Page 220 - Encyclopedia of Nursing Research

FETAL MONITOrING n 187

fetus when a nonreassuring pattern is seen. substitute for supportive health care person-
Current concerns are focused on the best nel. Additionally, specific indications, such as
ways to prevent or reduce the inappropri- oxytocin induction or augmentation of labor, F
ate use of EFM and develop the best ways to abnormal fetal heart rate by auscultation,
assess and monitor fetal development and twin gestation, hypertension or preeclamp-
safety in labor. use of the NICHd guidelines sia, dysfunctional labor, meconium staining,
should resolve this problem. vaginal breech delivery, diabetes, or prema-
McCartney (2000) discussed the pro- turity, as noted by Smith, ruffin, and Green
posed benefits of automated EFM assessment (1993), are still applicable. A major change is
(computer analysis): it is objective, standard- the recommendation that the terms “hyper-
ized, and reproducible. She discusses the use stimulation” and “hypercontractility” have
of artificial intelligence and how it may prove no meaning and should be abandoned (2008
to be of great value along with smart monitors NICHd update).
and electronic databases in improving the Haggerty (1999) presented an extensive
interpretation of EFM. Porter (2000) reported overview of the reliability, validity, and effi-
that in May 2000, the use of fetal pulse oxim- cacy of EFM. Her work looks at both sides
etry has been approved by the FdA for clin- of the controversy and includes the recom-
ical use to provide more information about mendations of the American College of
fetal oxygen status, especially in cases of Obstetricians and Gynecologists, the united
nonreassuring fetal heart rate patterns. States Preventive Services Task Force (1996),
The American College of Obstetricians and the AWHONN that both EFM and IA
and Gynecologists (2009) and the Association have a place in fetal monitoring. Feinstein
of Women’s Health, Obstetrical, and Neonatal (2000) also researched the efficacy of IA,
Nurses (AWHONN), in cooperation with the especially with low-risk pregnant women.
NICHd, have developed standards and guide- Miltner (2002) concluded that integrating sup-
lines for practice concerning fetal assessment portive care provided by labor nurses with
and the use of EFM and other modalities of other direct and indirect care interventions
fetal heart rate assessment. These new guide- (such as monitoring modalities) may offer
lines outline a three-tier, simplified categori- the best model for providing high-quality
zation and interpretation of fetal heart rate intrapartum nursing care. The previous find-
tracings. Category 1 describes normal trac- ings are supported in more recent research
ings, category II describes indeterminate conclusions.
tracings, and category III describes abnor- Further prospective studies should be
mal tracings (robinson & Nelson, 2008). The conducted to try to determine the optimal
presence or absence of fetal acidemia is the balance of intermittent or continuous EFM
significant factor (robinson & Nelson, 2008). and auscultation and the other modalities
Additionally, AWHONN position papers of fetal assessment and pregnancy manage-
call for these standards of practice to deter- ment. rigorous study protocols and close
mine the accepted conduct of antepartal and attention to the principles of scientific inquiry
intrapartal care and provide the core of safe are needed so that study results will be reli-
practice. It is the responsibility of all nursing able and valid. The major concerns of perina-
and medical health care providers to be pro- tal care should be optimal and cost-effective
ficient in the use and interpretation of EFM outcomes for mother and infant, without
and other intervention modalities used in concern for protection of the caregiver from
perinatal health care delivery. Other recom- litigious actions.
mendations include using EFM as a diagnos-
tic rather than a screening tool and not as a Susan M. Miovech