Artifactual fetal electrocardiographic detection using internal monitoring following intrapartum fetal demise during VBAC trial

Maternal or Fetal Heart Rate? Avoiding Intrapartum Misidentification

“…When uniform accel-erations are seen during the second stage, it is a good habit to monitor the MHR and FHR simultaneously; for example, with a pulse oximeter attached to the fetal monitor. Ramsey, Johnston, Welter, and Ogburn (2000) reported a similar case of uterine rupture and fetal demise. They recommended meticulous labor management and close attention to both maternal and fetal vital signs to provide early identification of fetal compromise due to acute uterine rupture.…”

VBAC: Safety for the Patient and the Nurse

“…The cessation of uterine activity may come after the tachysystole or may occur independently. However, many authors have stated that usually there is no disruption of the uterine activity (Blanchette et al, 2001;Flamm, 1992;Menihan, 1998;Ramsey, Johnston, Welter, & Ogburn, 2000).…”

“…The most significant sign of uterine rupture described in the literature is a change in the fetal heart rate tracing (Blanchette et al, 2001;Cowan, Kinch, Ellis, & Anderson, 1994;Kieser, 2002;Leung, Farmer, et al, 1993;Menihan, 1998), which was described as early as 1992 by Flamm. Several authors have indicated that when uterine rupture occurs, variable decelerations are frequently seen, or they have reported cases of variable decelerations followed by bradycardia (Ramsey et al, 2000;Webb et al, 2000). However, others have indicated that bradycardia can occur without preceding decelerations (Bennett, 1997;Flamm, 2001;Menihan, 1999 The most significant sign of uterine rupture is change in the fetal heart rate tracing.…”

Improvements in fetal heart rate analysis by the removal of maternal-fetal heart rate ambiguities

“…Fetal heart rate (FHR) monitoring may be affected by the temporary acquisition of the maternal heart rate (MHR), both when using external monitoring with Doppler ultrasound [1], and when using internal monitoring with electrocardiography (ECG) [2–6]. Inadvertent MHR acquisition with external monitoring has been reported in up to 90 % of intrapartum recordings, for an average of 6.2 % of tracing length [1], while with internal monitoring it is usually due to the detection of maternal signals transmitted via the fetal electrode in cases of fetal death [2, 5].…”

“…Inadvertent MHR acquisition with external monitoring has been reported in up to 90 % of intrapartum recordings, for an average of 6.2 % of tracing length [1], while with internal monitoring it is usually due to the detection of maternal signals transmitted via the fetal electrode in cases of fetal death [2, 5]. Overall, significant errors in FHR interpretation may occur, including missing the diagnoses of newborn acidemia [7, 8] and fetal death [2–6]. …”