One challenge of modern obstetric care is the need to correctly identify fetuses that experience true hypoxia during labor-a difficult endeavor when fetal heart rate (FHR) patterns are borderline or mildly abnormal. To assess fetal well being during labor complicated by absent variability, repetitive late decelerations, and prolonged or severe variable decelerations that can result in an operative delivery, facilities can implement fetal oxygen saturation monitoring.
Technology at work
A single-use, latex-free fetal sensor delivers real-time measurement of fetal oxygen saturation. The sensor rests against the fetal cheek or temple and is held in place with the normal uterine forces during labor. The technology interfaces with most fetal heart rate monitors to document saturation levels. Indicator lights and audible tones provide feedback to the health care team for accurate sensor positioning.
Contraindications include a gestational age less than 36 weeks and suspected previa or abruptio. Prerequisites to placement include ruptured membranes, labor with plans for delivery, dilation of at least 2 cms, and patient agreement and understanding after education. An obstetric health care provider places the sensors. Nursing staff provides continuous monitoring results documentation, making adjustments as needed.
Implementation specifics
Successful technology implementation within our community hospital included a 2-day onsite inservice to educate staff. After the initial inservice, each staff member reviewed a procedural video and completed a written posttest.
Prior to inservice, manufacturer representatives interfaced cables to each of our fetal monitors and our computerized fetal monitoring surveillance and documentation system. To determine the number of monitors we'd need, we calculated our annual birth volume and number of labor rooms. We decided to store all necessary equipment-the monitor, sensors, cable, instruction manual, and sterile examination gloves-on a rolling cart with drawers. We laminated and attached our department's relevant policy and procedure to encourage staff review.
Positive outcomes
Our staff elected to review each use for effectiveness, outcome, documentation, and appropriateness, per hospital policy. We've experienced enhanced clinical and patient satisfaction results: Application and use during pushing with deep variable decelerations have encouraged pushing to continue rather than delivery involving vacuum intervention. In addition, patient perception of this technology remains positive-a testament to our staff's patient education efforts.
In our community hospital setting, fetal oxygen saturation monitoring provides an additional objective clinical tool to assist in assessing fetal wellness. It aids the health care team in decision-making, thus improving overall diagnosis specificity.