II. Contraindications
- Does not detect overall Fetal Heart Rate variability
- High risk maternal or fetal risk factors
- See Continuous Electronic Fetal Monitoring (CEFM) for its specific high risk indications
- See Peripartum Risk to the Fetus
III. Requirements
- Requires one-to-one nursing (every 15 minute monitoring)
- Nurses must be skilled in FHR auscultation
- Nurses must be able to palpate contractions
- Non-reassuring findings require clinical evaluation
IV. Technique
- Monitoring frequency
- Stage 1:
- Low Risk: Every 15-30 minutes
- High risk: Every 15 minutes
- Continuous Electronic Fetal Monitoring is recommended in high risk cases
- Stage 2:
- Low Risk: Every 5-15 minutes
- High Risk: Every 5 min or after each contraction
- Continuous Electronic Fetal Monitoring is recommended in high risk cases
- Other indications as needed
- Before and after procedure (e.g. AROM, IUPC)
- Before and after ambulation
- Before and after medication including Anesthesia
- Abnormal uterine contraction pattern
- After vaginal examination
- Stage 1:
- Procedure
- Baseline Fetal Heart Rate (FHR)
- Auscultate and count FHR for 60 seconds
- Perform between contractions
- Fetal response to labor
- Auscultate and count FHR for 60 seconds
- Perform immediately after contraction
- Variability assessment
- See FHR Variability
- Baseline Fetal Heart Rate (FHR)
- Indications to transition to Continuous Electronic Fetal Monitoring (CEFM)
- Irregular Fetal Heart Rate
- Fetal Tachycardia (>160 bpm for >10 minutes)
- Fetal Bradycardia (<110 bpm for >10 minutes)
- Recurrent fetal decelerations after contractions (>50% of contractions)
- Prolonged deceleration (2-10 minutes)
V. Efficacy
- Decreased rate of cesarean and operative Vaginal Delivery
- No increase in unfavorable outcomes compared with Continuous Electronic Fetal Monitoring (CEFM) in low risk patients