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• W2108018813 abstract "Electronic fetal monitoring (EFM) is a popular technology used to establish fetal well-being. Despite its widespread use, terminology used to describe patterns seen on the monitor has not been consistent until recently. In 1997, the National Institute of Child Health and Human Development (NICHD) Research Planning Workshop published guidelines for interpretation of fetal tracings. This publication was the culmination of 2 years of work by a panel of experts in the field of fetal monitoring and was endorsed in 2005 by both the American College of Obstetricians and Gynecologists (ACOG) and the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN). In 2008, ACOG, NICHD, and the Society for Maternal-Fetal Medicine reviewed and updated the definitions for fetal heart rate patterns, interpretation, and research recommendations. Following is a summary of the terminology definitions and assumptions found in the 2008 NICHD workshop report. Normal values for arterial umbilical cord gas values and indications of acidosis are defined in Table 1.Decelerations are tentatively called recurrent if they occur with ≥50% of uterine contractions in a 20-minute period.Decelerations occurring with <50% of uterine contractions in a 20-minute segment are intermittent.A three-tier Fetal Heart Rate Interpretation system has been recommended as follows:Data from Macones GA, Hankins GDV, Spong CY, Hauth J, Moore T. The 2008 National Institute of Child Health and Human Development workshop report on electronic fetal monitoring. Obstet Gynecocol. 2008;112:661–666.We encourage readers to examine each strip in the case presentation and make a personal interpretation of the findings before advancing to the expert interpretation provided.A 23-year-old previously normotensive G1P0 woman presents to labor and delivery from her prenatal clinic visit at 35–4/7 weeks' gestation with an elevated blood pressure of 152/102 mm Hg, 1+ proteinuria, elevated uric acid of 6.8 mg/dL (404.5 mcmol/L), and new onset of scotomata. She reports increasing swelling in her hands and legs over the past week. She denies right upper quadrant pain, headache, contractions, vaginal bleeding, or fluid leakage. She states that the fetus has been moving well. No findings of note are apparent on her past medical history. Laboratory studies are repeated on arrival and reveal 2+ proteinuria and hemoconcentration with a hematocrit of 37.6% (0.376). Her blood pressure is 136/102 mm Hg. Severe preeclampsia is diagnosed, based on blood pressure and symptomatology. Her cervix is 2 cm dilated, 50% effaced, and -2 station. Ultrasonography confirms that the fetus is cephalic and has an amniotic fluid index of 10 (normal). Leopold maneuvers yield an estimated fetal weight of 6 lb. A fetal tracing is obtained at admission (Fig. 1).Findings on EFM Strip #1 are:A Foley bulb is placed in the cervix and low-dose oxytocin per protocol is started for cervical ripening. Intravenous magnesium is administered for seizure prophylaxis. Because the patient's group B streptococcal status is unknown and she is preterm, penicillin is started per Centers for Disease Control and Prevention guidelines. (3) Her blood pressures range from 136 to 162/88 to 104 mm Hg.Approximately 11 hours after admission, she is 4 cm dilated, 70% effaced, and -1 station. The Foley bulb is removed, and standard-dose oxytocin is initiated per protocol. Epidural analgesia is administered for pain relief. Six hours later, 17 hours after presentation, the maternal heart rate is in the 120s, and she complains of a mild headache. Her laboratory results remain stable. Her fluid is ruptured because she is unchanged since the prior examination. Her EFM strip is shown in Figure 2.Findings on EFM Strip #2 are:Oxytocin is stopped, and the fetal heart rate tracing appears to recover over the next several hours (Fig. 3). An intrauterine pressure catheter is placed.Findings on EFM Strip #3 are:Results of her cervical examination are 6 cm dilated, 80% effaced, and -1 station. Over the next 3 hours, oxytocin is stopped intermittently due to concerns about the fetal heart rate tracing (Fig. 4).Findings on EFM Strip #4 are:An amnioinfusion is started. The cervical examination reveals 9.5 cm dilation, +1 station, and right occiput posterior. She begins to push with good progress, but difficulty is noted in monitoring the fetal heart rate (Fig. 5).Findings on EFM Strip #5 are:Initially, the patient refuses fetal scalp electrode monitoring or assisted delivery. Ultimately, she agrees to fetal scalp electrode placement after further discussion of concerning fetal status (Fig. 6). Her cervical examination shows +3 station and complete dilation.Findings on EFM Strip #6 are:After further discussion, the patient agrees to forceps-assisted vaginal delivery. A 2,435-g female infant is delivered over a mediolateral episiotomy through one contraction. A loose nuchal cord is reduced easily. The infant's heart rate initially is greater than 100 beats/min, but she is without respiratory effort and has poor tone for 30 seconds despite stimulation. Two breaths of positive-pressure ventilation result in spontaneous breathing and cry. Because the infant is grunting and having difficulty maintaining temperature, she is taken to the neonatal intensive care unit for observation. Apgar scores are 5 at 1 minute and 7 at 5 minutes. The arterial cord gas findings (Table 2) reflect a mixed acidosis. No placental pathology is available.A follow-up venous blood gas measurement 3 hours later shows a pH of 7.34 with a base excess of 0.0 on room air. The infant's tone improves by the second postnatal day. Ampicillin and gentamicin therapy is initiated until neonatal sepsis is ruled out. She is discharged on postnatal day 4.Maternal blood pressures quickly return to normal postpartum. Her laboratory results remain normal, and she is discharged on postpartum day 2 in good condition." @default.
• W2108018813 created "2016-06-24" @default.
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• W2108018813 date "2010-03-01" @default.
• W2108018813 modified "2023-09-26" @default.
• W2108018813 title "Strip of the Month: March 2010" @default.
• W2108018813 cites W1588000104 @default.
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• W2108018813 doi "https://doi.org/10.1542/neo.11-3-e150" @default.
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