Read by QxMD icon Read

Electronic fetal monitoring

Thomas P Sartwelle, James C Johnston
A half century after continuous electronic fetal monitoring (EFM) became the omnipresent standard of care for the vast majority of labors in the developed countries, and the cornerstone for cerebral palsy litigation, EFM advocates still do not have any scientific evidence justifying EFM use in most labors or courtrooms. Yet, these EFM proponents continue rationalizing the procedure with a rhetorical fog of meaningless words, misleading statistics, archaic concepts, and a complete disregard for medical ethics...
January 2018: Surgery Journal
Courtney Sundin, Lauren Mazac, Kathleen Ellis, Candon Garbo
BACKGROUND: Oxytocin is one of the most common drugs administered in obstetrics. Since its designation as a high-alert medication by the Institute for Safe Medication Practices in 2007, there has been much attention to oxytocin administration during labor. Oxytocin is generally safe when administered correctly, but adverse perinatal outcomes can occur during uterine tachysystole. PURPOSE: The purpose of this project was to evaluate and compare results of maternal and fetal outcomes of induction of labor for women at term prior to and after implementation of a newly developed oxytocin checklist...
February 27, 2018: MCN. the American Journal of Maternal Child Nursing
Waldo Sepulveda, Jose H Ochoa, Daniel Cafici, Amy E Wong, Federico Badano, Elena Andreeva, Elena Y Andreeva
Introduction: Congenital splenic cysts are a rare cause of abdominal cystic masses in the fetus. We describe nine cases of this condition, the largest reported experience to date. A review of the literature for similar cases was also performed. Methods: Cases of congenital splenic cyst were collected from three prenatal diagnostic centers and from a dedicated website of prenatal diagnosis. Information regarding clinical and sonographic findings was obtained by reviewing ultrasound reports and medical records...
February 2018: Ultrasound: Journal of the British Medical Ultrasound Society
Mark I Evans, Robert D Eden, David W Britt, Shara M Evans, Barry S Schifrin
BACKGROUND: Even key opinion leaders now concede that electronic fetal monitoring (EFM) cannot reliably identify fetal acidemia which many vouch as the only labor mediated pathophysiologic precursor for cerebral palsy (CP). We have developed the "Fetal Reserve Index" - an algorithm combining five dynamic components of EFM (1. Rate, 2. Variability, 3. Accelerations, 4. Decelerations, and 5. Excessive uterine activity) considered individually that are combined with the presence of: 6...
February 28, 2018: Journal of Maternal-fetal & Neonatal Medicine
Peter Brocklehurst, David Field, Keith Greene, Edmund Juszczak, Sara Kenyon, Louise Linsell, Chris Mabey, Mary Newburn, Rachel Plachcinski, Maria Quigley, Philip Steer, Liz Schroeder, Oliver Rivero-Arias
BACKGROUND: Continuous electronic fetal monitoring (EFM) in labour is widely used and computerised interpretation has the potential to increase its utility. OBJECTIVES: This trial aimed to find out whether or not the addition of decision support software to assist in the interpretation of the cardiotocograph (CTG) reduced the number of poor neonatal outcomes, and whether or not it was cost-effective. DESIGN: Two-arm individually randomised controlled trial...
February 2018: Health Technology Assessment: HTA
Sara Rivenes Lafontan, Johanne Sundby, Hege L Ersdal, Muzdalifat Abeid, Hussein L Kidanto, Columba K Mbekenga
To increase labor monitoring and prevent neonatal morbidity and mortality, a new wireless, strap-on electronic fetal heart rate monitor called Moyo was introduced in Tanzania in 2016. As part of the ongoing evaluation of the introduction of the monitor, the aim of this study was to explore the attitudes and perceptions of women who had worn the monitor continuously during their most recent delivery and perceptions about how it affected care. This knowledge is important to identify barriers towards adaptation in order to introduce new technology more effectively...
February 9, 2018: International Journal of Environmental Research and Public Health
Alison G Cahill, Methodius G Tuuli, Molly J Stout, Julia D López, George A Macones
BACKGROUND: Intrapartum electronic fetal monitoring (EFM) is the most commonly used tool in obstetrics in the United States, however, which EFM patterns predict acidemia remains unclear. OBJECTIVE: This study was designed to describe the frequency of patterns seen in labor using modern nomenclature, and to test the hypothesis that visually interpreted patterns are associated with acidemia and morbidities in term infants. We further identified patterns prior to delivery, alone or in combination, predictive of acidemia and neonatal morbidity...
January 31, 2018: American Journal of Obstetrics and Gynecology
Jostein Grytten, Irene Skau, Rune Sørensen, Anne Eskild
OBJECTIVE: To examine the effect that the introduction of new diagnostic technology in obstetric care has had on fetal death. DATA SOURCE: The Medical Birth Registry of Norway provided detailed medical information for approximately 1.2 million deliveries from 1967 to 1995. Information about diagnostic technology was collected directly from the maternity units, using a questionnaire. STUDY DESIGN: The data were analyzed using a hospital fixed-effects regression with fetal mortality as the outcome measure...
January 19, 2018: Health Services Research
Bruna Maria Lopes Barbosa, Agatha S Rodrigues, Mario Henrique Burlacchini Carvalho, Roberto Eduardo Bittar, Rossana Pulcineli Vieira Francisco, Lisandra Stein Bernardes
BACKGROUND: To evaluate possible predictive factors of spontaneous prematurity in fetuses with congenital diaphragmatic hernia (CDH). METHODS: A retrospective cohort study was performed. Inclusion criteria were presence of CDH; absence of fetoscopy; absence of karyotype abnormality; maximum of one major malformation associated with diaphragmatic hernia; ultrasound monitoring at the Obstetrics Clinic of Clinicas Hospital at the University of São Paulo School of Medicine, from January 2001 to October 2014...
January 12, 2018: BMC Pregnancy and Childbirth
Jennifer Webb, Asta Sorensen, Samantha Sommerness, Beth Lasater, Kamila Mistry, Leila Kahwati
BACKGROUND: The use of health information technology (IT) has been shown to promote patient safety in Labor and Delivery (L&D) units. The use of health IT to apply safety science principles (e.g., standardization) to L&D unit processes may further advance perinatal safety. METHODS: Semi-structured interviews were conducted with L&D units participating in the Agency for Healthcare Research and Quality's (AHRQ's) Safety Program for Perinatal Care (SPPC) to assess units' experience with program implementation...
December 19, 2017: BMC Medical Informatics and Decision Making
Jacqueline H Wolf
When physicians performed cesarean sections in the nineteenth century, they customarily sought agreement from all present before proceeding. In contrast, after the introduction of electronic fetal monitoring in the late 1960s, obstetricians obtained permission for a cesarean by offering a choice that ensured consent-give birth by cesarean or give birth vaginally to a damaged or dead baby. This article argues that the manner in which physicians obtained consent for cesareans in the nineteenth century was one factor that kept the cesarean rate low, while the manner in which physicians obtained consent in the late twentieth and early twenty-first centuries was one factor driving up the cesarean rate...
December 12, 2017: Journal of the History of Medicine and Allied Sciences
Rebecca L Cypher
Contemporaneous, complete, and objective documentation is the foundation for continuity of patient care and facilitates communication between all levels of healthcare clinicians. The impact of electronic fetal monitoring on obstetric safety has become a high priority, with documentation being essential to evaluating care quality. Over several decades, electronic fetal monitoring documentation has reached a higher level of precision because paper is being replaced with health information technology that incorporates system's features such as checklists, drop-down boxes, and decision analysis...
December 13, 2017: Journal of Perinatal & Neonatal Nursing
Edward Mullins, Christoph Lees, Peter Brocklehurst
No abstract text is available yet for this article.
December 5, 2017: BMJ: British Medical Journal
Thomas P Sartwelle, James C Johnston, Berna Arda
Bioethics abolished the prevailing Hippocratic tenet instructing physicians to make treatment decisions, replacing it with autonomy through informed consent. Informed consent allows the patient to choose treatment after options are explained by the physician. The appearance of bioethics in 1970 coincided with the introduction of electronic fetal monitoring (EFM), which evolved to become the fetal surveillance modality of choice for virtually all women in labor. Autonomy rapidly pervaded all medical procedures, but there was a clear exemption for EFM...
2017: Maternal Health, Neonatology and Perinatology
Michelle Oberman
The problem at the heart of "Stemming the Standard-of-Care Sprawl: Clinician Self-Interest and the Case of Electronic Fetal Monitoring," an article by Kayte Spector-Bagdady and colleagues in the November-December 2017 issue of the Hastings Center Report, is the persistence of a suboptimal standard of care long after evidence-driven approaches would dictate a change. That problem is not simply defensive medicine, or what the authors call "standard-of-care sprawl." Instead, it is that, in some cases, the standard of care lags behind best practices...
November 2017: Hastings Center Report
(no author information available yet)
In one way or another, several pieces in the November-December 2017 of the Hastings Center Report reflect an insistence on turning away from abstractions to learn how a whole community understands a problem at issue-how a community understands what's at stake in individuals' autonomous choices, how a community understands the results of a clinical trial, how a community understands, and generates and adjusts, medical standards. In the lead article, Kayte Spector-Bagdady and colleagues argue that, given extensive research showing that electronic fetal monitoring during childbirth offers very little benefit to the mother and child, a mechanism is needed to ensure that the medical standard of care is based on the right kinds of considerations...
November 2017: Hastings Center Report
Kayte Spector-Bagdady, Raymond De Vries, Lisa Hope Harris, Lisa Kane Low
The "best interests of the patient" standard-a complex balance between the principles of beneficence and autonomy-is the driving force of ethical clinical care. Clinicians' fear of litigation is a challenge to that ethical paradigm. But is it ever ethically appropriate for clinicians to undertake a procedure with the primary goal of protecting themselves from potential legal action? Complicating that question is the fact that tort liability is adjudicated based on what most clinicians are doing, not the scientific basis of whether they should be doing it in the first place...
November 2017: Hastings Center Report
Robert D Eden, Mark I Evans, Shara M Evans, Barry S Schifrin
OBJECTIVE: The near-ubiquitous use of electronic fetal monitoring has failed to lower the rates of both cerebral palsy and emergency operative deliveries (EODs). Its performance metrics have low sensitivity, specificity, and predictive values for both. There are many EODs, but the vast majority have normal outcomes. The EODs, however, cause serious disruption in the delivery suite routine with increased complications, anxiety, and concern for all. METHODS: We developed the fetal reserve index (FRI) as multicomponent algorithm including 4 FHR components (analyzed individually), uterine activity, and maternal, obstetrical, and fetal risk factors to assess risk of cerebral palsy and EOD...
January 1, 2017: Reproductive Sciences
Eran Ashwal, Shiri Shinar, Amir Aviram, Sharon Orbach, Yariv Yogev, Liran Hiersch
BACKGROUND: Intrapartum fetal heart rate (FHR) monitoring is well recommended during labor to assess fetal wellbeing. Though commonly used, the external Doppler and fetal scalp electrode monitor have significant shortcomings. Lately, non-invasive technologies were developed as possible alternatives. OBJECTIVE: The objective of this study is to compare the accuracy of FHR trace using novel Electronic Uterine Monitoring (EUM) to that of external Doppler and fetal scalp electrode monitor...
November 2, 2017: Journal of Maternal-fetal & Neonatal Medicine
Nandini Raghuraman, Alison G Cahill
Electronic fetal monitoring (EFM) is widely used to assess fetal status in labor. Use of intrapartum continuous EFM is associated with a lower risk of neonatal seizures but a higher risk of cesarean or operative delivery. Category II fetal heart tracings (FHTs) are indeterminate in their ability to predict fetal acidemia. Certain patterns of decelerations and variability within this category may be predictive of neonatal morbidity. Adjunct tests of fetal well-being can be used during labor to further triage patients...
December 2017: Obstetrics and Gynecology Clinics of North America
Fetch more papers »
Fetching more papers... Fetching...
Read by QxMD. Sign in or create an account to discover new knowledge that matter to you.
Remove bar
Read by QxMD icon Read

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"