Find real-world, clinically useful information on all aspects of electronic fetal monitoring! Authored by a nurse-midwife, a perinatologist, and a nurse, Mosbys Pocket Guide to Fetal Monitoring:: A Multidisciplinary Approach, 10th 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.
1 Physiologic Basis for Electronic Fetal 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
2 Methods and Instrumentation Intermittent Auscultation of the Fetal Heart Rate Description Leopolds Maneuver Utilization of Intermittent Auscultation Procedure for Intermittent Auscultation Frequency of Intermittent Auscultation Interpretation of Auscultated Fetal Heart Rate Benefits and Limitations of Auscultation Electronic Fetal Monitoring Overview Converting Raw Data Into a Visual Display of Fetal Heart Rate External Mode of Monitoring Ultrasound Transducer Tocotransducer Advantages and Limitations of External Transducers Internal Mode of Monitoring Fetal Spiral Electrode Contraindications Intrauterine Pressure Catheter Contraindications Advantages and Limitations of Internal Monitoring Display of Fetal Heart Rate, Uterine Activity, and Other Information Monitor Tracing Scale Monitoring Multiple Gestations Offset Feature Systematic Labeling Parameters Fetal Heart Rate Artifact and Detection Signal Ambiguity (Coincidence) With Maternal Heart Rate Telemetry Electronic Fetal Monitoring Troubleshooting Selected Troubleshooting Actions Computerized Perinatal Data Systems Clinical Decision Support Computer Decision Analysis of the Fetal Heart Rate Summary
3 Evaluation and Management of Uterine Activity Assessment Methods: Palpation and Electronic Monitoring Manual Palpation Electronic Monitoring of Uterine Activity Electronic Display of Uterine Activity Normal Labor Parameters Defining Adequate Uterine Activity Defining Excessive Uterine Activity Common Underlying Causes of Excessive Uterine Activity Corrective Measures to Decrease Excessive Uterine Activity 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
4 Fetal Heart Rate Pattern Recognition and Interpretation The Evolution of Standardized FHR 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 Categories of Baseline Rate Tachycardia Bradycardia Baseline Fetal Heart Rate Variability Categories of Baseline Variability Absent Variability Minimal Variability Moderate Variability Marked Variability Periodic and Episodic Fetal Heart Rate Patterns Acceleration Decelerations Types of Decelerations Early Deceleration Late Deceleration Variable Deceleration Prolonged Deceleration Fetal Cardiac Arrythmias Terms and Concepts Not Supported by Evidence or Consensus Wandering Baseline Lambda Pattern Shoulder Checkmark Pattern End-Stage Bradycardia and Terminal Bradycardia Uniform Accelerations Variable Deceleration Terminology Variable Deceleration With a Late Component Mild, Moderate, and Severe Variable Decelerations V-Shaped Variables and W-Shaped Variable Decelerations Variability Within a Deceleration Other Mechanisms That Lack Scientific Basis Summary
5 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 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 Umbilical Cord Blood Gas Analysis Summary
6 Influence of Gestational Age on Fetal Heart Rate The Preterm Fetus Physiologic Principles in the Preterm Fetus Preterm Fetal Heart Rate Preterm Baseline Variability Preterm Accelerations Prostaglandin Synthase Inhibitors Calcium Channel Blocker Beta-Adrenergic Receptor Agonists Fetal Neuroprotection Monitoring the Preterm Fetus The Late-Term and Postterm Fetus Risks Associated With Postterm Pregnancy Summary
7 Fetal Assessment in Nonobstetric Settings Pregnancy Anatomy and Physiology Obstetric Patients in the Emergency Department Emergency Medical Treatment and Active Labor Act Pregnant Trauma Victim Assessment and Care Prehospital Care In-Hospital Care Traumatic Cardiac Arrest and Resuscitative Cesarean Delivery Stabilization and Discharge Nonobstetric Surgical Procedures: Maternal-Fetal Assessment and Care Intraoperative Fetal Surveillance Fundamentals of Nonobstetric Surgery A Culture of Patient Safety Summary
8 Antepartum Fetal Testing Comparing Antepartum Testing Methods Methods of Testing Contraction Stress Test and Oxytocin Challenge Test Nonstress Test Doppler Velocimetry of Maternal and Fetal Blood Vessels Biophysical Profile The Modified Biophysical Profile Fetal Movement Counts Amniocentesis Biochemical Assessment for Fetal Lung Maturity Summary
9 Patient Safety and Risk Management Risk Management The Decision-Making Process in Electronic Fetal Monitoring and Intermittent Auscultation Understanding Liability Claims Components of Care: Assessment, Communication, and Documentation Liability in Fetal Monitoring Summary
10 Fetal Monitoring Documentation Electronic Health Records The Clear Concept Standardized Terminology Intermittent Auscultation Documentation Electronic Fetal Monitoring Documentation Documentation of Uterine Activity Appropriate Use of Fetal Heart Rate and Uterine Activity Terminology Electronic Fetal Monitoring Assessment and Documentation Frequency Location of Nursing Assessment and Documentation Late Entry Frequent Documentation Questions Three-Tier Fetal Heart Rate Categories Reassuring and Nonreassuring Terminology Quantification of Decelerations Patterns That Do Not Meet Standardized Definitions Montevideo Units Chain of Communication (Chain of Command) Electronic Fetal Monitoring Documentation Guidance Summary
11 Obstetric Models of Care and International Fetal Surveillance Concepts Obstetric Continuity of Care Models Midwifery Model of Care Physician Model of Care Interprofessional and Intraprofessional Models of Care Birth Setting 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 Criteria and Procedure pH and Lactate Results Umbilical Cord Gas Analysis ST Analysis of the Fetal Electrocardiogram Criteria and Procedure Role of ST Analysis in Contemporary Practice Summary
APPENDIX A: Intrapartum Amnioinfusion Potential Indications for Intrapartum Amnioinfusion Potential Amnioinfusion Risks Contraindications for Amnioinfusion Equipment and Supplies Procedure Preprocedure Procedure Patient Care
APPENDIX B: Fetal Heart Rate Tracings Review Key for Appendix B Fetal Heart Rate Tracings
APPENDIX C: Self-Assessment Answer Key for Self-Assessment Index
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