managing decels?

Scalp stim is also a common practice where I work.... but I am always leary because there seems to be some controversy. Priciples and practices of FH monitoring (AWHONN) lists scalp stim as interventions for variable and late decelerations....

However these are other references (from a different list).....

Freeman and Garite, Third Edition. Page 108. "It is inappropriate to use scalp or vibroabcoustic stimulation during a deceleration. The value of these techniques is when the stimulation occurs during a time when the FHR is at its baseline rate and the accelertion evoked is above the baseline.

See Michelle Murray Antepartal and Intrapartal Fetal Monitoring Text2nd edition Page 317

(As you know scalp stim is used to elecit an acceleration to rule out metabolic acidosis.)

Murray says:

"It is NOT appropriate to rub the fetal scalp during a deceleration as it serves absolutely no purpose. The deceleration usually reflects a vagal respnse which prevents any sympathetic nerve response during scalp stimulation. The goal is to elicit a sympathetic nerve response. An acceleration in the FHR after stimulation is assocaited with a scalp blood pH of greater than 7.19."

I am interested in what everyone else is doing....

Always go with Michelle Murray. She is THE expert in IMHO. Her lectures and books have saved many a baby (and my a$$!)

Originally posted by fourbirds4me

Scalp stim is also a common practice where I work.... but I am always leary because there seems to be some controversy. Priciples and practices of FH monitoring (AWHONN) lists scalp stim as interventions for variable and late decelerations....

However these are other references (from a different list).....

Freeman and Garite, Third Edition. Page 108. "It is inappropriate to use scalp or vibroabcoustic stimulation during a deceleration. The value of these techniques is when the stimulation occurs during a time when the FHR is at its baseline rate and the accelertion evoked is above the baseline.

See Michelle Murray Antepartal and Intrapartal Fetal Monitoring Text2nd edition Page 317

(As you know scalp stim is used to elecit an acceleration to rule out metabolic acidosis.)

Murray says:

"It is NOT appropriate to rub the fetal scalp during a deceleration as it serves absolutely no purpose. The deceleration usually reflects a vagal respnse which prevents any sympathetic nerve response during scalp stimulation. The goal is to elicit a sympathetic nerve response. An acceleration in the FHR after stimulation is assocaited with a scalp blood pH of greater than 7.19."

I am interested in what everyone else is doing....

yep that is what we are being told too.We never stim during a decel and not even after unless a true absence of variability exists. You can have lates but ifyou have GOOD recovery and variablitiy, still be ok. Stim during a decel actually can make things much worse. WE have NEVER done this where I work that I know of.

I agree w/ the above, serves no purpose during decels. This is what I was always taught.

Will do it however if I am questioning a non-reactive strip. Scarry when you get no responce and the veriability is out the window.

Thanks for the M Murray quote!

I use FSE to accertain fetal well being on a flat strip or after I have had prolonged decel and it has recovered. I have attended Michelle Murrary's Fetal Monitoring Certification Course and practice her caution on not doing scalp stim during a decel because of possibility of causing a vagal response in the fetus and worsening or prolonging the decel.