Fetal Heart Monitoring during Labor - Research Paper Example

Fetal Heart Monitoring During Labor Outline I. II. Introduction (Elimian et al., 2003). III. Comparing continuous fetalheart monitoring to intermittent fetal heart monitoring during labor (Bailey, 2009; Hinshaw & Ullal, 2007). IV. Different types of fetal heart monitoring and the need for each type (Hinshaw & Ullal, 2007). V. Positive and negative outcomes of the fetal heart monitoring during labor process (Young, 2011). VI. The aspects of the intermittent fetal heart monitoring during labor (Young, 2011). VII. Positive and negative outcomes of the intermittent fetal heart monitoring during labor (Young, 2011). VIII. Views and opinion from the local doctors working in the labor and delivery section IX. Potential problems and the likelihood to occur without use of fetal heart monitoring during labor (Bailey, 2009). X. Conclusion XI. Annotated Bibliography Abstract The fetal heart rate monitoring was in use from the year 1960s. The procedure was used to diagnose the causes and the risks that arise from heart rate failure. Some of these risks results into heart hypoxia, cerebral palsy, ischemia encephalopathy, and fetal death. In this regard, the research will determine if continuous fetal heart monitoring decrease fetal incidents compared to intermittent fetal heart monitoring during labor. The paper will discuss the different types of fetal monitoring as well as the need for each kind of monitoring. Positive as well as negative outcomes of fetal heart monitoring during labor will also be described. Similarly, the paper will discuss the aspects of intermittent fetal heart monitoring and the negative and positive aspects that are included. Additionally, the paper will describe the interview performed on doctors working in Labor and Delivery at the local hospital; their views and opinions will be noted. Last will be a determination of potential problems that could arise without the use of fetal monitoring and provide evidence of the possibility of them occurring. Introduction The fetal heart monitoring is the standard method and the most preferred technique to determine the heart rate of the fetus during labor. Determination of the fetal heart rate is vital because it enables the prevention of the fetal distress and fetal death as well as prevention of fetal seizures. Although this procedure is vital for the health of the mother and of the fetus, doctors’ delay in acting when fetal distress detection is shown on the electronic monitor can lead to death of the mother and fetus (Elimian, Lawlor, Figueroa, Wiencek, Garry, & Quirk, 2003). The continuous use of the fetal monitoring electronically has shown a positive impact on the fetal development. The process further reduces the chances of incidences like the fetal failure and eventually fetal death. Comparing CEFM to Intermittent Fetal Heart Monitoring during Labor The continuous fetal heart monitoring is famous in the United States but it has fewer benefits for the pregnant woman or the fetus. Continuous fetal heart monitoring (CEFM) has a negative effect on the labor process in pregnant women. This process can also affect the satisfaction of the maternal delivery by decreasing the maternal mobility, physical contact of the pregnant mother with the partner, and the time period with the nurse or the doctor in comparison to the intermittent auscultation procedure (Bailey, 2009). The intermittent auscultation procedure is known to increase the rate of medical risks. This is chiefly because of the inadequate number of expertise who can use the machines to perform this procedure. The CEFM reduces the risks of neonatal seizures while intermittent monitoring of the fetal heart rate has no effect on neonatal death rate. The intermittent procedure has no effective improvement on the fetal development but rather leads to an increase in the intervention of the epidural analgesia (Hinshaw & Ullal, 2007). Different types of Fetal Heart Monitoring and the need for each type There are different types of procedures used to check the heart rate of an unborn baby. First is the electronic fetal monitoring (EFM), which is important during the fetal heart monitoring to in patients with a high-risk to conditions like fetal seizures. Second is the intermittent auscultation fetal monitoring, which utilizes systemic technique and is needed for patients at a lower-risk than the former (Hinshaw & Ullal, 2007). Third is internal fetal monitoring, which is necessary for high risk mothers. Fourth is telemetry monitoring, which is similar to EFM but its mobility is less limited. Last is the use of fetoscope for mothers who want to avoid the risk of mechanical errors. Positive and Negative outcomes of the Fetal Heart Monitoring during Labor Process Monitoring is vital because it enables the doctor to predict early the absence or the presence of fetal heart distress during labor. The procedure further helps in identifying any form of risks that can occur during the labor process. Thus it enables the doctors to take action in good time and avoid delay that can impose danger on the mother and the fetus (Elimian et al, 2003). The negative impact may include the probability of risking the life of the mother because the technique involves rupturing of the membrane and further monitoring the internal fetal scalp. The procedure puts the mother and the fetus life at risk. Aspects of the Intermittent Fetal Heart Monitoring during Labor The intermittent fetal heart rate monitoring is the technique that involves the use of systemic method called Doppler assessment. The process assesses the fetal heart rate during labor at set rate of time intervals. The procedure is similar to the continous assessment of the electronic fetal monitoring procedure on a low-risk patient. The technique is normally done for a period of 15 to 30 minutes during the first labor stage. The second step involves the patient subjection to the frequency for the next 5 minutes while pushing. The procedure involves the palpation of the abdomen to determine the fetus position. The Doppler is then put on the area with the maximum fetal heart intensity rate. The rate is then put in differentiation and comparison to that of the mother’s pulse rate. Uterine contraction palpation is also determinate followed by FHR counting of the uterine contraction to determine the fetal response on the active labor (Liston, Sawchuck, & Young, 2007). Positive and Negative Outcomes of the Intermittent Fetal Heart Monitoring during Labor For an effective procedure, there ought to be an equal number of the doctors or the nurse in relation to that of the patients. There also should be a well establishment of the techniques that ought to guide the doctors during the procedure. The advantage of the intermittent fetal heart monitoring is that it is essential in studying the heart rate of high-risk patients. The technique has a disadvantage because of its effects on the outcome of the number of the fetal deaths. Moreover, the procedure cannot perform its function in patients with low-risk babies. Furthermore, the procedure can be questioned for change if the fetus is preterm, or show restriction growing, or if the fetus is exposed to the uteroplacental insufficiency mainly due to the effects of preeclampsia (Young, 2011). Views and Opinion from the local Doctors working in the labor and delivery section The doctors’ claimed that the procedure of monitoring fetal heart rate increases the reports of mothers who are referred for cesarean section operations in many cases. The procedure according to most doctors contributed to the use of assisting instrument for vaginal births. Many doctors said that the continuous fetal heart monitoring procedures on pregnant woman during labor is the most preferable technique in comparison to the intermittent monitoring of the fetal heart rate procedure. The doctors further explained that if the patient has a normal FHR tracing then either the intermittent auscultation or the CEFM methods can be used on the patients with low-risk features. The idea may be put into consideration for a change when the pregnancy labor is still in progress. This is because, if the FHR turns out to be abnormal, then interventions are necessary. For instance, if the position of the fetus changes, the oxygen supply of the mother to the fetus, and the administration of the intravenous fluid is necessary (Young, 2011). Potential Problems and the likelihood to occur without use of Fetal Heart Monitoring Fetal heart rate examination is extremely important for all pregnant women during labor process. This is because the physician or the nurse can monitor the progress of the labor process and the condition of the fetus during labor. Undergoing the labor process without the fetal heart rate examination can lead to dangerous and negative effects on the fetus and on the mother. The pregnant mother may have illnesses that may affect the fetus and thus monitoring is necessary to prevent the impact. Diseases such as urinary infections can complicate delivery and affect the health of the baby like syphilis, which can make the baby blind upon delivery. The other potential risks may include the development of fetal distress and cerebral palsy in fetus. Another potential risk is the development of neonatal seizure, which can eventually lead to death of the fetus (Bailey, 2009). Conclusion Although the continuous EFM appears to be the mostly used procedure in many hospitals, new techniques ought to be developed to enhance the service. This is because the new methods will be capable of overcoming the negative and setbacks that come along with the current monitoring procedures. The development will improve the well being of the fetus and the mother during labor stage because the current procedures predispose mothers to operative delivery and prenatal mortality. Further, the survival of both the fetus and the mother will be higher. However, the importance of the current monitoring procedures cannot be overlooked. This is because they have managed to help pregnant women deliver without complication because of early detections of any risk factors. The continuous monitoring appears more preferable to the intermittent one. Hence, mother should consider the most appropriate procedure that will not have side effects and thus ensure successful labor process and delivery. Annotated Bibliography Bailey, E. (2009). Intrapartiate fetal monitoring. American Academy of Family Physicians, 80 (12):1388-1396. Proquest Bailey (2009) discusses intrapartiate fetal monitoring by describing the background of the procedure during labor. The author claims that electronic fetal monitoring reduces neonatal seizures incidence, but notes that the procedure have no positive effect in reducing neonatal mortality or cerebral palsy. Bailey arrived at the conclusion by convening a workshop to offer a systematic approach for interpreting the EFM. Elimian, A., Lawlor, P., Figueroa, V., Wiencek, D., Garry, D., and Quirk, G., (2003, June), Intrapartum assessment of fetal well being: any role for a fetal admission test? Journal of maternal- fetal & neonatal medicine, 13, 6. proquest medical library, New York. Emilian et al., (2003) undertook the research to assess if the fetal admission test predicts intrapartum complications. The authors’ methodology involved the study of heart rate tracings on 426 women. The authors found that women with a non-reactive fetal admission test were more possibly to deliver by Cesarean section. Additionally, they were to have a longer neonatal hospital and have fetal distress leading to Cesarean section. The authors concluded that fetal admission tests are important in predicting the absence of intrapartum fetal distress despite the criterion employed during evaluation. Hinshaw, K., & Ullal, A. (2007). Peripartum and intrapartum assessment of the fetus. Anaesthesia & Intensive Care Medicine, 8(8): 331-336. Hinshaw (2007) argues that intrapartum fetal surveillance is a must in every labor. Hinshaw continuous to claim that continuous electronic fetal monitoring is the mostly used procedure both in medium and high-risk cases. The author provides an in depth analysis of the positive and negative sides of the intrapartum fetal monitoring. Liston, R., S awchuck, D., & Young, D. (2007). Fetal health surveillance: antepartum and intrapartum consensus guideline. Journal of Obstetrics and Gynecology Canada, 29(11):909. Liston and colleagues provides recommends the use of fetal monitoring in both the antepartuma and intapartum period. The reason for their recommendation is because they argue that the surveillance reduce the cases of asphyxia at birth and at the same time ensuring the likelihood of obstetrical intervention at the lowest level. The authors achieved their objective by conducting randomized controlled tests. Young, B. K. (2011, April 06). Intrapartum fetal heart rate assessment. Retrieved from http://www.uptodate.com/contents/intrapartum-fetal-heart-rate-assessment Young (2011) believes that examination of the fetus during labor is a hard task. He argues that the procedures used to monitor the growth like heart rate are dangerous both the baby and the mother. However, mothers have to seek the surveillance because there are benefits as advised by obstetrical firms. Young arrived at his conclusions through the use a trial to compare the differences between when a pregnant woman undertakes the assessment and when not. One of the major findings was that auscultation increased the risk of operative delivery and at the same time did not guarantee decrease of perinatal mortality. Read More