intermittent monitoring

Specialties Ob/Gyn

Published

Hi all,

I have searched the AWHONN site and their wonderful book but cannot find the answer to this specific question. Regarding intermittent monitoring, it is clear how often FHR needs to be auscultated in each stage of labor depending on low vs. high risk. However, it is unclear how long you should auscultate each time. Some providers argue that you need only listen before, during and up to 1min following 1 contraction. Others say you need to listen up to 20 mins - like and NST each interval.

anyone?

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Hi all,

I have searched the AWHONN site and their wonderful book but cannot find the answer to this specific question. Regarding intermittent monitoring, it is clear how often FHR needs to be auscultated in each stage of labor depending on low vs. high risk. However, it is unclear how long you should auscultate each time. Some providers argue that you need only listen before, during and up to 1min following 1 contraction. Others say you need to listen up to 20 mins - like and NST each interval.

anyone?

I took the AWHONN FM course last year and if I remember correctly it was the before, during, and after. I don't think the 20 minutes thing comes from AWHONN. I guess if they don't lay it out it IS provider preference but 20 minutes seems a little excessive.

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Specializes in LDRP.

First of all, high risk should be continuously monitored. WHere I am, intermittant monitoring is only for low risk moms.

We do listening to FHR before/during/after 2 ctx q30min. Dont have to strap them down, or put on toco, just hold up external monitor to belly. if a decel traces-on the toco and see what happens.

q5min while pushing.

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Best practise states can not find my references just yet but will find later.

Intermittent montioring for low risks mothers first stage ascultate for one min after a contraction every 15mins second stage asculate 1 min after contraction every 5mins - patient condition dictates if and when a20 min strip is required.

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First of all, high risk should be continuously monitored. WHere I am, intermittant monitoring is only for low risk moms.

We do listening to FHR before/during/after 2 ctx q30min. Dont have to strap them down, or put on toco, just hold up external monitor to belly. if a decel traces-on the toco and see what happens.

q5min while pushing.

Personallly, I agree that high-risk should be on continuous monitoring - however AWHONN does give guidelines for high-risk intermittent monitoring in the event a pt wants it. (Of course a situation like pitocin usage requires cont. monitoring per my hospital policy). Many factors involved which is one reason this is such a litigious area of nursing.

Thanks for all the feedback everyone!

SG

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Specializes in OB L&D Mother/Baby.

When I took intermediate fetal monitoring our instructor said that awohnn standards were to listen before, during and after a ctxn... Our hospital policy is 20 min out of every hour BUT... I will say that honestly very few of our patients get only this. Many of our patients are inductions, augs, or unstable in some other way and end up with continuous monitoring, and once they're pushing it is usually easier to have the monitor on rather than tying up a hand getting fht's nearly constantly.

I love to have a patient come in on night shift because they don't have to be tied down to the bed or monitor. I would love to see our hospital go for a more up and at em approach to labor but that seems to be falling to the wayside and instead we have lots of inductions and sections.

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