LAS VEGAS — When it comes to effective risk management in electronic fetal monitoring, step No. 1 is to adopt a set of uniform definitions for fetal heart-rate tracings, Lisa A. Miller advised at a conference on fetal monitoring sponsored by Symposia Medicus.
“If we are not speaking the same language in electronic fetal monitoring, we are not going to be able to effectively communicate,” said Ms. Miller, a certified nurse-midwife, lawyer, and perinatal risk management educator/consultant in Chicago.
Detailed guidelines for the interpretation of fetal heart-rate tracings were published 8 years ago by a panel of experts convened by the National Institute of Child Health and Human Development (Am. J. Obstet. Gynecol. 1997;177:1385ndash;90). The purpose of the effort was to develop “standardized and unambiguous definitions” for visual reading of fetal heart-rate tracings.
The panel included 16 physicians who specialized in maternal/fetal medicine or obstetrics, 1 epidemiologist, 1 NICHD physician, and 1 nursing expert.
Even though the panel clearly defined terms like baseline “variability,” “sinusoidal baseline,” and “prolonged acceleration” for use in clinical practice, Ms. Miller said that adoption of the NICHD nomenclature by clinicians during the last 8 years has been inconsistent. “It's all over the map,” she said. “In some [obstetrics] residency [programs], it's didactic. In some, it's hands-on. In some, it's a combination. In some residencies, they test for it; in some, they don't.”
She called the NICHD guidelines “the best that we have,” because they are easily teachable, they come from a panel of experts, and they're the most widely accepted in the literature.
“If you want to increase education, you want to decrease liability, and you want to make the world a better place, move to the NICHD nomenclature,” she said. “Standardization of terms can improve communication. Therefore, it should improve clinical management. We still need research on the clinical helpfulness of electronic fetal monitoring. But, she said, “meaningful research” requires that everyone use the same language.
She also advised physicians, nurses, and midwives to get their electronic fetal monitoring education together. “It is ridiculous to have the nurses going to one program and doctors going to another,” she said. “It makes absolutely no sense.”
According to the Centers for Disease Control and Prevention, 80% of American women have had some amount of electronic fetal monitoring during labor and delivery, making it the most common obstetric procedure in the United States.