The role of fetal ECG monitoring in labour

Abstract

Objectives: To determine if the degree of caput impacts the accuracy of assessing fetal position in labour when completed by third and fourth year obstetrics residents. Methods: Assessment of fetal position during labour was performed by third and fourth year residents when patients were 8 cm dilated or more, had ruptured membranes, and the gestation was 35 weeks or greater. The residents performed digital examinations for location and axis of fetal sutures and fontanelles in order to determine the orientation of the fetal brow and occiput. Ultrasound assessment was performed immediately following resident examination. Residents were blinded to ultrasound findings. Assessments were considered correct if within 15 degrees of ultrasound findings. Transabdominal and transperineal scanning with a 3.5mHz abdominal probe were utilised. Caput was measured at the time of transperineal ultrasound and grouped into no/mild (0-0.99 cm), moderate (1.0-1.99 cm), and marked (2cm+) caput. Chi-squared analysis was performed using SPSS. Results: Twelve residents assessed 143 labouring women. Mean maternal age was 26.4 years (SD 6.2), mean gestational age was 39.3 weeks (SD 1.2), and 42% had a history of a vaginal delivery. Maternal ethnicity was 60.1% black, 35.7% Caucasian, and 4.2% ''other.'' The overall accuracy of the resident exams was 47.9%. The amount of caput widely varied from 0 to 3.10 cm, with the largest number having 1.0-1.99 cm of caput. Caput did not change the accuracy of assessment of fetal position (table 1). Conclusions: Degree of caput did not play an important role in the ability to assess fetal position of sutures and fontanelles by palpation. P13.01: Table 1. Amount of caput Correct % (N) Incorrect % (N) Total N (% of total) No/minimal Objectives: To determine if a history of vaginal delivery and station of the fetus at the time of vaginal exam impact the accuracy of determining fetal position in labour when assessed by third and fourth year obstetrics residents. Methods: Residents performed digital examinations for location and axis of fetal sutures and fontanelles when patients were 8 cm dilated or more, had ruptured membranes, and the gestation was 35 weeks or greater. Transabdominal and transperineal scanning using a 3.5mHz probe were performed immediately following digital exams. Exams were considered correct if within 15 degrees of ultrasound findings. For analysis, assessments were grouped based upon a history of vaginal delivery and then by fetal station of-1 or higher (high), 0 to +1.5 (mid), and +2 or lower (low). Chi-squared analysis was performed using SPSS. Results: Twelve residents assessed 143 labouring women for fetal position. The overall accuracy rate was 47.9%. Women who had a prior vaginal delivery were more likely to have fetal position inaccurately assessed by exam. Correct assessment occurred in 55.4% (N=46) of women without a history of vaginal delivery versus 38.3% (N=23) of women with a vaginal delivery (p=0.044). When the axis of the fetal head was assessed without taking into acc...

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