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Electronic fetal monitoring

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https://www.readbyqxmd.com/read/29329576/spontaneous-prematurity-in-fetuses-with-congenital-diaphragmatic-hernia-a-retrospective-cohort-study-about-prenatal-predictive-factors
#1
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
https://www.readbyqxmd.com/read/29258525/advancing-perinatal-patient-safety-through-application-of-safety-science-principles-using-health-it
#2
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
https://www.readbyqxmd.com/read/29240893/risk-and-reputation-obstetricians-cesareans-and-consent
#3
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
https://www.readbyqxmd.com/read/29240649/electronic-fetal-monitoring-documentation-connecting-points-for-quality-care-and-communication
#4
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
https://www.readbyqxmd.com/read/29208652/is-continuous-electronic-fetal-monitoring-useful-for-all-women-in-labour
#5
Edward Mullins, Christoph Lees, Peter Brocklehurst
No abstract text is available yet for this article.
December 5, 2017: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/29201387/a-half-century-of-electronic-fetal-monitoring-and-bioethics-silence-speaks-louder-than-words
#6
REVIEW
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
https://www.readbyqxmd.com/read/29171054/the-sticky-standard-of-care
#7
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
https://www.readbyqxmd.com/read/29171052/social-practices
#8
(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
https://www.readbyqxmd.com/read/29171044/stemming-the-standard-of-care-sprawl-clinician-self-interest-and-the-case-of-electronic-fetal-monitoring
#9
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
https://www.readbyqxmd.com/read/29137550/reengineering-electronic-fetal-monitoring-interpretation-using-the-fetal-reserve-index-to-anticipate-the-need-for-emergent-operative-delivery
#10
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
https://www.readbyqxmd.com/read/29096560/a-novel-modality-for-intrapartum-fetal-heart-rate-monitoring
#11
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
https://www.readbyqxmd.com/read/29078943/update-on-fetal-monitoring-overview-of-approaches-and-management-of-category-ii-tracings
#12
REVIEW
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
https://www.readbyqxmd.com/read/29026371/proportion-and-factors-associated-with-low-fifth-minute-apgar-score-among-singleton-newborn-babies-in-gondar-university-referral-hospital-north-west-ethiopia
#13
Temesgen Worku Gudayu
BACK GROUND: New born babies with low Apgar scores are at an increased risk of perinatal morbidity and mortality. OBJECTIVE: To assess proportion and factors associated with low 5(th) minute Apgar Apgar score among singleton newborn babies in Gondar University referral hospital; North West Ethiopia. METHODS: A cross-sectional study was conducted on singleton 261 live births from March - May, 2013. Data was collected from mother/newborn index using a structured and pre-tested questionnaire...
March 2017: African Health Sciences
https://www.readbyqxmd.com/read/29016232/algorithm-for-the-management-of-asthma-in-pregnant-women-a-protocol-to-optimize-processes-in-healthcare
#14
Eva Martinez-Moragón, Auxiliadora Romero-Falcón, Juan Luis García-Rivero
Asthma is the most common chronic disease in pregnant women. Its evolution during pregnancy could improve, stay the same or worsen, especially in cases where there is a loss of clinical control. This can lead to maternal and fetal hypoxia with serious adverse perinatal outcomes. Areas covered: This article reviews physiological modifications in pregnancy, effects of pregnancy on asthma, and possible consequences on fetus development. Furthermore, it reviews evidence on assessment and both pharmacological and non-pharmacological management of asthma in pregnant and breastfeeding women as well as in acute exacerbations...
December 2017: Expert Review of Respiratory Medicine
https://www.readbyqxmd.com/read/28953855/from-apparent-death-to-birth-asphyxia-a-history-of-blame
#15
REVIEW
Michael Obladen
Since the sixteenth century, competition between midwives and surgeons has created a culture of blame around the difficult delivery. In the late seventeenth century, 100 years before oxygen was discovered, researchers associated "apparent death of the newborn" with impaired respiratory function of the placenta. The diagnosis "birth asphyxia" replaced the term "apparent death of the newborn" during the mass phobia of being buried alive in the eighteenth century. This shifted the interpretation from unavoidable fate to a preventable condition...
November 8, 2017: Pediatric Research
https://www.readbyqxmd.com/read/28946843/intermittent-auscultation-versus-continuous-fetal-monitoring-exploring-factors-that-influence-birthing-unit-nurses-fetal-surveillance-practice-using-theoretical-domains-framework
#16
Andrea M Patey, Janet A Curran, Ann E Sprague, Jill J Francis, S Michelle Driedger, France Légaré, Louise Lemyre, Marie-Pascale A Pomey, Jeremy M Grimshaw
BACKGROUND: Intermittent Auscultation (IA) is the recommended method of fetal surveillance for healthy women in labour. However, the majority of women receive continuous electronic monitoring. We used the Theoretical Domains Framework (TDF) to explore the views of Birthing Unit nurses about using IA as their primary method of fetal surveillance for healthy women in labour. METHODS: Using a semi-structured interview guide, we interviewed a convenience sample of birthing unit nurses throughout Ontario, Canada to elicit their views about fetal surveillance...
September 25, 2017: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/28902389/women-s-experiences-of-continuous-fetal-monitoring-a-mixed-methods-systematic-review
#17
Alexandra Crawford, Dexter Hayes, Edward D Johnstone, Alexander E P Heazell
INTRODUCTION: Antepartum stillbirth is often preceded by detectable signs of fetal compromise, including changes in fetal heart rate and movement. It is hypothesised that continuous fetal monitoring could detect these signs more accurately and objectively than current forms of fetal monitoring and allow for timely intervention. This systematic review aimed to explore available evidence on women's experiences of continuous fetal monitoring to investigate its acceptability prior to clinical implementation and to inform clinical studies...
September 13, 2017: Acta Obstetricia et Gynecologica Scandinavica
https://www.readbyqxmd.com/read/28899619/first-do-the-experiment-do-computerised-interpretation-of-cardiotocography-and-other-widely-used-interventions-improve-newborn-outcomes
#18
REVIEW
Philip Steer
The introduction of continuous electronic fetal heart rate monitoring (EFM) in labour has coincided with a steady and remarkable fall in perinatal mortality. Whether this is cause or coincidence remains unclear because randomised trials have been underpowered. Attempts to improve the sensitivity and specificity of fetal compromise detection using fetal blood sampling and pH measurement, pulse oximetry, and fetal electrocardiogram analysis have failed to provide evidence of additional value in randomised trials...
November 2017: Early Human Development
https://www.readbyqxmd.com/read/28853105/different-approaches-to-detect-nanobacteria-in-patients-with-kidney-stones-an-infectious-cause-or-a-subset-of-life
#19
Hani Ansari, Abbas Akhavan Sepahi, Mohsen Akhavan Sepahi
PURPOSE: This research focused on the detection of nanobacteria in kidney stones of 30 Iranian patients without adding fetal bovine serum (FBS) to the culture media. MATERIALS AND METHODS: Nanobacteria were isolated from a nephro-ureterolithiasis extract of the urinary tract and kidney of patients and were cultured in the laboratory. The growth of nanobacteria was monitored using a spectrophotometer, and with inverted microscopy technique, their crystallization was analyzed after two days...
August 29, 2017: Urology Journal
https://www.readbyqxmd.com/read/28851241/obesity-s-impact-on-intrapartum-electronic-fetal-monitoring
#20
Brian Brocato, David Lewis, Madhuri Mulekar, Susan Baker
OBJECTIVE: The objective of this study is to evaluate the impact maternal obesity has on the percentage of unmonitored electronic fetal monitoring (EFM). STUDY DESIGN: Women undergoing induction of labor at term were categorized into three groups: Group 1 (body mass index (BMI) < 30 kg/m2), Group 2 (30 < BMI < 40 kg/m2), and Group 3 (BMI ≥ 40 kg/m2). External EFM tracings were reviewed from the time of induction of labor until amniotomy; the percentage of time off of EFM was calculated...
September 17, 2017: Journal of Maternal-fetal & Neonatal Medicine
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