability Claims, 246
Components of Care: Assessment, Communication, and
Documentation, 248
Liability in Fetal Monitoring, 251
Fetal Monitoring Documentation, 251
Documentation Components of the Electronic Fetal
Monitoring Evaluation, 253
Common Documentation Dilemmas, 255
Use of Fetal Heart Rate Categories, 255
Documentation of Uterine Activity, 257
Quantification of Decelerations, 258
Frequency of Electronic Fetal Monitoring Assessment
and Documentation, 258
Electronic Fetal Monitoring Documentation
Policies, 263
Summary, 266
11 Obstetric Models of Care and Electronic
Fetal Monitoring Outside the United
States, 269
Obstetric Models of Care, 269
Electronic Fetal Monitoring: Cardiotocography, 271
International Intermittent Auscultation and
Cardiotocography Guidelines, 273
Guidelines for Terminology and Interpretation, 276
Methods of Determining Fetal Acid–Base Status, 279
Fetal Blood Sampling, 279
ST Analysis of the Fetal Electrocardiogram, 281
Summary, 282
Appendix A: Amnioinfusion, 288
Appendix B: Fetal Heart Rate Tracings Review, 291
Appendix C: Self-Assessment, 332
Index, 338
Mosby’s® Pocket Guide to Fetal Monitoring: A Multidisciplinary Approach (Nursing Pocket Guides) 9th Edition PDF Ebook
