Be wary of fetal monitors in nonobstetric setting.(Obstetrics)

LAS VEGAS -- Take adequate precautions when fetal monitoring is requested in a nonobstetric setting, Patricia M. Witcher, a registered nurse clinician, advised at a conference on fetal monitoring sponsored by Symposia Medicus.

First, ask yourself: Do we have the capability in this setting to do more than initiate intrauterine resuscitation measures? "In most nonobstetric settings we don't," noted Ms. Witcher, a nurse at Northside Hospital in Atlanta who specializes in labor and delivery and high-risk obstetrics. "That's going to lead to criticism if we identify nonreassuring fetal heart rate patterns that should have been acted upon from a delivery standpoint. If we don't have a plan in place to deliver that patient, we are going to assume a great vulnerability."

Many times, she said, operating room personnel make a request for fetal monitoring without informing the obstetrician. That situation should be avoided because once you put on a fetal monitor, you need to be prepared to intervene based on the information you receive, she added. This means "going beyond intrauterine resuscitation measures toward delivery and necessary care," Ms. Witcher explained.

"If she's 24 weeks and we're concerned about viability and we're not going to intervene on behalf of the fetus anyway, we don't need to collect that information. we don't need to monitor anymore," she said.

To limit your vulnerability from a legal and clinical standpoint, make it hospital policy to have the request for fetal monitoring in a nonobstetric setting come from an obstetrician only. "The order needs to come from an obstetrician. I guarantee you that the [fetal] monitoring in the ORs is going to go down [if you do this], because most obstetricians are going to say no. If you are going to monitor in the OR, a nurse who's capable of interpreting [the tracings] must go with that monitor, and that nurse needs to stay in the OR."

In that ...