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Re: EFM & AmnioinfusionFrom: Andrew Folley (agfolley@hotmail.com)Wed Dec 5 11:50:56 2007
NOTE: Purpose of efm is to assess hypoxia and/or acidosis in the fetus. Hypoxic fetus will demonstrate either late decellerations or severe variables. Acidosis is manifested by loss of beat to beat variability and no fetal accelerations. A baby will not go from a normal tracing (ie fetal accelerations and good bbv to acidosis without passing through the efm manifestations of hypoxia. Date: Wed, 5 Dec 2007 08:45:36 -0600From: rd.braun@gmail.comTo: ob-gyn-l@dns.obgyn.netSubject: EFM & AmnioinfusionThere is your level A evidence for using amnioinfusion that we were all looking for a month or two ago.Dan On Dec 4, 2007 8:49 PM, Efrain Ramirez < eramirezt@coqui.net> wrote: At Tue, 04 Dec 2007, Joe wrote:>>Need alittle help, gang. Where did I read that is was "inappropriate" or>whatever to read and interpret a fetal tracing after the event? Was this>an ACOG statement? Or just my dreams? In a study? Joe C What is the interobserver and intraobserver variability of electronicfetal heart rate monitoring assessment?There is a wide variation in the way obstetricians interpret and respondto EFM tracings. When four obstetricians, for example, examined 50 cardiotocograms, they agreed in only 22% of the cases (13). Two monthslater, during the second review of the same 50 tracings, the cliniciansinterpreted 21% of the tracings differently than they did during the first evaluation (14). In another study, five obstetriciansindependently interpreted 150 cardiotocograms (15). The obstetriciansinterpreted the tracings similarly in 29% of the cases, suggesting poorinterobserver reliability. An important factor that influences the interpretation ofcardiotocograms is whether the tracing is normal, equivocal, or ominous,with greater agreement if the tracing is reassuring (16). Withretrospective reviews, the foreknowledge of neonatal outcome may alter the reviewer's impressions of the tracing. Given the same intrapartumtracing, a reviewer is more likely to find evidence of fetal hypoxia andcriticize the obstetrician's management if the outcome was supposedly poor versus good (17).Summary of Recommendations and ConclusionsThe following recommendations are based on good and consistentscientific evidence (Level A):The false-positive rate of EFM for predicting adverse outcomes is high. The use of EFM is associated with an increase in the rate of operativeinterventions (vacuum, forceps, and cesarean delivery).The use of EFM does not result in a reduction of cerebral palsy rates.With persistent variable decelerations, amnioinfusion reduces the need to proceed with emergent cesarean delivery and should be considered.The following recommendations are based on limited or inconsistentscientific evidence (Level B):The labor of parturients with high-risk conditions should be monitored continuously.Reinterpretation of the FHR tracing, especially knowing the neonataloutcome, is not reliable.The use of fetal pulse oximetry in clinical practice cannot be supportedat this time.--"I can accept failure, but I can't accept not trying." - Michael Jordan-- R. Daniel Braun, MD FACOG(L) CMTProfessor EmeritusDept. of Obstetrics and Gynecology Indiana U. School of MedicineR. Daniel Braun "Science without Religion is LAME; Religion without Science is BLIND" Einstein 1941 _________________________________________________________________ Your smile counts. The more smiles you share, the more we donate.=A0 Join i= _________________________________________________________________ n. http://www.windowslive.com/smile?ocid=TXT_TAGLM_Wave2_oprsmilewlhmtagline
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