Electronic Fetal Heart Rate Monitoring: The 5-Tier System: The 5-Tier System

Electronic Fetal Heart Rate Monitoring: The 5-Tier System, Third Edition reviews the practice of fetal heart rate monitoring. Beginning with a description of the anatomy of fetal circulation, placental function as a respiratory organ, and acid-base balance, it also presents normal fetal cardiovascular and cerebral metabolism. In addition, the pathophysiologic mechanisms involved in progressive fetal asphyxia are examined via a review of the seminal animal and human studies conducted in this field. Also included is a brief summary of fetal heart rate monitoring technology currently used in clinical practice and standard nomenclature for fetal heart rate characteristics. Variant fetal heart rate patterns and the underlying physiologic mechanisms are presented as well. The Third Edition summarizes the research identifying the relationship between specific fetal heart rate patterns and an increasing risk of fetal acidemia, including the effect of deceleration depth, duration, and pattern evolution. It also evaluates the scientific basis that supports management algorithms currently in use and recommends the Parer/Ikeda 5-tier system. This algorithm assigns fetal heart rate patterns to 5 categories based on their progressive risk of fetal acidemia and has been tested in several studies. Clinical management using the 5-tier system is presented in detail. Title Page Copyright ACKNOWLEDGMENTS PREFACE TO THE FIRST EDITION PREFACE TO THE SECOND EDITION PREFACE TO THE THIRD EDITION CONTENTS CONTRIBUTORS PART I History CHAPTER 1 Development of Intrapartum Surveillance of the Fetus References PART II Physiology CHAPTER 2 Uteroplacental Circulation and Respiratory Gas Exchange I. PLACENTAL ANATOMY AND CIRCULATION II. MECHANISMS OF PLACENTAL EXCHANGE III. DETERMINANTS OF DIFFUSION IV. UTERINE BLOOD FLOW V. OXYGEN TRANSFER TO THE FETUS VI. CARBON DIOXIDE TRANSFER VII. ACID–BASE BALANCE VIII. CLINICAL IMPLICATIONS References CHAPTER 3 Fetal Cardiorespiratory and Cerebral Physiology I. ANATOMY OF FETAL CIRCULATION II. DISTRIBUTION OF BLOOD FLOWS III. FETAL BLOOD PRESSURES IV. FACTORS CONTROLLING FETAL HEART RATE V. FETAL CEREBRAL METABOLISM References CHAPTER 4 Acid–Base Physiology I. ACIDS PRODUCED BY THE BODY II. LIMITS OF ACIDITY COMPATIBLE WITH SURVIVAL III. NORMAL ACID–BASE VALUES References CHAPTER 5 Fetal Asphyxia: Pathogenic Mechanisms and Consequences I. FETAL CARDIORESPIRATORY RESPONSES TO HYPOXIA II. CENTRAL NERVOUS SYSTEM RESPONSE TO HYPOXIA III. FETAL ASPHYXIA AND NEWBORN MORBIDITY IV. FACTORS THAT MODIFY FETAL VULNERABILITY TO ASPHYXIA V. TREATMENTS FOR NEWBORNS WITH NEONATAL ENCEPHALOPATHY VI. CONCLUSION References PART III Instrumentation and Techniques CHAPTER 6 The Fetal Heart Rate Monitor I. FETAL HEART RATE II. UTERINE ACTIVITY References PART IV Nomenclature and Interpretation CHAPTER 7 Fetal Heart Rate Patterns: Nomenclature and Etiology I. INTRODUCTION II. BASELINE FETAL HEART RATE FEATURES III. PERIODIC AND EPISODIC FETAL HEART RATE PATTERNS IV. ALTERATIONS IN BASELINE RATE V. SINUSOIDAL PATTERN VI. COMPUTER ANALYSIS OF FETAL HEART RATE PATTERNS References CHAPTER 8 The Relationship Between Fetal Heart Rate Patterns and Fetal or Newborn Acidemia I. DEVELOPMENT OF ACIDEMIA WITH RECURRENT DECELERATIONS OVER TIME II. FETAL HEART RATE PATTERN EVOLUTION III. VARIANT FETAL HEART RATE PATTERNS AND TIMING OF ACIDEMIA IV. CLINICAL IMPLICATIONS References PART V Clinical Management CHAPTER 9 Clinical Management of Fetal Heart Rate Patterns During Labor I. INTRODUCTION II. THE 3-TIER SYSTEM OF FETAL HEART RATE INTERPRETATION AND MANAGEMENT III. THE 2-, 3-, 4-, AND 5-TIER SYSTEMS OF FETAL HEART RATE INTERPRETATION IV. THE PARER–IKEDA 5-TIER SYSTEM OF FETAL HEART RATE INTERPRETATION V. ANCILLARY TESTING DURING INTRAPARTUM FETAL HEART RATE MANAGEMENT VI. CLINICAL MANAGEMENT OF CATEGORY I/ GREEN FETAL HEART RATE PATTERNS VII. CLINICAL MANAGEMENT OF CATEGORY IIA/ BLUE TO CATEGORY IIC/ORANGE FETAL HEART RATE PATTERNS VIII. CLINICAL MANAGEMENT OF CATEGORY III/ RED FETAL HEART RATE PATTERNS IX. FETAL HEART RATE PATTERNS IN THE SECOND STAGE OF LABOR References CHAPTER 10 Modifiers of Fetal Heart Rate Interpretation and Unusual Fetal Heart Rate Patterns I. MATERNAL AND FETAL CONDITIONS THAT AFFECT THE FETAL RESPONSE TO HYPOXIA II. FETAL HEART RATE CHARACTERISTICS ASSOCIATED WITH ACUTE CATASTROPHIC EVENTS III. CONGENITAL ANOMALIES IV. UNUSUAL FETAL HEART RATE PATTERNS V. EFFECT OF DRUGS ON THE FETAL HEART RATE References PART VI Additional Aspects of Fetal Heart Rate Monitoring CHAPTER 11 Antepartum Fetal Heart Rate Testing I. FETAL BEHAVIORAL STATES II. FETAL MOVEMENT OR “KICK COUNTS” III. CONTRACTION STRESS TEST IV. NONSTRESS TEST V. BIOPHYSICAL PROFILE VI. MODIFIED BIOPHYSICAL PROFILE (NONSTRESS TEST/AMNIOTIC FLUID INDEX) VII. DOPPLER VELOCIMETRY VIII. INDICATIONS FOR ANTENATAL TESTING References CHAPTER 12 Medical Legal Considerations, Documentation, and Fetal Heart Rate Credentialing I. MEDICAL LEGAL CONSIDERATIONS IN FETAL HEART RATE MONITORING II. FETAL HEART RATE EDUCATION AND FETAL HEART RATE CREDENTIALING INITIATIVES III. CONCLUSION References INDEX