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Monitoring Interpretation
• ACOG-2005 terminology
• Baseline variability
• Presence of accelerations
Absent
• Undetectable from baseline
Minimal
• Visually detectable, <5bpm
Moderate
• 6-25 bpm
Marked
• >25 bpm
Sinusoidal
• Increasing the heart rate is the only way a fetus can increase cardiac
output in the setting of hypoxemia.
Prolonged Deceleration
• Decrease of >15 bpm from baseline
• Duration >2 minutes
• Less than 10 minutes
• Change of baseline >10 minutes
• Gradual or abrupt onset
Prolonged Deceleration
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Categories
Points of NICHD
• Timely
• Did the nurse documenting ”no decels or fetal heart tones problems”
mean there were none?
• On the flip side, had it been a category 1 strip and the nurse
documented variable and late decelerations, would that have made any
difference in the outcome of the baby?
• Evaluates variables vs. Earlies: is the onset to nadir > or < 30 seconds?
• What was the variability before and after the FHR change? Were there
accelerations?
Elements of Medical Malpractice
1. Duty
2. Breach of Duty
3. Causation
When reviewing a labor chart for legal purposes, one wants to see:
• The FHR strip was accurately assessed and interpreted
• *More importantly,* if required, appropriate and timely interventions
were employed, i.e.
• Continue to monitor (EFM, vital signs, labs, etc)
• Notify MD
• Maternal lateral positioning
• IVF bolus
• Decrease/DC pitocin/tocolysis
• Some assessment of fetal acid/oxygenation status – NST, BPP, Scalp stim
• These interventions were evaluated for effectiveness within a timely
manner
• If ineffective, the next interventions were carried out within a timely manner
Documentation
Assessment
Evaluation Plan
Implementation
10 Rules of Labor Eval for Attorneys
• What would you like to know more about? We want to hear your
suggestions!
References