Regarding counting strategies you might like to look at the following
references which outline the principles and give some evaluation.
Steer PJ Beard RW (1970) A continuous record of fetal heart rate
obtained by serial counts. The Journal of Obstetrics and Gynaecology
of the British Commonwealth (77): 908-914.
Schifrin BS Amsel J Burdorf G. (1992) The accuracy of auscultatory
detection of fetal cardiac decelerations: A computer simulation,
American Journal of Obstetrics and Gynecology. (166): 566-76.
Best wishes
Julie Harrison
Senior Lecturer (Midwifery and Womens Health)
Faculty of Health and Social Care Sciences
Kingston University and St George's University of London.
----- Original Message -----
From: Beatrice Hogg <[log in to unmask]>
Date: Friday, July 6, 2007 1:48 pm
Subject: SV: intermittent auscultation
To: [log in to unmask]
> I have been working as a midwife in Stockholm, Sweden, and we were
> taught to
> listen every 15 minutes after a contrction and at least for 15
> seconds x 4
> to count out the frequency. Sometimes we listened for a minute if
> we were
> unsure of the FHR.
>
> Beatrice Hogg
>
>
>
> _____
>
> Från: A forum for discussion on midwifery and reproductive health
> research.[mailto:[log in to unmask]] För Ellen Blix
> Skickat: den 14 juni 2007 11:02
> Till: [log in to unmask]
> Ämne: Re: intermittent auscultation
>
>
>
> 15 minutes must be a British tradition. The Norwegian tradition
> used to be
> every 30 minute during most of first stage, more often at the end
> of stage 1
> and after every contraction during active pushing. New guidelines
> from 2006
> recommends every 15 min during first stage. These guidelines are
> based on
> systematic rewiev of meta-analysis of RCTs (and thereby evidence
> level 1a)
> comparing IA with continuous electronic fetal monitoring, the RCTs
are
> mainly conducted in countries where auscultation every 15 min is the
> tradition. The knowledge that IA every 15 min is better than
> continuous CTG
> in low risk women is extrapolated to that IA every 15 min is best in
> low-risk women.
>
>
>
> I have no idea about what is the best, but how can you do
> auscultationsevery 15 min if you do not have one-to-one care?
>
>
>
> Ellen
>
> ----- Original Message -----
>
> From: Ann <mailto:[log in to unmask]> Thomson
>
> To: [log in to unmask]
>
> Sent: Thursday, June 14, 2007 10:11 AM
>
> Subject: Re: intermittent auscultation
>
>
>
> Could I just point out that when I was a student midwife in 1967
> we were
> taught that the fetal heart should be auscultated every 15
> minutes. So this
> time interval existed before the RCTs, but I have no idea where it
> camefrom. This is a very interesting project.
>
>
>
> Ann
>
>
>
> Ann M Thomson
>
> Professor of Midwifery,
>
> School of Nursing, Midwifery & Social Work,
>
> University of Manchester,
>
> Coupland III Building,
>
> Manchester M13 9PL,
>
> UK
>
> Tel (0)161 275 5342
>
> Fax (0)161 275 5346
>
>
>
>
> _____
>
>
> From: A forum for discussion on midwifery and reproductive health
> research.[mailto:[log in to unmask]] On Behalf Of
> Robyn Maude [CCDHB]
> Sent: 14 June 2007 00:50
> To: [log in to unmask]
> Subject: intermittent auscultation
>
>
>
> Hello Everyone
>
>
>
> In March last year, just prior to my first PhD school, I emailed
> the list to
> make an initial contact with those of you interested in and/or
>
> doing or done some work around fetal moniotiring in labour
> specificallyintermittent auscultation. Since then I have had a
> really enjoyable year
> engaging with the literature and have conducted an audit of the
> practice of
> fetal monitoring in the hospital where I work. Now I am ready to
> think about
> how I may go about designing my research around this aspect of
> care.
>
>
>
> The literature frequently points out the lack of evidence around
> timing,freqency and duration of IA. Current fetal moniotirng
> guidelines (RCOG/NICE,
> ACOG, SOGC, RANZCOG etc ) recommned IA for 'low risk' women and have
> outlined the timing, frequency and duration. These are based on
> protocolsdeveloped for RCT's comparing IA and EFM . Over time
> these IA guidelines
> have become common practice without being 'tested'.
>
>
>
> I am particularly interested in exploring whether IA guidelines
> (timing,frequency and duration) are appropiate, necessary, are
> being used, take into
> account other variables like 1 to 1 care in labour, continuity of
> care,fetal movements etc
>
>
>
> My supervisor and I have toyed with a few ideas, but I am keen to
> hear your
> ideas as well. Some ideas are :
>
> * An RCT comparing 15 min with 30 min auscultation -potentially
> problematic as the numbers needed to demonstrate no difference
> would be
> huge
> * A survey (nationally, internationally)of current practice
around IA
> and what informs this practice - i.e if midwives' practice does
> not reflect
> the current guidelines for IA (i.e 15-30 min in first stage and
> 5min or
> after each contraction in second stage, for 1 full minute, after a
> contraction, comparing with maternal pulse) then what do they do
> and how do
> they ressure themselves and women about the baby's well-being in
> labour?
> * An international eDelphi study - the creation of international
> expert midwifery opinion to inform practice around IA
> * developing a (midwifery) model for IA and testing it
>
> I would be grateful for any feedback or advice you could give me.
>
>
>
> Cheers,
>
> Robyn Maude
>
> Midwifery Advisor
>
> Capital and Coast DHB
>
> Private Bag 7902
>
> Wellington South
>
> New Zealand
>
> Office - Level K - Ward 14 -Grace Neill Block
>
> (04) 3855999 ext. 5298
>
> 0274793826
>
>
>
>
>
>
>
>
>
>
> _____
>
>
>
>
>
>
>
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