EFM-1 - Electronic Fetal Monitoring D. Lata Sharma, MD,...

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Electronic Fetal Monitoring D. Lata Sharma, MD, FRANZCOG Senior Lecturer, University Of Queensland, Australia
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HISTORY - EFM 1818-Francios Major in Geneva-DDx between FH and Maternal Pulse 1827- John C Ferguson –described FHR sounds. 1849-Killian indicated FHr parameters requiring interventions. 1876-Pinard produced his design for a fetal stethoscope. 1893-Winkel set normal FHR120-169 bpm. 1958-Hon in USA and Hammacher in Europe introduced first EFM. 1964- Doppler ultrasound scan replaced phonocord. 1966- Saling in Berlin introduced FBS. 1968-Hamacher and Hewitt-Packard developed first fetal monitor. 1985- Dublin RCT changed terminology for the CTG interpretation.
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Electronic Fetal Monitoring Pioneered in 1958 by Hon.in USA and Hammacher in Europe Commercially available 1968 Continues monitoring of FH in low risks pregnant -lacks evidence Needs to be viewed in conjunction with other assessment e.g. FBS and clinical situation. Should be used for the right reason and with appropriate degree of skill.
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EFM-ISSUES Detect fetal hypoxia i.e reduce and avoid harm to the fetus and improve fetal and baby out-come. Severe acidosis may result in FHR changes. Could occur in Normal physiological response in labor. Misunderstanding the physiological and pathphysiological CTGs will improve the Mx.
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EFM Problems and Realities Electronic Intra-partum FHR Monitoring is now considered mandatory for high-risk pregnancies. Difficulties with interpretation include over confidence and not- only difference in opinion between practitioners but, also when the same practitioner examines the same CTG twice. Increases CS rates 1.41%rr. Increases operative vaginal delivery 1.20%rr. And no change in incidence of C Palsy. Reduction in Neonatal seizures rates 0.51% No difference in APGAR scores. ? About the efficacy.
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EFM- Facts Reliability of interpretation-50-75% are false positive . False positive Dx reduces to 105 with FBS. FBS 93% sensitivity, 6% false positive. PH Vs Lactate -39% Vs 2.3(rr 16.7).
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Electronic Fetal Monitoring- Indications Indications for the continuous EFM High risk pregnancies IOL and Augmentation of Labour. Reduced FM. Premature labour/TPL. APH/IPH Oligohydramnios Hypertension. Abnormal FHR detected. Malpresentation and in labour. DM,Multiple Gestation. Previous CS. Abdominal Trauma. Prolonged ROM. Meconium Liq.
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EFM- Interpretation Consider : Intrapartum/antepartum trace. Stage of labour. Gestation. Fetal presentation, ?Malpresentation. Any augmentation,?IOL Medications Direct or indirect monitoring/
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EFM- 4 Basic Features of FH Trace
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EFM-4 Basic Features. Baseline FHR - Mean level of FHR when this is stable,
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EFM-1 - Electronic Fetal Monitoring D. Lata Sharma, MD,...

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