Both devices are embedded into adjustable monitoring strips which are strapped around the mother's belly like a belt. The fetal heart strip is strapped around the center of the abdomen and the strip that measures contractions goes at the top of the abdomen. Both strips connect to a monitoring terminal which displays the FHR and maternal contractions on a computer screen or a print out. The FHR pattern information together with the measurements of the mother's contractions are referred to as EFM tracings.
The EFM tracings provide critical insight into the level of stress the baby is under during labor and birth. The FHR monitor identifies the normal baseline heart rate and then tracks how the rate rhythm accelerates and decelerates during each contraction. Interpreting the acceleration and deceleration FHR patterns in response to contractions tells doctors and nurses if the baby is under duress and may not be getting enough oxygen.
Electronic fetal heart rate monitoring is commonly used to assess fetal well-being during labor. Although detection of fetal compromise is one. Standardized guidelines for the interpretation of the fetal heart rate have been suggested by the National Institute of Child Health and Human Development.
In order for EFM to be an effective tool at preventing potential harm to babies during delivery, the doctors and nurses in the delivery room must properly monitor and accurately interpret the EFM tracings. Interpreting EFM tracings can be somewhat complicated and subjective. In the early days of EFM doctors and nurses tended to interpret the meaning of EFM tracings very differently based on their background and educational training.
More recently efforts to standardize EFM interpretation has led to the development of uniform guidelines for EFM data. Category I tracings are considered normal or "reassuring" and indicate that everything is okay with the baby. Category II tracings are described as "non-reassuring" and an indication that the doctor may need to intervene to prevent harm to the baby.
Normal baseline FHR range is between beats per minute. Information from the National Library of Medicine Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below.
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Study Description. All women who are admitted for labor at Ayder Referral Hospital in Mekelle, Ethiopia will be asked to participate and a physician will obtain consent. Data will be collected for patients receiving EFM without pattern interpretation as the first phase of the study, as this is the current practice at Ayder Hospital. For the third phase of this study, paper will be provided for the use of EFM with pattern interpretation for all patients receiving EFM.
Outcome Measures. Eligibility Criteria. Inclusion Criteria: Women who have a singleton pregnancy. Pregnant women aged 18 years or older. Receiving EFM for intrapartum management. Patients assigned to receive EFM will be designated by the current protocol regarding "high risk" vs. Exclusion Criteria: Women who are carrying multiple gestation. Social, organisational and cultural features of maternity units and the wider institutions in which they sit may inhibit staff from taking the appropriate action, communicating their concerns or reacting appropriately to a request for intervention.
Interpreting and reacting to a CTG trace is therefore best understood as a complex sociotechnical process involving individuals from multiple professions and disciplines, taking place over a number of stages and in highly pressurised contexts.
Given this, purely technical interventions eg, computer-assisted CTG analysis and individual-based training are unlikely to fully address these challenges. We propose that understanding what can go wrong when EFM is used requires full characterisation of the work and social practices involved, the multiple professions who conduct such practices and the context where the process takes place. The overarching aim of this study is to advance understanding of how intrapartum EFM is currently performed in UK maternity units and where risks may occur, in order to inform the development of an intervention to improve practice.
The study comprises two workstreams figure 1 :. An ethnographic study informed by systems engineering to characterise how intrapartum EFM is currently undertaken in UK maternity units. Production of a framework of the types of errors, hazards and failure modes in intrapartum EFM in UK maternity units. This workstream adopts an ethnographic approach combined with systems engineering analytical techniques to characterise how intrapartum EFM is currently undertaken in UK maternity units.
We will conduct observations and semi-structured interviews with healthcare professionals in three different maternity units in the UK, in order to:. Systems engineering focuses on how to design and manage complex systems over their lifecycles.
The approach is particularly useful in gaining a comprehensive and thorough understanding of the risks and hazards that may affect complex healthcare processes. Systems engineers working on health services can collect and use multiple types of data, both quantitative and qualitative, including data collected through observation.
The research participants in this study will be staff in the maternity units who are directly or indirectly involved in the process of EFM with CTG. For the interviews, we will include doctors and midwives in the participating maternity units who are directly involved in using EFM with CTG. Three maternity units will be included in the study.
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They will be selected purposively based on their size, calculated through annual number of births. We will also take into account the geographic situation of the hospital. The objective of this sampling strategy is to understand CTG processes and practices and their variations in practice.
In each maternity unit, we will recruit up to 12 individual members of staff for interviews. Interview participants will be selected purposively: we will seek to interview participants with different professional backgrounds midwives and obstetricians , seniority and professional experiences in maternity care. Our observations will focus on EFM with CTG in intrapartum care rather than ante-natal care ; we therefore expect the bulk of the observations to be conducted in labour wards.
However, depending on how each unit organises admission procedures and early labour checks, and because of the practicalities of shadowing staff, observers may also occasionally visit the antenatal ward. The data collected will consist of anonymised field notes taken during the observations. At the end of each day, these notes will be dictated and recorded using an encrypted voice recorder for later transcription or written up manually.
No photos or videos will be taken of human subjects, but we may take pictures of equipment. Researchers will additionally request relevant documents eg, local guidelines, CTG proformas and documentation tools, training materials, posters, etc from sites. If these documents contain identifying information about any individuals, they will be anonymised prior to storage and analysis. As we have found in previous studies, it will not be practical or appropriate to obtain written consent in all situations where we will be conducting observations.
Therefore, we plan to use an approach we have used successfully in previous studies, which relies on obtaining permission from those being observed, ensuring that those who wish to opt out can easily make this known and recording only completely anonymised data.
We will ensure that staff being observed are informed of the project and are given written information to explain it. Researchers will always explain who they are and will wear an appropriate identifying badge. They will obtain verbal permission from staff where possible sometimes this may be from a senior person on behalf of a group to conduct observations. However, the nature of the ethnography means that we may carry out observations of staff as they come into contact with women while carrying out their routine clinical duties.
Pregnant and postpartum women will only be observed with their permission and agreement and the permission of clinical staff. Women and birth partners will be advised verbally and in writing using posters and leaflets that they can decline observations. The researchers will be sensitive to explaining the aims of the study in a way that will not raise undue concerns in women and birth partners. Staff will be offered the choice of being interviewed individually or in a small group of two or three participants. Interviews may also be arranged by telephone if participants are not available on the days of the visits.
Data analysis will run alongside ongoing fieldwork and will be conducted in two phases, comprising initial, disciplinary-specific analyses of data, followed by an integrative analysis. In the first phase of analysis, the ethnographers and the systems engineer will analyse their observation data separately ie, the systems engineer will only analyse data they will have collected, and the ethnographers will only analyse data collected by ethnographers.
This is because observations are expected to be dependent on the perspective and sensitising concepts used by the different observers. In this phase, ethnographers and systems engineers will additionally analyse the whole interview dataset separately. In their respective first phase analyses of observation and interview data, the researchers will adopt different but complementary approaches.
These concepts may be revised, modified or made redundant as analysis proceeds. The main aim of the analysis will be to produce a comprehensive description of the process of EFM with CTG, using systems modelling techniques to describe the processes, actors and their interactions. In the second phase of analysis, the researchers will integrate their analyses.