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The leaders of AWHONN's Fetal Heart Monitoring Principles and Practices Program announced their decision to transition to the use of the NICHD (National Institute of Child Health and Human Development) terminology for electronic fetal heart monitoring interpretation.
As you may recall, in 1997, the Institute released their recommendations for fhr interpretation terminology. The main intent of their work was to produce standardized terminology that would facilitate the combination of research efforts. While some organizations chose to adopt their recommendations, many did not.
Recently, the Joint Commission on Accreditation of Health Care Organizations (JCAHO) recommended standardized terminology based upon a sentinel alert (JCAHO, 2004). AWHONN participated with ACOG as ACOG updated their Intrapartum Fetal Heart Rate Monitoring Practice Bulletin (ACOG, 2005). AWHONN now will transition their FHMPP program to include the NICHD terminology.
While AWHONN and ACOG may recommend this change, we are reminded to communicate our interpretations using our institution's terminology. Perhaps in time, we all may communicate with a common fetal language. Below is a summary of the terms and their definitions from the NICHD (1997) article:
- Baseline
- The mean fhr rounded to increments of 5 beats per min during a 10 min segment, excluding:
- Periodic or episodic changes
- Periods of marked fhr variability
- Segments of baseline that differ by more than 25 beats per minute
- The baseline must be for a minimum of 2 min in any 10-min segment
- Baseline variability
- Fluctuations in the fhr of two cycles per min or greater
- Variability is visually quantitated as the amplitude of peak-to-trough in beats per min
- Absent-amplitude range undetectable
- Minimal-amplitude range detectable but 5 beats per min or fewer
- Moderate (normal)- amplitude range 6-25 beats per min
- Marked-amplitude range greater than 25 beats per min
- Acceleration
- A visually apparent increase (onset to peak in less than 30 sec) in the fhr from the most recently calculated baseline
- The duration of an acceleration is defined as the time from the initial change in fhr from the baseline to the return of the fhr to the baseline
- At 32 weeks of gestation, an acceleration has an acme of 10 beats per min or more above baseline with a duration of 10 sec or more but less than 2 min
- Prolonged acceleration lasts 2 min or more but less than 10 min
- If an acceleration last 10 min or longer, it is a baseline change
- Bradycardia
- Baseline fhr less than 110 beats per min
- Early deceleration
- In association with a uterine contraction, a visually apparent, gradual (onset to nadir 30 sec or more) decrease in fhr with return to baseline
- Late deceleration
- In association with a uterine contraction, a visually apparent, gradual (onset to nadir 30 sec or more) decrease in fhr with return to baseline
- Onset, nadir, and recovery of the deceleration occur after the beginning, peak, and end of the contraction, respectively
- Tachycardia
- Baseline fhr greater than 160 beats per min
- Variable deceleration
- In association with a uterine contraction, a visually apparent decrease in the fhr below the baseline
- The decrease in fhr is 15 beats per min or more, with a duration of 15 sec or more but less than 2 min
- Prolonged deceleration
- Visually apparent decrease in the fhr below the baseline
- Deceleration is 15 beats per min or more, lasting 2 min or more but less than 10 min from onset to return to baseline
References:
AWHONN (2005, June). AWHONN to make transition to NICHD fetal heart monitoring terminology. Paper presented at the AWHONN 2005 Convention, Salt Lake City, Utah.
NICHD (1997). Electronic fetal heart rate monitoring: Research guidelines for interpretation. Journal of Obstetric, Gynecologic and Neonatal Nursing, 26, 635-640.
ACOG ( May 2005). Practice bulletin: Intrapartum fetal heart rate monitoring. 62.
JCAHO (2004). Editor's note to sentinel event alert issue #30. Sentinel Event Alert, 30. Retrieved on August 7, 2005, from http://www.jcaho.org/about+us/news+letters/sentinel+event+alert/sea30.htm.
Submitted by: Colleen Whatley, MS, RN, Dartmouth-Hitchcock Medical Center, Lebanon, NH | | | | Page: Index | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | | | to top | | | | | | |
