Transcript Intrapartum FHR Parameter Trending

sonicaidTrend
Intrapartum FHR
parameter trending
Presented by:
David Stanger
Global Business Unit Manager
Obstetric Systems
sonicaid – monitoring fetal and maternal wellbeing
Intrapartum FHR
Parameter Trending
• Unique new Dawes and Redman
Intrapartum FHR analysis system
• For use during the first stage of labour
sonicaid – monitoring fetal and maternal wellbeing
Intrapartum FHR
Parameter Trending
Based on further development of the Care (System
8000/8002, FetalCare) Antepartum CTG analysis
originated by Professor Dawes, Professor Redman
and Mary Moulden at the John Radcliffe Hospital,
Oxford
sonicaid – monitoring fetal and maternal wellbeing
Intrapartum FHR
Parameter Trending
• The effectiveness of fetal monitoring is often limited
by the clinicians level of ability of visual
interpretation
• The Intrapartum FHR Parameter Trending of
essential parameters can not advise on the fetal
condition
sonicaid – monitoring fetal and maternal wellbeing
Intrapartum FHR
Parameter Trending
• Can help to remove the subjective element of visual
interpretation on some key fetal heart rate
parameters
• Baseline Heart Rate
• Short Term Variability (STV)
• Decelerations
sonicaid – monitoring fetal and maternal wellbeing
Intrapartum FHR
Parameter Trending
The analysis provides measurement of fetal heart rate
parameters at regular intervals offering a new way
of describing the attributes of the intrapartum CTG
trace that is quantitative not qualitative
sonicaid – monitoring fetal and maternal wellbeing
Intrapartum FHR
Parameter Trending
Note - It is not intended as a replacement for
skilled visual interpretation of the CTG trace.
sonicaid – monitoring fetal and maternal wellbeing
Intrapartum FHR
Parameter Trending
With continuous fetal monitoring, it allows the clinician
to assess long-term changes in the fetal heart rate
pattern.
sonicaid – monitoring fetal and maternal wellbeing
Intrapartum FHR
Parameter Trending
No guidelines on interpretation or limits of normality are
provided
Instead, the clinician can use the numeric values to
identify and quantify the relative changes in fetal heart
rate parameters over a period of time
Some French clinical papers are now available
describing it’s use
sonicaid – monitoring fetal and maternal wellbeing
Intrapartum FHR
Parameter Trending
• A numerical description of the CTG trace enables
better quantitative communication between colleagues
and direct comparison between different traces
• It also provides training support for trace
interpretation, and readily available data for clinical
research projects
sonicaid – monitoring fetal and maternal wellbeing
Intrapartum FHR
Parameter Trending
Analysis is performed every 15 minutes and calculates the
following parameters:
•Baseline heart rate (bpm) for the last 60 minutes
•Baseline heart rate (bpm) for the last 15 minutes
•Short Term Variation (msecs) for the last 60 minutes
•Deceleration size (beats) for the last 60 minutes
•Deceleration size (beats) for the last 15 minutes
Note - The ‘Deceleration size’ parameter is only available when
selected.
sonicaid – monitoring fetal and maternal wellbeing
Intrapartum FHR
Parameter Trending
Confidence Indicator
The analysis provides a High ‘H’, Medium
‘M’, or Low ‘L’ confidence level as an
indicator of the reliability of the analysis
results
Mainly associated with the baseline fitting,
can also be affected with high signal loss
sonicaid – monitoring fetal and maternal wellbeing
Intrapartum FHR
Parameter Trending
When an analysis has been performed, the results
and the confidence indicator are printed on the
contractions section of the CTG trace.
A key to the parameters is printed on the CTG
header, and again three minutes before the end of
each 60 minute period.
sonicaid – monitoring fetal and maternal wellbeing
Intrapartum FHR
Parameter Trending
The analysis results are printed on the CTG every 15 minutes. In this
example the deceleration parameter is not enabled.
sonicaid – monitoring fetal and maternal wellbeing
Intrapartum FHR
Parameter Trending
Following each 15 minute analysis the monitor will display the
results from that last analysis. This will revert back to the normal
FHR display after two minutes, or when EXIT is selected
TIME
21:06
60 MIN BASELINE

15 MIN BASELINE

60 MIN STV

60 MIN DECEL          
350
15 MIN DECEL          
90
CONFIDENCE

H
139
144
7.8
Note - The deceleration parameters are only present if this have
been enabled.
sonicaid – monitoring fetal and maternal wellbeing
Intrapartum FHR
Parameter Trending
Display Results
Both display screens are available to user
interrogation at any time during the analysis
Note - The graphical CTG display facility on Team is
not available when using the IP Trend analysis
sonicaid – monitoring fetal and maternal wellbeing
Intrapartum FHR
Parameter Trending
When monitoring twins, both fetal heart rate
channels are analysed simultaneously
The results for both twins are printed on the CTG
and the results for the selected audio channel will be
displayed
Note – On Team with no audio selected the display
defaults to showing results for channel 1 (Yellow).
sonicaid – monitoring fetal and maternal wellbeing
Intrapartum FHR
Parameter Trending
Parameters Not Available
When a calculated value is not available the following
symbols are used on both the printed CTG and the
results displays:
NA
If not enough time has elapsed for a
parameter value to be calculated.
SL
If there is too much signal loss (>50%) for a
parameter to be calculated.
sonicaid – monitoring fetal and maternal wellbeing
Intrapartum FHR
Parameter Trending
Selecting TREND from the menu will access another
display containing the results from that last analysis and
those for the previous three hours.
TIME
21:06
60 MIN BASELINE 139
141
60 MIN STV
7.8
8.6
60 MIN DECEL
280
CONFIDENCE
M
22:06 23:06 00:06
143
138
8.1
8.0
290
310
350
H
H
H
Note - The deceleration parameter is only present if this is enabled.
sonicaid – monitoring fetal and maternal wellbeing
Intrapartum FHR
Parameter Trending
Printer Stop
When the printer is switched off the monitor unit
will display the following message:
PRINTER SWITCHED OFF
CONTINUE PRINT & ANALYSIS?
sonicaid – monitoring fetal and maternal wellbeing
Intrapartum FHR
Parameter Trending
Summary of Benefits
• Trend analysis is a valuable new objective aid to
assist visual interpretation of the intrapartum CTG
• Provides reliable, quantitative measurements of
fetal heart rate baseline and variability
• Allows an objective method of identifying and
quantifying relative changes in fetal heart rate
parameters over time
sonicaid – monitoring fetal and maternal wellbeing
Intrapartum FHR
Parameter Trending
Summary of Benefits
• Enables better quantitative communication
between colleagues through numeric analysis of
results
• Prints analysis results on the CTG trace
• Displays 4 hour trended results on the monitor
• Supports training in trace interpretation
• Gives easy access to data for clinical research
projects
sonicaid – monitoring fetal and maternal wellbeing