The American body of Obstetricians...

The American body of Obstetricians and Gynecologists (ACOG) Committee forward Practice Bulletins-Obstetrics recently released a practice bulletin in succession fetal heart rate monitoring. ACOG Practice Bulletin No. 62 was published in the May 2005 issue of Obstetrics and Gynecology

Electronic fetal heart rate monitoring is used to determine whether a fetus is well oxygenated. It is being used increasingly for pregnant women in the United States (62 percent of pregnant women in 1988 74 percent in 1992 and 85 percent in 2002) Fetal heart rate monitoring can be performed internally or externally.

According to the ACOG committee, the false-positive rate of electronic fetal monitoring for predicting adverse issues is high. Data showed that the use of electronic fetal monitoring increased the likelihood of cesarean delivery and the use of vacuum or forceps operative vaginal deliveries when compared with intermittent auscultation. Electronic fetal monitoring does not appear to lessen the incidence of cerebral palsy or overall perinatal mortality, although perinatal mortality caused through fetal hypoxia seems to be reduced

The practice bulletin commends that the heart rate of patients without complications be reviewed each 30 minutes during the first stage of labor and each 15 minutes during the other stage. For patients with complications (eg fetal increase restriction, preeclampsia), fetal heart rate should be reviewed each 15 minutes during the first stage of delivery and each five minutes during the next to the first stage. Patients with high-risk conditions should be monitored continuously during labor. The ACOG committee praises that physicians document and store the fetal heart rate tracings.

An ancillary proof of fetal status, fetal measured [i]or[/i] regular beat oximetry, is associated with a significantly lower rate of cesarean delivery. However, because of troubles about false reassurance of fetal oxygenation, use of fetal measured [i]or[/i] regular beat oximetry is not recommended at this time.

COPYRIGHT 2005 American Academy of Family Physicians

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