BOOK
Mosby's Pocket Guide to Fetal Monitoring - E-Book
Lisa A. Miller | David A. Miller | Rebecca L. Cypher
(2017)
Additional Information
Book Details
Abstract
Authored by a nurse-midwife, a perinatologist, and a nurse, Mosby’s Pocket Guide to Fetal Monitoring: A Multidisciplinary Approach, 8th Edition is an evidence-based resource on fetal heart rate monitoring for all clinicians — whether you are a nurse, a physician or a midwife, a student or an instructor, this guide has information crucial to your practice. Designed specifically for the clinical environment, it provides a single source for interpretation and management of electronic fetal monitoring – in labor and delivery, the intensive care unit, inpatient antepartum units, or the obstetric or midwifery office.
- Pocket-sized, two-color design offers portability and easy access to information.
- Descriptions of the relationship between fetal heart rate and fetal acidemia alert you to important considerations in the care of the laboring patient.
- Patient safety and risk management strategies with case study illustrations and legal commentary include guidelines for providing safe and competent care.
- Coverage of innovative practices supports a culture of patient safety and improved quality outcomes in high-reliability perinatal units addressing:
- Use of a common language for fetal heart rate patterns with a common construct for interpretation
- Emergency preparedness (multidisciplinary mock emergencies, simulations, debriefing after critical events, and exemplary practice)
- Human factor issues (step-by-step process to improve communication, situational awareness, no-fault/just culture, teamwork, and collegiality)
- Selected FHR Tracings and Cases: Interpretation and Documentation appendix provides an important reference tool for all clinicians.
- Expert author team with international presence.
- NEW! Two simple principles of interpretation that are evidence- and consensus-based.
- NEW! Content on Category II tracing management prepares you to assist in delivery decisions.
- NEW! Neonatal encephalopathy content keeps you in the know.
- UPDATED! Revised chapters feature the most up-to-date information.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Inside Front Cover | ES2 | ||
| Mosby's Pocket Guide to Fetal Monitoring: A Multidisciplinary Approach | i | ||
| Copyright | ii | ||
| Reviewers | iii | ||
| Acknowledgments | iv | ||
| Preface | v | ||
| Description | v | ||
| Features | vi | ||
| Organization | vi | ||
| Contents | ix | ||
| Chapter 1: A Brief History of Fetal Monitoring | 1 | ||
| Historical overview | 1 | ||
| Randomized trials of electronic fetal monitoring | 2 | ||
| Research at the end of the twentieth century | 4 | ||
| Fetal monitoring in the twenty-first century | 5 | ||
| Summary | 6 | ||
| References | 6 | ||
| Chapter 2: Physiologic Basis for Electronic Fetal Heart Rate Monitoring | 10 | ||
| Transfer of oxygen from the environment to the fetus | 10 | ||
| External Environment | 11 | ||
| Maternal Lungs | 11 | ||
| Maternal Blood | 12 | ||
| Maternal Heart | 13 | ||
| Maternal Vasculature | 14 | ||
| Uterus | 15 | ||
| Placenta | 15 | ||
| Intervillous Space Pao2 | 18 | ||
| Intervillous Space Blood Flow | 19 | ||
| Chorionic Villous Surface Area | 19 | ||
| Diffusion Across the “Blood-Blood” Barrier | 20 | ||
| Interruption of Placental Blood Vessels | 20 | ||
| Summary of Placental Causes of Disrupted Oxygenation | 20 | ||
| Fetal Blood | 21 | ||
| Umbilical Cord | 21 | ||
| Fetal response to interrupted oxygen transfer | 23 | ||
| Mechanisms of Injury | 23 | ||
| Injury Threshold | 24 | ||
| Summary | 25 | ||
| References | 26 | ||
| Chapter 3: Methods and Instrumentation | 27 | ||
| Intermittent auscultation of fetal heart rate | 27 | ||
| Description | 27 | ||
| Leopold’s Maneuvers | 30 | ||
| Utilization, Procedure, and Frequency of Intermittent Auscultation | 32 | ||
| Documentation of Auscultated Fetal Heart Rate | 33 | ||
| Interpretation of Auscultated Fetal Heart Rate | 35 | ||
| Benefits and Limitations of Auscultation | 35 | ||
| Benefits | 35 | ||
| Limitations | 35 | ||
| Electronic fetal monitoring | 36 | ||
| Overview | 36 | ||
| Converting Raw Data Into a Visual Display of FHR | 37 | ||
| External mode of monitoring | 39 | ||
| Ultrasound Transducer | 39 | ||
| Description | 39 | ||
| Placement of Ultrasound Transducer | 40 | ||
| Tocotransducer | 42 | ||
| Description | 42 | ||
| Placement of Tocotransducer | 42 | ||
| Advantages and Limitations of External Transducers | 44 | ||
| Advantages | 44 | ||
| Limitations | 44 | ||
| Internal mode of monitoring | 44 | ||
| Fetal Spiral Electrode | 44 | ||
| Description | 44 | ||
| Contraindications | 45 | ||
| Situations Requiring Caution | 46 | ||
| Placement of Fetal Spiral Electrode | 46 | ||
| Intrauterine Pressure Catheter | 47 | ||
| Description | 47 | ||
| Placement of Intrauterine Pressure Catheter | 48 | ||
| Advantages and Limitations of Internal Monitoring | 50 | ||
| Advantages | 50 | ||
| Limitations | 51 | ||
| Display of fetal heart rate, uterine activity, and other information | 51 | ||
| Monitor Tracing Scale | 52 | ||
| Monitoring Multiple Gestations | 52 | ||
| Artifact Detection and Signal Ambiguity (Coincidence) with MHR | 56 | ||
| Telemetry | 61 | ||
| Troubleshooting the Monitor | 61 | ||
| Computerized Perinatal Data Systems | 64 | ||
| Data-input Devices | 68 | ||
| Integrated abdominal fetal heart rate and uterine activity monitoring | 69 | ||
| Summary | 72 | ||
| References | 72 | ||
| Chapter 4: Uterine Activity Evaluation and Management | 75 | ||
| Assessment methods: palpation and electronic monitoring | 75 | ||
| Manual Palpation | 75 | ||
| Electronic Monitoring of Uterine Activity | 76 | ||
| Electronic Display of Uterine Activity | 78 | ||
| Redefining normal labor | 80 | ||
| Defining adequate uterine activity | 81 | ||
| Defining excessive uterine activity | 85 | ||
| Common Underlying Causes of Excessive Uterine Activity | 91 | ||
| Interventions to Decrease Excessive Uterine Activity | 91 | ||
| New trends in labor support and management | 91 | ||
| Latent Phase Abnormalities | 92 | ||
| Management Strategies for Latent Phase Disorders 1 | 93 | ||
| Active-Phase Abnormalities | 93 | ||
| Management Strategies for Active-Phase Disorders 2 | 94 | ||
| Second-Stage Abnormalities | 94 | ||
| Uterine activity and oxytocin use | 95 | ||
| Summary | 98 | ||
| References | 99 | ||
| Chapter 5: Pattern Recognition and Interpretation | 103 | ||
| The evolution of standardized FHR definitions | 103 | ||
| The 2008 NICHD Consensus Report | 103 | ||
| Evidence-based Interpretation of FHR Patterns | 106 | ||
| NICHD definitions: general considerations | 108 | ||
| Five Essential Components of an FHR Tracing | 109 | ||
| Definitions, physiology, and interpretation of specific FHR patterns | 109 | ||
| Baseline Rate | 109 | ||
| Definition | 109 | ||
| Physiology | 111 | ||
| Categories of baseline rate | 111 | ||
| Tachycardia | 111 | ||
| Definition | 111 | ||
| Interpretation | 111 | ||
| Bradycardia | 113 | ||
| Definition | 113 | ||
| Interpretation | 113 | ||
| Baseline FHR Variability | 114 | ||
| Definition | 114 | ||
| Physiology | 117 | ||
| Categories of baseline variability | 117 | ||
| Absent Variability | 117 | ||
| Definition | 117 | ||
| Interpretation | 117 | ||
| Minimal Variability | 119 | ||
| Chapter 6: Intrapartum Management of the Fetal Heart Rate Tracing | 144 | ||
| Fundamental principles | 144 | ||
| Standard of Care | 145 | ||
| Confirm FHR and Uterine Activity | 146 | ||
| Evaluate FHR Components | 146 | ||
| A Standardized “ABCD” Approach to FHR Management | 148 | ||
| A: Assess the Oxygen Pathway and Consider Other Causes of FHR Changes | 151 | ||
| B: Begin Corrective Measures as Indicated | 152 | ||
| Supplemental Oxygen | 152 | ||
| Maternal Position Changes | 152 | ||
| Intravenous Fluid Administration | 153 | ||
| Correct Maternal Blood Pressure | 153 | ||
| Reduce Uterine Activity | 153 | ||
| Alter Second-stage Pushing Technique | 154 | ||
| Amnioinfusion | 154 | ||
| Reevaluate the FHR Tracing | 155 | ||
| C: Clear Obstacles to Rapid Delivery | 155 | ||
| D: Delivery Plan | 156 | ||
| Expectant Management Versus Delivery | 156 | ||
| Other methods of fetal monitoring | 158 | ||
| Intrapartum Fetal Scalp pH and Lactate Determination | 158 | ||
| Fetal Scalp Stimulation and Vibroacoustic Stimulation | 158 | ||
| Computer Analysis of FHR | 159 | ||
| Fetal Pulse Oximetry | 159 | ||
| ST Segment Analysis | 159 | ||
| Umbilical Cord Blood Gas Analysis | 161 | ||
| Summary | 163 | ||
| References | 163 | ||
| Chapter 7: Influence of Gestational Age on Fetal Heart Rate | 168 | ||
| The preterm fetus | 168 | ||
| Baseline Fetal Heart Rate in the Preterm Fetus | 170 | ||
| Baseline Variability in the Preterm Fetus | 170 | ||
| Periodic and Episodic Heart Rate Changes in the Preterm Fetus | 170 | ||
| Accelerations | 170 | ||
| Decelerations | 172 | ||
| Behavioral States in the Preterm Fetus | 172 | ||
| Preterm Uterine Activity | 175 | ||
| Tocolytic Therapy and Effect on Fetal Heart Rate | 175 | ||
| Indomethacin | 177 | ||
| Nifedipine | 177 | ||
| Beta mimetics | 177 | ||
| Magnesium Sulfate | 178 | ||
| Antenatal Corticosteroid Therapy | 178 | ||
| Monitoring the Preterm Fetus | 180 | ||
| Antepartum Fetal Assessment | 180 | ||
| Triage and Inpatient Antepartum Monitoring | 180 | ||
| Intrapartum Monitoring | 181 | ||
| The late term and postterm fetus | 181 | ||
| Fetal Assessment | 182 | ||
| Risks Associated with Postterm Pregnancy | 182 | ||
| Postmaturity or Dysmaturity Syndrome | 182 | ||
| Oligohydramnios | 182 | ||
| Meconium | 183 | ||
| Management of Postterm Pregnancy | 183 | ||
| Summary | 183 | ||
| References | 184 | ||
| Chapter 8: Fetal Assessment in Non-obstetric Settings | 189 | ||
| Pregnancy anatomy and physiology | 189 | ||
| Emergency department assessment and care | 191 | ||
| Pregnant trauma victim assessment and care | 193 | ||
| Maternal–Fetal Transport, Assessment, and Care | 193 | ||
| Primary and Secondary Survey in the Emergency Department | 196 | ||
| Primary Survey | 196 | ||
| Secondary Survey | 197 | ||
| Emergent and Perimortem Cesarean Birth | 199 | ||
| Stabilization and Discharge | 201 | ||
| Non-obstetric surgical procedures: maternal–fetal assessment and care | 201 | ||
| Intraoperative Maternal–Fetal Assessment | 202 | ||
| Tocolytic Agents and Antenatal Corticosteroids | 205 | ||
| Surgery When Gestation Is Greater Than 24 Weeks | 205 | ||
| Federal law and triage | 206 | ||
| Summary | 206 | ||
| References | 206 | ||
| Chapter 9: Antepartum Fetal Assessment | 210 | ||
| Comparing antepartum testing methods | 210 | ||
| Contraction stress test and oxytocin challenge test | 214 | ||
| Interpretation and Management | 214 | ||
| Advantages and Limitations | 215 | ||
| Procedures for Contraction Stress Testing | 216 | ||
| Procedure for Nipple-Stimulated Contraction Stress Test | 216 | ||
| Procedure for Oxytocin Challenge Test | 216 | ||
| The nonstress test | 217 | ||
| Interpretation and Management | 218 | ||
| Advantages and Disadvantages | 219 | ||
| The biophysical profile | 220 | ||
| Interpretation and Management | 220 | ||
| Advantages and Limitations | 221 | ||
| The modified biophysical profile | 222 | ||
| Interpretation and Management | 222 | ||
| Advantages and Limitations | 223 | ||
| Fetal movement counts | 224 | ||
| Interpretation and Management | 224 | ||
| Umbilical artery doppler velocimetry | 224 | ||
| Biochemical assessment | 225 | ||
| Amniocentesis for Fetal Lung Maturity | 225 | ||
| Lecithin-to-Sphingomyelin Ratio | 226 | ||
| Foam Stability Test | 227 | ||
| Phosphatidylglycerol | 227 | ||
| Fluorescence Polarization (FLM-II Assay) | 228 | ||
| Lamellar Body Count | 228 | ||
| Summary | 228 | ||
| References | 229 | ||
| Chapter 10: Patient Safety, Risk Management, and Documentation | 232 | ||
| Human error | 232 | ||
| Error prevention and risk reduction | 235 | ||
| High-Reliability Perinatal Units | 235 | ||
| Guidelines to Promote Safety and Reduce Risks | 236 | ||
| Policies, Procedures, and Protocols | 236 | ||
| Competency | 236 | ||
| Fetal Monitoring | 237 | ||
| Neonatal Resuscitation | 237 | ||
| Organizational Resources and Systems to Support Timely Interventions | 237 | ||
| Perinatal Teamwork: Collaboration and Communication | 239 | ||
| Interdisciplinary Case Reviews | 240 | ||
| Chain of Communication | 240 | ||
| Joint Nurse/Provider Education | 241 | ||
| Adverse outcomes and litigation | 241 | ||
| Disclosure of Unanticipated Outcomes | 242 | ||
| Elements of Malpractice | 242 | ||
| EFM, IA, and Informed Consent | 243 | ||
| Notification and Clinical Review | 244 | ||
| Reporting of Sentinel Events | 245 | ||
| Documentation | 245 | ||
| Components of Care: Assessment, Communication, Documentation | 246 | ||
| Deposition Excerpt | 249 | ||
| Documentation Issues Specific to Electronic Fetal Monitoring | 250 | ||
| Components of Electronic Fetal Monitoring Evaluation | 251 | ||
| Use of FHR Categories | 251 | ||
| Documentation of Uterine Activity | 252 | ||
| Quantification of Decelerations | 252 | ||
| Frequency of Electronic Fetal Monitoring Assessment Versus Frequency of Electronic Fetal Monitoring Documentation | 253 | ||
| Electronic Medical Records and Information Systems | 254 | ||
| Record Storage and Retrieval | 257 | ||
| Summary | 258 | ||
| References | 259 | ||
| Chapter 11: Obstetric Models and Electronic Fetal Monitoring in Europe | 264 | ||
| Models of care | 264 | ||
| Electronic fetal monitoring (EFM)– cardiotocography (CTG) | 266 | ||
| Quality of EFM-CTG | 266 | ||
| Guidelines for Terminology and Interpretation | 267 | ||
| Examples of 1- and 2-cm CTG Tracings | 268 | ||
| Methods of Determining Fetal Acid–Base Status | 268 | ||
| Fetal Scalp Blood Sampling for pH | 272 | ||
| Fetal Scalp Blood Sampling for Lactate | 273 | ||
| ST Analysis of the Fetal ECG | 273 | ||
| Summary | 274 | ||
| References | 274 | ||
| Appendix A Amnioinfusion | 278 | ||
| Indications for amnioinfusion | 279 | ||
| Equipment and supplies | 279 | ||
| Procedure | 279 | ||
| Patient care | 280 | ||
| Appendix B: Instructions for Reviewing Appendix B FHR Tracings | 281 | ||
| Key for Appendix B FHR tracings | 281 | ||
| Appendix B Self-Assessment | 312 | ||
| Answer Key for Self Assessment | 317 | ||
| Index | 318 |