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
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.
Call us today to get started with your potential case.