Source: ACOG (The American College of Obstetricians and Gynecologists) July 2009
ACOG has now published a revised version of it’s guidelines for Fetal Heart Rate (FHR) monitoring. In practice Bulletin #106, ACOG has sought to improve consistency of common terms and to reduce variability (bad word choice) in FHR interpretation.
FHR was used in less than 45% of pending deliveries in 1980 and 85% in 2002. Oddly, the rates of perinatal mortality and of cerebral palsy (CP) have remained the same despite advances in monitoring. Some of the more interesting findings include the following: false-positive rates of EFM (Electronic Fetal Monitoring) for predicting cerebral palsy exceeds 99%; Pulse oximetry has not been shown to be clinically useful for assessing fetal status; Interpretation of FHR tracing is subject to high inter (between) and intra (within)-observer variability (not a good thing).
Hyperstimulation and hypercontractility are no longer recommended terms. Only Medical Malpractice lawyers will recognize why that is so funny. (Not “Ha! Ha!” funny either).
The best recommendations are also the most obvious: woman with high-risk pregnancies should undergo continuous FHR monitoring when used during labor (as opposed to…?) nurses and physicians should review the EFM frequently–approximately every 30 minutes in the first stage of labor and every 15 minutes in the second stage.
posted by David Marc Schwadron, Esq.