Update on fetal monitoring.(CLINICAL PEARLS)

First of all, Happy New Year! I hope this will be a great year for all of you. Long-time readers know that this column includes tips from doctors all over the country, but I frequently sneak some of my own pearls into the mix. For this issue, I'm going to hog the whole column because there have been some major changes in fetal heart rate (FHR) monitoring terminology. In 1997, an expert panel from the National Center of Child Health and Human Development proposed specific definitions for intrapartum FHR tracings, and in 2005, both the American College of Obstetricians and Gynecologists and the Association of Women's Health, Obstetric and Neonatal Nurses included these new definitions in their revised electronic fetal monitoring (EFM) guidelines. The following pearls will help everyone learn and remember what's new. We'll have another string of pearls on this subject in a future column.

Dips and Dumps are for Chumps

Recently a colleague was giving me a report as she handed over a very busy labor and delivery service. As we stood at the labor and delivery board, she mentioned that there had been a few dips in room three and a couple of dumps in room four and then she went on to describe the other patients. Dips? Dumps? In the context of fetal monitoring, exactly what do these terms mean? Should I first check the patient who has been pushing for 2 hours or should I evaluate the dips and dumps? Are dips worse than dumps, or vice versa? Remember that "failure to communicate" is a major reason why bad things happen to good people. The next pearl presents the solution.

Say It So They Can See It!

We've all been called by a nurse and told, "Doctor, I don't like the strip in room three." What does this mean? Why doesn't she like it? Should you rush to labor and delivery? In contrast, the following brief report paints a picture that is ...