NICHD definitions and terminology

Class, today I am posting a power point presentation that discusses the NICHD definitions and terminology for FHR baseline, variability, late and variable decelerations. Please post any questions or comments you may have after viewing the presentation.
Please click on the link below to view power point.



www.slideshare.net/dhastee/electronic-fetal-monitoring-ppt

Emergency response

Class

This post contains a 9 minute video on emergency response. This is the first part of a four part series on indentifying and responding to non- reassuring fetal heart patterns, SBAR communication, and appropriate documentation. This video is emergency response. Please post your comments when you finish viewing the video.
I had the pleasure of attending a two day fetal monitor interpretation education with the presenter, Michael Fox on the video a few years ago.


http://www.youtube.com/watch?v=1PwGRDnXwow

Electronic Fetal Monitoring definitions

Class,
            The previous post described the six components to interpretation of the fetal monitor tracing. This post contains the pattern definitions. We will be referring to the contents of these two posts as we explore fetal heart tracing interpretation and the significance of the various patterns to fetal well being.    

Pattern Definitions

Baseline • The mean FHR rounded to increments of 5 beats per minute during a 10-minute segment, excluding:

—Periodic or episodic changes

—Periods of marked FHR variability

—Segments of baseline that differ by more than 25 beats per minute

• The baseline must be for a minimum of 2 minutes in any 10-minute segment, or the baseline for that time period is indeterminate. In this case, one may refer to the prior 10-minute window for determination of baseline.

• Normal FHR baseline: 110–160 beats per minute

• Tachycardia: FHR baseline is greater than 160 beats per minute

• Bradycardia: FHR baseline is less than 110 beats per minute

Baseline variability • Fluctuations in the baseline FHR that are irregular in amplitude and frequency

• Variability is visually quantitated as the amplitude of peak-to-trough in beats per minute.

—Absent—amplitude range undetectable

—Minimal—amplitude range detectable but 5 beats per minute or fewer

—Moderate (normal)—amplitude range 6–25 beats per minute

—Marked—amplitude range greater than 25 beats per minute

Acceleration • A visually apparent abrupt increase (onset to peak in less than 30 seconds) in the FHR

• At 32 weeks of gestation and beyond, an acceleration has a peak of 15 beats per minute or more above baseline, with a duration of 15 seconds or more but less than 2 minutes from onset to return.

• Before 32 weeks of gestation, an acceleration has a peak of 10 beats per minute or more above baseline, with a duration of 10 seconds or more but less than 2 minutes from onset to return.

• Prolonged acceleration lasts 2 minutes or more but less than 10 minutes in duration.

• If an acceleration lasts 10 minutes or longer, it is a baseline change

.

Early deceleration • Visually apparent usually symmetrical gradual decrease and return of the FHR associated with a uterine contraction

• A gradual FHR decrease is defined as from the onset to the FHR nadir of 30 seconds or more.

• The decrease in FHR is calculated from the onset to the nadir of the deceleration.

• The nadir of the deceleration occurs at the same time as the peak of the contraction.

• In most cases the onset, nadir, and recovery of the deceleration are coincident with the beginning, peak, and ending of the contraction, respectively.

Late deceleration • Visually apparent usually symmetrical gradual decrease and return of the FHR associated with a uterine contraction

• A gradual FHR decrease is defined as from the onset to the FHR nadir of 30 seconds or more.

• The decrease in FHR is calculated from the onset to the nadir of the deceleration.

• The deceleration is delayed in timing, with the nadir of the deceleration occurring after the peak of the contraction.

• In most cases, the onset, nadir, and recovery of the deceleration occur after the beginning, peak, and ending of the contraction, respectively.

Variable deceleration • Visually apparent abrupt decrease in FHR

• An abrupt FHR decrease is defined as from the onset of the deceleration to the beginning of the FHR nadir of less than 30 seconds.

• The decrease in FHR is calculated from the onset to the nadir of the deceleration.

• The decrease in FHR is 15 beats per minute or greater, lasting 15 seconds or greater, and less than 2 minutes in duration.

• When variable decelerations are associated with uterine contractions, their onset, depth, and duration commonly vary with successive uterine contractions.

Prolonged deceleration • Visually apparent decrease in the FHR below the baseline

• Decrease in FHR from the baseline that is 15 beats per minute or more, lasting 2 minutes or more but less than 10 minutes in duration.

• If a deceleration lasts 10 minutes or longer, it is a baseline change.

Sinusoidal pattern • Visually apparent, smooth, sine wave-like undulating pattern in FHR baseline with a cycle frequency of 3–5 per minute which persists for 20 minutes or more.

Abbreviation: FHR, fetal heart rate.

Macones GA, Hankins GD, Spong CY, Hauth J, Moore T. The 2008 National Institute of Child Health and Human Development workshop report on electronic fetal monitoring:

update on definitions, interpretation, and research guidelines. Obstet Gynecol 2008;112:661–6.

Introduction to appropriate use of terms describing FHR patterns

Appropriate clinical management of various fetal heart rate (FHR) patterns is dependent on the use of standardized definitions that have been determined by the NICHD. Adopting a common language for FHR pattern definitions and documentation is agreed upon by providers to enhance communication among care givers and therefore, enhance maternal-fetal safety. Timely intervention during non reassuring FHR patterns is dependent on clear communication between providers who are caring for the individual patient. There are several patterns that are predictive of current or impending fetal asphyxia so severe that the fetus is at risk for neurologic and other fetal damage. Members of the perinatal team have a shared method of interpreting FHR patterns and management guidelines.
A full description of an EFM tracing requires a qualitative and quantitative description of:
            1. Uterine contractions
            2. Baseline FHR
            3. Baseline FHR variability
            4. Presence of accelerations
            5. Periodic or episodic decelerations
            6. Changes or trends of FHR patterns over time

Next posting will include fetal heart characteristics and pattern definitions.


Macones, G., Hankins, G., Spong, C., Hauth, J., and Moore, T. (2008). The 2008 National Institute of Child Health and Development Workshop Report on Electronic Fetal Monitoring. Obstetrics and Gynecology, 112 (3), pp. 661-666.

Simpson, K. & Creehan, P. (2008). Fetal assessment during labor. In Perinatal Nursing, 3^rd ed.  Philadelphia, Pa.: Lippincott, Williams, and Wilkens

Objectives

The objectives for the EFM course are as follows. The student will be able to:

1. Identify fetal oxygenation needs, mechanical and pharmacological factors influencing fetal oxygenation.
2. Recognize EFM elements consistent with normal oxygenation and possible evolving metabolic acidemia, and the interventions for each.
3. Define and recognize all elements of EFM tracing including: FHR baseline, variability, accelerations, decelerations, and uterine contraction characteristics using the standard NICHD nomenclature.
4. Distinguish abnormal FHR tracings from normal
5. Recognize common perinatal complications, noting both maternal and fetal responses.
6. Evaluate interventions and modify plan of care.
7. Apply current standards of practice, documentation essentials and legal principles relative to EFM.

Electronic Fetal Monitoring

Monday, June 13, 2011

Electronic Fetal Monitoring

The introduction of electronic fetal monitoring (EFM) in the late 1960's has had a huge impact on perinatal care and the practice of nursing. With attention on the effects of perinatal morbidity and mortality and the role in healthcare costs and malpracticee litigation, EFM is used in the majority of labor and delivery units in the United States. The National Institute for Child Health and Development (NICHD) introduced standardized FHR pattern definitions and Joint Commission on Accreditation of Healthcare Organizations (JCAHO) recommended use of standard language for communication and documentation of FHR patterns. In 2005, the Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN) and the American College of Obstetricians and Gynecologists (ACOG) supported the adoption of the definitions for FHR patterns.
Clincal reliance on EFM is high and is used in the clinical setting to determine adequacy of fetal oxygenation and well-being during labor. Adoption of a common language for FHR pattern definitions and documentation is routinely used by all providers which enhances interdisciplinary communication and maternal-fetal safety.
Over the next 4 weeks, there will be postings that will define FHR patterns, discuss physiologic basis for FHR monitoring, interpretation of FHR, and nursing management of FHR patterns.

Simpson, K. (2009). Fetal assessment during labor. In Simpson, K. & Creehan, P. (2008). Perinatal Nursing, 3rd ed. Philadelphia, Pa: Lippincott, Williams, and Wilkens.