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Phillips K, Sanders J, Warren LE. UK student midwives' theoretical knowledge, confidence, and experience of intermittent auscultation of the fetal heart rate during labour: An online cross-sectional survey. Midwifery 2024; 132:103952. [PMID: 38442530 DOI: 10.1016/j.midw.2024.103952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 07/21/2023] [Accepted: 02/10/2024] [Indexed: 03/07/2024]
Abstract
AIM This study aimed to explore student midwives' theoretical knowledge of intrapartum intermittent auscultation, their confidence in, and their experience of this mode of fetal monitoring. DESIGN AND SETTING An online cross-section survey with closed and open questions. Descriptive statistics were used to analyse participants' intermittent auscultation knowledge, confidence, and experience. Reflexive thematic analysis was used to identify patterns within the free text about participants' experiences. PARTICIPANTS Undergraduate midwifery students (n = 303) from Nursing and Midwifery Council-approved educational institutions within the United Kingdom. FINDINGS Most participants demonstrated good theoretical knowledge. They had witnessed the technique being used in clinical practice, and when performed, the practice was reported to be in line with national guidance. In closed questions, participants reported feeling confident in their intermittent auscultation skills; however, these data contrasted with free-text responses. CONCLUSION This cross-sectional survey found that student midwives possess adequate knowledge of intermittent auscultation. However, reflecting individual clinical experiences, their confidence in their ability to perform intermittent auscultation varied. A lack of opportunity to practice intermittent auscultation, organisational culture, and midwives' preferences have caused student midwives to question their capabilities with this essential clinical skill, leaving some with doubt about their competency close to registration.
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Affiliation(s)
- K Phillips
- School of Healthcare Sciences, Cardiff University, Room 0.43, Ground Floor, Ty'r Wyddfa, Heath Park West, St. Agnes Road, Cardiff CF14 4US, United Kingdom.
| | - J Sanders
- School of Healthcare Sciences, Cardiff University, Room 0.43, Ground Floor, Ty'r Wyddfa, Heath Park West, St. Agnes Road, Cardiff CF14 4US, United Kingdom
| | - L E Warren
- School of Healthcare Sciences, Cardiff University, Room 0.43, Ground Floor, Ty'r Wyddfa, Heath Park West, St. Agnes Road, Cardiff CF14 4US, United Kingdom
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Tamber KK, Hayes DJL, Carey SJ, Wijekoon JHB, Heazell AEP. A systematic scoping review to identify the design and assess the performance of devices for antenatal continuous fetal monitoring. PLoS One 2020; 15:e0242983. [PMID: 33259507 PMCID: PMC7707469 DOI: 10.1371/journal.pone.0242983] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 11/12/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Antepartum fetal monitoring aims to assess fetal development and wellbeing throughout pregnancy. Current methods utilised in clinical practice are intermittent and only provide a 'snapshot' of fetal wellbeing, thus key signs of fetal demise could be missed. Continuous fetal monitoring (CFM) offers the potential to alleviate these issues by providing an objective and longitudinal overview of fetal status. Various CFM devices exist within literature; this review planned to provide a systematic overview of these devices, and specifically aimed to map the devices' design, performance and factors which affect this, whilst determining any gaps in development. METHODS A systematic search was conducted using MEDLINE, EMBASE, CINAHL, EMCARE, BNI, Cochrane Library, Web of Science and Pubmed databases. Following the deletion of duplicates, the articles' titles and abstracts were screened and suitable papers underwent a full-text assessment prior to inclusion in the review by two independent assessors. RESULTS The literature searches generated 4,885 hits from which 43 studies were included in the review. Twenty-four different devices were identified utilising four suitable CFM technologies: fetal electrocardiography, fetal phonocardiography, accelerometry and fetal vectorcardiography. The devices adopted various designs and signal processing methods. There was no common means of device performance assessment between different devices, which limited comparison. The device performance of fetal electrocardiography was reduced between 28 to 36 weeks' gestation and during high levels of maternal movement, and increased during night-time rest. Other factors, including maternal body mass index, fetal position, recording location, uterine activity, amniotic fluid index, number of fetuses and smoking status, as well as factors which affected alternative technologies had equivocal effects and require further investigation. CONCLUSIONS A variety of CFM devices have been developed, however no specific approach or design appears to be advantageous due to high levels of inter-device and intra-device variability.
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Affiliation(s)
- Kajal K. Tamber
- Faculty of Biology, Division of Developmental Biology and Medicine, Maternal and Fetal Health Research Centre, School of Medical Sciences, Medicine and Health, University of Manchester, St. Mary’s Hospital, Manchester, United Kingdom
| | - Dexter J. L. Hayes
- Faculty of Biology, Division of Developmental Biology and Medicine, Maternal and Fetal Health Research Centre, School of Medical Sciences, Medicine and Health, University of Manchester, St. Mary’s Hospital, Manchester, United Kingdom
| | - Stephen J. Carey
- School of Electrical and Electronic Engineering, University of Manchester, Manchester, United Kingdom
| | - Jayawan H. B. Wijekoon
- School of Electrical and Electronic Engineering, University of Manchester, Manchester, United Kingdom
| | - Alexander E. P. Heazell
- Faculty of Biology, Division of Developmental Biology and Medicine, Maternal and Fetal Health Research Centre, School of Medical Sciences, Medicine and Health, University of Manchester, St. Mary’s Hospital, Manchester, United Kingdom
- Manchester University NHS Foundation Trust, St. Mary’s Hospital, Manchester Academic Health Science Centre, Manchester, United Kingdom
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Hamelmann P, Vullings R, Kolen AF, Bergmans JWM, van Laar JOEH, Tortoli P, Mischi M. Doppler Ultrasound Technology for Fetal Heart Rate Monitoring: A Review. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2020; 67:226-238. [PMID: 31562079 DOI: 10.1109/tuffc.2019.2943626] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Fetal well-being is commonly assessed by monitoring the fetal heart rate (fHR). In clinical practice, the de facto standard technology for fHR monitoring is based on the Doppler ultrasound (US). Continuous monitoring of the fHR before and during labor is performed using a US transducer fixed on the maternal abdomen. The continuous fHR monitoring, together with simultaneous monitoring of the uterine activity, is referred to as cardiotocography (CTG). In contrast, for intermittent measurements of the fHR, a handheld Doppler US transducer is typically used. In this article, the technology of Doppler US for continuous fHR monitoring and intermittent fHR measurements is described, with emphasis on fHR monitoring for CTG. Special attention is dedicated to the measurement environment, which includes the clinical setting in which fHR monitoring is commonly performed. In addition, to understand the signal content of acquired Doppler US signals, the anatomy and physiology of the fetal heart and the surrounding maternal abdomen are described. The challenges encountered in these measurements have led to different technological strategies, which are presented and critically discussed, with a focus on the US transducer geometry, Doppler signal processing, and fHR extraction methods.
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Rosenbaum AJ, Smith RM, Hade EM, Gupta A, Yilmaz A, Cackovic M. Use and experiences with external fetal monitoring devices among obstetrical providers. J Matern Fetal Neonatal Med 2018; 33:2348-2353. [PMID: 30541361 DOI: 10.1080/14767058.2018.1548604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Introduction: Fetal heart rate monitoring presents one of the few available methods for evaluating the fetus prior to birth. However, current devices on the market have significant shortcomings. We sought to describe the use and experiences with external fetal monitoring (EFM) devices among obstetrical providers.Materials and methods: We performed a cross-sectional survey in an academic medical center between April and July 2017 including nurse, midwife, and physician obstetrical providers (n = 217) who were invited to participate in this study regarding their experiences with the external fetal monitoring (EFM) device utilized by their hospital system in the outpatient, inpatient, and labor and delivery (L&D) settings. Associations between provider characteristics, device use, perception of challenging patients, and potential usefulness of an improved system were assessed by Fisher's exact test.Results: The 137 respondents (63.1%) reported difficulties monitoring obese women (98.5%), multiple gestation pregnancies (90.5%), and early gestational ages (71.5%). Over half (59.5%) of L&D nurses reported interacting with EFM devices for greater than 1-hour during a typical 12-hour shift and fewer than half (42.3%) reported being satisfied with current EFM devices. There were no statistically significant associations between provider age, experience, or time spent utilizing the devices with perception of challenging patient types.Conclusions: In conclusion, obstetrical providers perceive shortcomings of current EFM devices across all levels of provider experience and time utilizing these devices. Nurses reported significant time operating the devices, representing an opportunity to reduce time and costs with an improved device.
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Affiliation(s)
- Alan J Rosenbaum
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Rachel M Smith
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Erinn M Hade
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Ashish Gupta
- Department of Civil, Environmental and Geodetic Engineering, The Ohio State University College of Engineering, Columbus, OH, USA
| | - Alper Yilmaz
- Department of Civil, Environmental and Geodetic Engineering, The Ohio State University College of Engineering, Columbus, OH, USA
| | - Michael Cackovic
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, USA
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Ladhani NNN, Fockler ME, Stephens L, Barrett JF, Heazell AE. No 369 - Prise en charge de la grossesse aprés une mortinaissance. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:1684-1700. [DOI: 10.1016/j.jogc.2018.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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No. 369-Management of Pregnancy Subsequent to Stillbirth. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:1669-1683. [DOI: 10.1016/j.jogc.2018.07.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Crawford A, Anyadi P, Stephens L, Thomas SL, Reid H, Higgins LE, Warrander LK, Johnstone ED, Heazell AEP. A mixed-methods evaluation of continuous electronic fetal monitoring for an extended period. Acta Obstet Gynecol Scand 2018; 97:1515-1523. [PMID: 30132798 DOI: 10.1111/aogs.13446] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/05/2018] [Accepted: 08/07/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Continuous fetal monitoring is used to objectively record the fetal heart rate and fetal activity over an extended period of time; however, its feasibility and acceptability to women is currently unknown. The study addressed the hypothesis that continuous fetal monitoring is feasible and acceptable to pregnant women. MATERIAL AND METHODS Pregnant participants (n = 22) were monitored using a continuous fetal electrocardiography device, the Monica AN24. Signal quality, duration of recording and cardiotocography findings were correlated with maternal and fetal factors. Participants' change in anxiety before and after monitoring was assessed using validated questionnaires. Participants' experiences were explored through a questionnaire (n = 20) and semi-structured interview (n = 13). RESULTS Recordings were successfully obtained in 19 of the 22 participants (86.3%). The mean recording quality of fetal heart rate was 69.0% (range 17.4%-99.4%) and maternal heart rate was 99.0% (90.9%-100.0%). Recording quality was positively correlated with gestational age (P = 0.05) and negatively correlated with uterine activity and maternal movement (P < 0.001). Overall, participants were satisfied with their experience of continuous fetal monitoring; 30% considered it preferable to intermittent monitoring. Continuous fetal monitoring did not significantly increase maternal anxiety, with a trend towards a reduction in Pregnancy Specific Anxiety score (P = 0.07). Qualitative analysis grouped women's responses into three themes: (a) reassurance and anxiety, (b) the physical device and (c) future developments in continuous fetal monitoring. CONCLUSIONS Continuous fetal monitoring is a feasible and acceptable form of monitoring to pregnant women although further practical improvements could be incorporated. Further research is required to assess the ability of continuous fetal monitoring to detect fetal compromise.
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Affiliation(s)
- Alexandra Crawford
- Maternal and Fetal Health Research Center, Division of Developmental Biology and Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St. Mary's Hospital, Manchester, UK
| | - Patrick Anyadi
- Maternal and Fetal Health Research Center, Division of Developmental Biology and Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St. Mary's Hospital, Manchester, UK
| | - Louise Stephens
- Manchester University NHS Foundation Trust, St. Mary's Hospital, Manchester Academic Health Science Center, Manchester, UK
| | - Suzanne L Thomas
- Manchester University NHS Foundation Trust, St. Mary's Hospital, Manchester Academic Health Science Center, Manchester, UK
| | - Holly Reid
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Lucy E Higgins
- Maternal and Fetal Health Research Center, Division of Developmental Biology and Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St. Mary's Hospital, Manchester, UK.,Manchester University NHS Foundation Trust, St. Mary's Hospital, Manchester Academic Health Science Center, Manchester, UK
| | - Lynne K Warrander
- Maternal and Fetal Health Research Center, Division of Developmental Biology and Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St. Mary's Hospital, Manchester, UK
| | - Edward D Johnstone
- Maternal and Fetal Health Research Center, Division of Developmental Biology and Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St. Mary's Hospital, Manchester, UK.,Manchester University NHS Foundation Trust, St. Mary's Hospital, Manchester Academic Health Science Center, Manchester, UK
| | - Alexander E P Heazell
- Maternal and Fetal Health Research Center, Division of Developmental Biology and Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St. Mary's Hospital, Manchester, UK.,Manchester University NHS Foundation Trust, St. Mary's Hospital, Manchester Academic Health Science Center, Manchester, UK
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Crawford A, Hayes D, Johnstone ED, Heazell AE. Women's experiences of continuous fetal monitoring - a mixed-methods systematic review. Acta Obstet Gynecol Scand 2017; 96:1404-1413. [DOI: 10.1111/aogs.13231] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 09/02/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Alexandra Crawford
- Maternal and Fetal Health Research Center; Division of Developmental Biology and Medicine; School of Medical Sciences; Faculty of Biology, Medicine and Health; University of Manchester; St Mary's Hospital; Manchester UK
| | - Dexter Hayes
- Maternal and Fetal Health Research Center; Division of Developmental Biology and Medicine; School of Medical Sciences; Faculty of Biology, Medicine and Health; University of Manchester; St Mary's Hospital; Manchester UK
| | - Edward D Johnstone
- Maternal and Fetal Health Research Center; Division of Developmental Biology and Medicine; School of Medical Sciences; Faculty of Biology, Medicine and Health; University of Manchester; St Mary's Hospital; Manchester UK
- Central Manchester University Hospitals NHS Foundation Trust; St Mary's Hospital; Manchester UK
| | - Alexander E.P. Heazell
- Maternal and Fetal Health Research Center; Division of Developmental Biology and Medicine; School of Medical Sciences; Faculty of Biology, Medicine and Health; University of Manchester; St Mary's Hospital; Manchester UK
- Central Manchester University Hospitals NHS Foundation Trust; St Mary's Hospital; Manchester UK
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