The Importance of Fetal Heart Monitoring
One of the greatest advances in the field of obstetrics has been the development of electronic fetal heart monitoring. It allows clinicians to evaluate, in real time, the adequacy of fetal oxygenation.
The first mention of a fetal heart beat was in a 17th century French poem. By the early 18th century, obstetricians were slowly beginning to recognize that listening to the fetal heart rate could help identify the presence of twins and fetal presentation. In 1833, an Irish physician published Observations on Obstetric Auscultation, which described instances in which listening to the fetal heart improved outcome. By 1848, a British physician proposed criteria for obstetrical intervention when the fetal heart rate dropped below, or exceeded, certain parameters.
Now, the science has advanced considerably. Electronic fetal monitoring (EFM) has largely replaced the stethoscope. By 1978, it was estimated that half of labors were monitored electronically—now, it has become the standard of care.
EFM works because the fetal heart rate creates characteristic tracing patterns when oxygenation is adequate, and when it is not. Some patterns have a high correlation with normal oxygenation and a healthy baby. However, some patterns are not reassuring and it is critical that both obstetricians and labor and delivery nurses are trained to recognize the difference.
EFM provides several types of information and treatises have been written that deal with the interpretation of fetal heart monitor tracings.
EFM allows clinicians to evaluate uterine activity and intervene when contractions become too strong (“tetanic”) or too frequent (“tachysystolic”) so that the fetus, or the mother’s uterus, does not become overstressed.
It creates a depiction of “accelerations” and “decelerations” which allows evaluation of the fetal response to contractions. It is critical that medical staff be trained to differentiate between early, variable and late decelerations, as well as all of their subsets.
EFM tracings permit assessment of the fetal heart rate baseline so that health care providers can recognize a heart rate that is too fast (tachycardia) or too slow (bradycardia).
Most importantly, EFM records beat-to-beat variability, which describes the neurological modulation of the fetal heart rate. Normal variability correlates with healthy babies; abnormal variability can be a danger sign.
EFM can be done externally and internally. Internal EFM is more sensitive—particularly regarding beat-to-beat variability, and therefore it is important for medical staff to know when the standard of care requires application of an internal monitor.
Most cases in which a baby is born with Hypoxic Ischemic Encephalopathy or develops cerebral palsy revolve around the adequacy of fetal heart monitoring. It is crucial that attorneys handling such cases understand the physiological underpinnings of fetal heart monitoring.
At Hampton & King, our Houston birth injury lawyers have the experience and resources to evaluate and prosecute birth injury cases. It’s what we do.
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