Fetal Heart Rate Monitoring: Interpretation and Collaborative Management

Abstract

Effective intrapartum fetal heart rate (FHR) monitoring requires ongoing collaboration among health care providers. Nurses, midwives, and physicians must have a shared understanding of 1) how FHR tracings are interpreted, 2) which FHR patterns are associated with actual or impending fetal acidemia, 3) when and within what time frame the physician or the midwife should be notified of variant FHR patterns, 4) how quickly physicians and midwives should respond when notified of variant patterns, and 5) the indications for and optimal timing of interventions such as operative delivery. This article reviews the literature on FHR monitoring and includes a discussion of the advantages and limitations of different monitoring modalities. An overview of those FHR patterns are associated with presumed fetal acidemia is presented, as well as sample multidisciplinary FHR monitoring guidelines and an exercise in intrapartum FHR pattern evaluation that can be used to initiate development of local FHR monitoring patterns.

Severe asphyxia due to delivery‐related malpractice in Sweden 1990–2005

“…The most frequently observed FHR patterns associated with CP in connection with intrapartal asphyxia are those with multiple late decelerations and decreased beat-to-beat variability 17,18. These patterns are weak predictors of CP, which emphasise that we must increase our attention to all available signs of asphyxia during labour 19. A previous study has shown that most delivery units in Sweden have written guidelines for CTG monitoring routines and FBS 20.…”

Closed Claims Analysis of 65 Medical Malpractice Cases Involving Nurse‐Midwives

“…On the basis of findings from this closed claims review, the following recommendations, proposed for consideration by the authors to limit liability exposure with fetal assessment and FHR monitoring interpretation, are noted in Table 2 16–18 …”

The human factor: the critical importance of effective teamwork and communication in providing safe care

“…9 He has adopted a method of fetal heart rate interpretation to enable medical staff such as doctors, nurses, midwives and medical students, to use a common language to optimise the chances of problem recognition. Once fetal distress has been identified, very simple and effective rules are activated: if you see a problem, you have 1 minute to look at by yourself; 2 minutes to look at it with someone else; and by minute three you are physically on your way to correcting the problem.…”