If the woman is experiencing a healthy pregnancy & labour, (i.e. with
adequate rest time between contractions, and no hypertension), what is the
rationale for 15 minutely ausculation?
Jenny
Jennifer Cameron FRCNA FACM
President NT branch ACMI
PO Box 1465
Howard Springs NT 0835
08 8983 1926
0419 528 717
----- Original Message -----
From: "Julie Harrison" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Sunday, July 08, 2007 5:30 AM
Subject: Re: SV: intermittent auscultation
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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