Page 219 - Encyclopedia of Nursing Research

186 n FETAL MONITOrING

rather than the purpose it serves it under- assessment to determine optimal fetal devel-
standing, explaining, and changing current opment and diagnose conditions of actual or
F experiences of women. potential fetal compromise (e.g., nonstress
test, contraction stress test, vibroacoustic
Sara L. Campbell stimulation, and biophysical profiles).
Controversies still continue over the
appropriate place of EFM in obstetric care. It
was introduced into clinical practice based on
Fetal monitoring animal studies and became widely used, with
no controlled assessment of its effectiveness
in improving the outcome of delivery, partic-
Fetal assessment is part of the process of pro- ularly in reducing the rates of cerebral palsy
viding prenatal care. It involves early iden- and neurologic injury (robinson & Nelson,
tification of real or potential problems and 2008). It was supposed to provide more accu-
enables the achievement of the best possible rate fetal assessment with the accompanying
obstetric outcomes. Fetal assessment involves prompt identification of fetal compromise.
low-tech and high-tech modalities such as The National Institutes of Child Health and
fetal movement counting (kick counts), inter- Human development (NICHd) has peri-
mittent auscultation (IA), electronic fetal odically issued guidelines for the use of
monitoring (EFM), nonstress tests, vibroa- continuous cardiotocography/EFM in fetal
coustic stimulation, auscultated acceleration, assessment, the most recent was published
contraction stress tests, amniotic fluid index, in 2008 (http://www.ncbi.nlm.nih.gov/pmc/
biophysical profiles, and doppler velocime- articles/PMC2621055/, accessed May 17, 2010).
try. The basis for all of these testing modal- Schmidt and McCartney (2000) pre-
ities is the evaluation of certain biophysical sented a thorough historical review and dis-
parameters related to the developmental and cussion of the development of fetal heart rate
health-related patterns of fetal behavior in assessment. They found that expectations
utero. Adequate uteroplacental function is of the benefits of EFM exceeded and pre-
necessary for these patterns of healthy behav- ceded research on outcomes, efficacy, and
ior. uteroplacental insufficiency has been safety. As knowledge accumulated through
shown to be the cause of at least two-thirds of research and practice, the theories of corre-
antepartal fetal deaths (Gegor & Paine, 1992). lation of causation and intrapartal events
EFM will serve as the focal point for this have changed. What were once considered to
discussion as it is the basic intervention used be significant intrapartal events cannot now
in fetal assessment. EFM, as an electronic data be linked as conclusively to brain damage
gathering and data processing device, was in neonates. Current research and improve-
developed during the 1960s. By the end of the ments continue to report the benefits of EFM:
1970s, almost all major obstetrical units had a decrease in neonatal seizures and decreased
at least one monitor, and 70% of all women operative intervention for fetal distress, with
in labor in the united States were monitored improved analysis.
(Bassett, 1996). In 2002, nearly 85% of approx- The major problem is still the risk of mis-
imately 4 million live births were assessed interpretation of the EFM tracing. Schmidt
with monitoring, also known as continuous and McCartney (2000) included study results
cardiotocography (robinson & Nelson, 2008). in which, with a reassuring pattern, EFM can
In addition to its use in monitoring fetal be a sensitive tool for identifying the well-
status during labor, modifications of EFM oxygenated fetus. However, it is not a spe-
have been developed for antepartal fetal cific tool for identifying the compromised