Name of the Procedure:

Fetal Monitoring during Labor by Consulting Physician (i.e., Non-Attending Physician) with Written Report; Supervision and Interpretation

Summary

Fetal monitoring during labor is a process where a consulting physician, who is not the primary attending doctor, supervises and interprets real-time data on the baby's heart rate and other vital signs. This includes providing a detailed written report on the findings. It ensures the wellbeing of the baby by detecting potential issues early on.

Purpose

Fetal monitoring is conducted to ensure the baby is not in distress during labor. By continuously tracking the baby’s heart rate and maternal contractions, physicians can identify and address any complications promptly, aiming for a safe delivery for both mother and child.

Indications

• Indications for fetal monitoring may include high-risk pregnancies, such as those with maternal hypertension, diabetes, or pre-eclampsia.
• Other factors include a history of complications during previous pregnancies, abnormal baby movements, or detected abnormal fetal growth.

Preparation

• Normally, no special preparation is required for fetal monitoring.
• The mother may be asked to change into a hospital gown.
• Ultrasound gel may be applied to facilitate the use of external monitoring devices.
• An initial physical exam might be conducted.

Procedure Description

1. External Monitoring: Sensors are placed on the mother's abdomen to track the baby's heart rate and contractions.
2. Internal Monitoring (if needed): A thin wire (electrode) is attached to the baby's scalp for more precise heart rate data.
3. The consulting physician oversees the data being recorded.
4. They interpret the readings and prepare a detailed written report.
5. Continuous supervision is provided to identify any signs of fetal distress.

Duration

The entire process lasts as long as the labor itself, which can range from a few hours to over a day. The monitoring is continuous or intermittent, based on the clinical need.

Setting

Fetal monitoring is typically performed in a hospital labor and delivery unit.

Personnel

• Consulting Physician (Non-Attending)
• Labor and Delivery Nurses
• Attending Obstetrician (as needed)

Risks and Complications

• External monitoring is generally risk-free.
• Internal monitoring might carry a small risk of infection or injury to the baby’s scalp.
• False positives or negatives in interpreting the data which might lead to unnecessary interventions.

Benefits

• Early detection of fetal distress can lead to timely interventions, improving outcomes for both mother and baby.
• Improved decision-making regarding labor and delivery procedures.

Recovery

• No recovery time is needed for the monitoring itself.
• Post-delivery, mother and baby will be observed for standard postpartum care.

Alternatives

• Intermittent auscultation using a handheld Doppler device.
• Elective Cesarean section if the baby is in distress and not tolerating labor.

Patient Experience

• Most mothers find external monitoring uncomfortable but not painful.
• Internal monitoring may cause mild discomfort upon insertion.
• Continuous monitoring may limit movement, requiring the mother to stay in bed. Pain management options vary and should be discussed with the care team.