![]() ![]() 20 Lactate fetal scalp sampling (direct measurement of lactate by a probe) is another option that boasts a sample-to-result time of two minutes however, its use has not resulted in improved newborn outcomes. 16 However, because of a 10% inadequate sample rate and a prolonged sample-to-result time of 18 minutes on average, this test is rarely performed in the United States. Fetal scalp sampling, which requires amniotomy, tests fetal pH for the presence of acidemia. Several adjuncts have been studied to overcome the high false-positive rate of continuous electronic fetal monitoring. Recommended frequency of structured intermittent auscultation during labor * †Īmerican College of Obstetricians and GynecologistsĪssociation of Women's Health, Obstetric and Neonatal NursesĪt least hourly (< 4 cm cervical dilation)ġ5 to 30 minutes (4- to 5-cm cervical dilation) With one hand holding the probe in place, the other hand palpates the uterine fundus to detect maternal contractionsįollowing contractions, baseline fetal heart rate is assessed by counting the number of beats during a 30- to 60-second intervalįor a minimum of 1 minute following contraction onset, fetal heart rate is reassessed at 6- to 10-second intervals to detect accelerations or decelerations in heart rate Labor nurse determines current fetal position and best location to place Doppler handheld probe (usually over the fetal back) with Leopold maneuvers transabdominal ultrasonography (passive mode) can be used to identify the location of the fetal heart if manual palpation proves difficult continuous electronic fetal monitoring patient agreement to structured intermittent auscultation is documented in medical record labor team ensures appropriate nurse staffing (1:1) The clinician and the patient with a low-risk pregnancy discuss the benefits of structured intermittent auscultation vs. Perform amnioinfusion for recurrent variable decelerations to reduce the risk of cesarean delivery. Guidelines, with one small disease-oriented randomized controlled trial and one Cochrane review focusing on tocolytics aspect of intrauterine resuscitation Treat placental fetal perfusion through intrauterine resuscitation before proceeding to immediate delivery for all Category II or III tracings with concern for fetal acidosis. The presence of moderate variability and/or accelerations is predictive of a lack of fetal acidosis. 1, 14, 16Ĭochrane review of low-quality evidence and practice guidelines from the American College of Obstetricians and Gynecologists Structured intermittent auscultation can be used for low-risk labor because it statistically decreases cesarean and operative vaginal delivery rates without increasing cerebral palsy or fetal death. Category III tracings are highly concerning for fetal acidosis, and delivery should be expedited if immediate interventions do not improve the tracing. Recurrent deep variable decelerations can be corrected with amnioinfusion. ![]() Category II tracing abnormalities can be addressed by treating reversible causes and providing intrauterine resuscitation, which includes stopping uterine-stimulating agents, fetal scalp stimulation and/or maternal repositioning, intravenous fluids, or oxygen. Presence of moderate fetal heart rate variability and accelerations with absence of recurrent pathologic decelerations provides reassurance that acidosis is not present. Category II tracings are indeterminate, are present in the majority of laboring patients, and can encompass monitoring predictive of clinically normal to rapidly developing acidosis. Category I tracings reflect a lack of fetal acidosis and do not require intervention. The National Institute of Child Health and Human Development terminology is used when reviewing continuous electronic fetal monitoring and delineates fetal risk by three categories. However, structured intermittent auscultation remains difficult to implement because of barriers in nurse staffing and physician oversight. Structured intermittent auscultation is an underused form of fetal monitoring when employed during low-risk labor, it can lower rates of operative and cesarean deliveries with neonatal outcomes similar to those of continuous electronic fetal monitoring. The widespread use of continuous electronic fetal monitoring has increased operative and cesarean delivery rates without improved neonatal outcomes, but its use is appropriate in high-risk labor. ![]() Because these events have a low prevalence, continuous electronic fetal monitoring has a false-positive rate of 99%. Continuous electronic fetal monitoring was developed to screen for signs of hypoxic-ischemic encephalopathy, cerebral palsy, and impending fetal death during labor. ![]()
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