Mosby's® Pocket Guide to Fetal Monitoring: A Multidisciplinary Approach

✍ Scribed by Lisa A. Miller CNM JD, David Miller, Rebecca L. Cypher

• Publisher: Mosby
• Year: 2021
• Tongue: English
• Leaves: 370
• Series: Nursing Pocket Guides
• Edition: 9
• Category: Library

✦ Synopsis

Find real-world, clinically useful information on all aspects of electronic fetal monitoring! Written by clinicians for clinicians, Mosby's Pocket Guide to Fetal Monitoring: A Multidisciplinary Approach, 9th Edition provides an evidence-based, collaborative approach to fetal heart monitoring during labor and in the antepartum period. It covers the physiologic basis for FHR monitoring, methods and instrumentation, standardized terminology, pattern recognition and interpretation, and management of care. Authored by a nurse-midwife, a perinatologist, and a nurse, this compact guide prepares you for success on the EFM certification exam and for success in today's clinical practice.

• Pocket-sized format makes this guide ideal to carry and use in the clinical setting, and a colorful design makes information easier to find.
• Coverage of fetal heart rate assessment, evaluation, interpretation, and management is supported by evidence-based practice and literature, helping you prioritize care and make clinical decisions.
• Patient safety and risk management strategies include case studies and legal commentary, plus guidelines for providing safe and competent care.
• Information on the relationship between fetal heart rate patterns and neonatal outcomes provides a guide to the correct use of fetal monitoring.
• Illustrations, tables, and fetal monitor tracings highlight critical information.
• Coverage of innovative practices supports patient safety and improved outcomes through the use of a common language for fetal heart rate patterns, a standardized approach to interpretation, a discussion of emergency preparedness, and a discussion of human factor issues such as improved communication, situational awareness, no-fault/just culture, and teamwork.
• Practical appendices offer a guide to FHR tracings and interpretation as well as self-assessment questions for credentialing and certification exam preparation.
• Expert author team provides clinical insight along with international presence.

• NEW information on Category II tracing management is included.
• NEW! Expanded section on common misconceptions and myths includes evidence supporting factual EFM characteristics.
• NEW! Detailed information on documentation and legal issues is added.
• NEW EFM tracings with interpretation are added.

✦ Table of Contents

OFC
IFC
Full Title
Copyright
Reviewers
Acknowledgments
Preface
CONTENTS
Chapter 1 - A Brief History of Fetal Monitoring
HISTORICAL OVERVIEW
RANDOMIZED TRIALS OF ELECTRONIC FETAL MONITORING
RESEARCH AT THE END OF THE 20th CENTURY
FETAL MONITORING IN THE 21st CENTURY
Summary
References
Chapter 2 - Physiologic Basis for Electronic Fetal Heart Rate Monitoring
TRANSFER OF OXYGEN FROM THE ENVIRONMENT TO THE FETUS
External Environment
Maternal Lungs
Maternal Blood
Maternal Heart
Maternal Vasculature
Uterus
Placenta
Intervillous Space Pao2
Intervillous Space Blood Flow
Chorionic Villous Surface Area
Diffusion Across the “Blood-Blood” Barrier
Interruption of Placental Blood Vessels
Summary of Placental Causes of Disrupted Oxygenation
Fetal Blood
Umbilical Cord
FETAL RESPONSE TO INTERRUPTED OXYGEN TRANSFER
Mechanisms of Injury
Injury Threshold
SUMMARY
References
Chapter 3 - Methods and Instrumentation
INTERMITTENT AUSCULTATION OF THE FETAL HEART RATE
Description
Leopold’s Maneuver
Utilization, Procedure, and Frequency of Intermittent Auscultation
Documentation of Auscultated Fetal Heart Rate
Interpretation of Auscultated Fetal Heart Rate
Benefits and Limitations of Auscultation
Benefits
Limitations
Palpation of the Uterus
ELECTRONIC FETAL MONITORING
Overview
Converting Raw Data Into a Visual Display of Fetal Heart Rate
EXTERNAL MODE OF MONITORING
Ultrasound Transducer
Description
Placement of Ultrasound Transducer
Tocotransducer
Description
Placement of Tocotransducer
Advantages and Limitations of External Transducers
Advantages
Limitations
Integrated Abdominal Fetal Heart Rate and Uterine Activity Monitoring
INTERNAL MODE OF MONITORING
Fetal Spiral Electrode
Description
Contraindications
Situations Requiring Caution
Placement of Fetal Spiral Electrode
Intrauterine Pressure Catheter
Description
Placement of Intrauterine Pressure Catheter
Advantages and Limitations of Internal Monitoring
Advantages
Limitations
DISPLAY OF FETAL HEART RATE, UTERINE ACTIVITY, AND OTHER INFORMATION
Monitor Tracing Scale
Monitoring Multiple Gestations
Artifact Detection and Signal Ambiguity (Coincidence) With Maternal Heart Rate
Telemetry
Electronic Fetal Monitoring Troubleshooting
Troubleshooting Actions
Computerized Perinatal Data Systems
Computer Decision Analysis of the Fetal Heart Rate
Data-Input Devices
SUMMARY
References
Chapter 4 - Uterine Activity Evaluation and Management
ASSESSMENT METHODS: PALPATION AND ELECTRONIC MONITORING
Manual Palpation
Electronic Monitoring of Uterine Activity
Electronic Display of Uterine Activity
PARAMETERS FOR NORMAL LABOR
DEFINING ADEQUATE UTERINE ACTIVITY
DEFINING EXCESSIVE UTERINE ACTIVITY
Common Underlying Causes of Excessive Uterine Activity
Corrective Measures to Decrease Excessive Uterine Activity
CURRENT TRENDS IN LABOR SUPPORT AND MANAGEMENT
Latent Phase Abnormalities
Management Strategies for Latent Phase Disorders

Active Phase Abnormalities
Management Strategies for Active Phase Disorders

Second-Stage Abnormalities
UTERINE ACTIVITY AND OXYTOCIN USE
SUMMARY
References
Chapter 5 - Pattern Recognition and Interpretation
THE EVOLUTION OF STANDARDIZED FETAL HEART RATE DEFINITIONS
The 2008 National Institute of Child Health and Human Development Consensus Report
Evidence-Based Interpretation of Fetal Heart Rate Patterns
NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT DEFINITIONS: GENERAL CONSIDERATIONS
Five Essential Components of a Fetal Heart Rate Tracing
DEFINITIONS, PHYSIOLOGY, AND INTERPRETATION OF SPECIFIC FETAL HEART RATE PATTERNS
Baseline Rate
Definition
Physiology
CATEGORIES OF BASELINE RATE
Tachycardia
Definition
Interpretation
Bradycardia
Definition
Interpretation
Baseline Fetal Heart Rate Variability
Definition
Physiology
CATEGORIES OF BASELINE VARIABILITY
Absent Variability
Definition
Interpretation
Minimal Variability
Definition
Interpretation
Moderate Variability
Definition
Interpretation
Marked Variability
Definition
Interpretation
Sinusoidal Pattern
Acceleration
Definition
Physiology
Interpretation
Decelerations
Definition
Physiology
TYPES OF DECELERATIONS
Early Deceleration
Definition
Interpretation
Late Deceleration
Definition
Interpretation
Variable Deceleration
Definition
Interpretation
Prolonged Deceleration
Definition
Interpretation
FETAL CARDIAC ARRhYTHMIAS
TERMS AND CONCEPTS NOT SUPPORTED BY EVIDENCE OR CONSENSUS
Wandering Baseline
Lambda Pattern
Shoulder
Checkmark Pattern
End-Stage Bradycardia and Terminal Bradycardia
Uniform Accelerations
Atypical Variable Decelerations
Overshoot
Variable Deceleration With a Late Component
Mild, Moderate, and Severe Variable Decelerations
V-Shaped Variables and W-Shaped Variables
Good Variability Within the Deceleration
Other Mechanisms That Lack Scientific Basis
Fetal Head Compression
Prediction and Prevention of Fetal Stroke
The “Fetal Reserve Index”
SUMMARY
References
Chapter 6 - Intrapartum Management of the Fetal Heart Rate Tracing
FUNDAMENTAL PRINCIPLES
Standard of Care
Confirm Fetal Heart Rate and Uterine Activity
Evaluate Fetal Heart Rate Components
A Standardized “ABCD” Approach to Fetal Heart Rate Management
A: Assess the Oxygen Pathway and Consider Other Causes of Fetal Heart Rate Changes
B: Begin Corrective Measures as Indicated
Supplemental Oxygen
Maternal Position Changes
Intravenous Fluid Administration
Correct Maternal Blood Pressure
Reduce Uterine Activity
Alter Second-stage Pushing Technique
Amnioinfusion
Reevaluate the Fetal Heart Rate Tracing
C: Clear Obstacles to Rapid Delivery
D: Delivery Plan
Expectant Management Versus Delivery
OTHER METHODS OF FETAL MONITORING
Intrapartum Fetal Scalp pH and Lactate Determination
Fetal Scalp Stimulation and Vibroacoustic Stimulation
Computer Analysis of Fetal Heart Rate
Fetal Pulse Oximetry
ST Segment Analysis
Umbilical Cord Blood Gas Analysis
Approximate Normal Values for Cord Blood
Types of Acidemia
Summary
References
Chapter 7 - Influence of Gestational Age on Fetal Heart Rate
THE PRETERM FETUS
Baseline Fetal Heart Rate in the Preterm Fetus
Baseline Variability in the Preterm Fetus
Periodic and Episodic Heart Rate Changes in the Preterm Fetus
Accelerations
Decelerations
Behavioral States in the Preterm Fetus
Preterm Uterine Activity
Short-Term Tocolytic Therapy and Effect on Fetal Heart Rate
Indomethacin
Nifedipine
Beta-Mimetics (Beta-Agonists)
Magnesium Sulfate
Antenatal Corticosteroid Therapy
Monitoring the Preterm Fetus
Antepartum Fetal Assessment
Triage and Inpatient Antepartum Monitoring
Intrapartum Monitoring
THE LATE-TERM AND POSTTERM FETUS
Fetal Assessment
Risks Associated with Postterm Pregnancy
Postmaturity or Dysmaturity Syndrome
Oligohydramnios
Meconium
Management of Postterm Pregnancy
SUMMARY
References
Chapter 8 - Fetal Assessment in Non-Obstetric Settings
Maternal Trauma Algorithm
A CULTURE OF PATIENT SAFETY
PREGNANCY ANATOMY AND PHYSIOLOGY
OBSTETRIC PATIENTS IN THE EMERGENCY DEPARTMENT
Federal Law and Emergency Medical Treatment and Active Labor Act
Pregnant Trauma Victim Assessment and Care
Maternal–Fetal Transport
Primary and Secondary Survey in the Emergency Department
Primary Survey
Secondary Survey
Emergent Cesarean Birth and Resuscitative Hysterotomy
Stabilization and Discharge
NON-OBSTETRIC SURGICAL PROCEDURES: MATERNAL–FETAL ASSESSMENT AND CARE
Intraoperative Maternal–Fetal Assessment
Tocolytic Agents and Antenatal Corticosteroids
Fundamentals of Non-Obstetric Surgery
SUMMARY
References
Chapter 9 - Antepartum Fetal Assessment
COMPARING ANTEPARTUM TESTING METHODS
METHODS OF TESTING
Contraction Stress Test and Oxytocin Challenge Test
Interpretation and Management
Advantages and Limitations
Procedures for Contraction Stress Testing
Procedure for Nipple-Stimulated Contraction Stress Test
Procedure for Oxytocin Challenge Test
The Nonstress Test
Interpretation and Management
Advantages and Disadvantages
The Biophysical Profile
Interpretation and Management
Advantages and Limitations
The Modified Biophysical Profile
Interpretation and Management
Advantages and Limitations
Fetal Movement Counts
Interpretation and Management
Doppler Velocimetry of Maternal and Fetal Blood Vessels
Biochemical Assessment
Amniocentesis for Fetal Lung Maturity
Lecithin-to-Sphingomyelin Ratio
Foam Stability Test
Phosphatidylglycerol
Fluorescence Polarization (Fetal Lung Maturity-II Assay)
Lamellar Body Count
SUMMARY
References
Chapter 10 - Patient Safety, Risk Management, and Documentation
RISK MANAGEMENT
THE DECISION-MAKING PROCESS IN ELECTRONIC FETAL MONITORING AND INTERMITTENT AUSCULTATION
CENTRAL CONCEPTS IN LIABILITY CLAIMS
COMPONENTS OF CARE: ASSESSMENT, COMMUNICATION, AND DOCUMENTATION
LIABILITY IN FETAL MONITORING
FETAL MONITORING DOCUMENTATION
DOCUMENTATION COMPONENTS OF THE ELECTRONIC FETAL MONITORING EVALUATION
COMMON DOCUMENTATION DILEMMAS
Use of Fetal Heart Rate Categories
Documentation of Uterine Activity
Quantification of Decelerations
Frequency of Electronic Fetal Monitoring Assessment and Documentation
Appropriate Use of Fetal Heart Rate and Uterine Activity Terminology
Deposition Excerpt
Location of Nursing Assessment and Documentation
Late Entry
ELECTRONIC FETAL MONITORING DOCUMENTATION POLICIES
SUMMARY
References
Chapter 11 - Obstetric Models of Care and Electronic Fetal Monitoring Outside the United States
OBSTETRIC MODELS OF CARE
ELECTRONIC FETAL MONITORING: CARDIOTOCOGRAPHY
INTERNATIONAL INTERMITTENT AUSCULTATION AND CARDIOTOCOGRAPHY GUIDELINES
Guidelines for Terminology and Interpretation
METHODS OF DETERMINING FETAL ACID–BASE STATUS
Fetal Blood Sampling
Fetal Blood Sampling for pH
Fetal Scalp Blood Sampling for Lactate
ST Analysis of the Fetal Electrocardiogram
SUMMARY
References
APPENDIX A - Amnioinfusion
INDICATIONS FOR AMNIOINFUSION
EQUIPMENT AND SUPPLIES
Procedure
Patient Care
APPENDIX B -  Fetal Heart Rate Tracings Review
KEY FOR APPENDIX B FETAL HEART RATE TRACINGS
Interpretation
Interpretation
Interpretation
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APPENDIX C - Self-Assessment
ANSWER KEY FOR SELF-ASSESSMENT
Index