Nursing procedure for fetal heart rate auscultation during labor

For many years attempts have been made to define clinically the indicators of fetal distress during labor. But the criteria for fetal distress have not been clearly defined and frequently paradoxical clinical situations have exited. Increased comprehension of the intrauterine state of the fetus has been the object of much perinatal research. Significant advances in fetal electrocardiography, biochemical studies and clinical assessment of the newborn have been made. Certain changes in fetal heart rate have been observed in association with uterine contractions and have been correlated with biochemical and clinical evidence of fetal and neonatal distress. Caldeyro-Barcia, one investigator of fetal heart rate changes during labor, identified two changes which indicate fetal distress; tachycardia, and a fall in rate which starts at or following the peak of the uterine contraction, reaches minimum values 30 to 50 seconds later, and recovers to initial values in about the same length of time as the fall. This pattern he calls a Type II dip. He states that these two indicators can be recognized by clinical auscultation it it is performed in a serial manner which he describes. A modification of this suggested serial auscultation procedures was carried out during the labors of 15 women to test in a beginning way the feasibility of the clinical application of this medical research finding to nursing practice. The results indicated the auscultation procedure to be feasible if care is taken to maintain mother and nurse comfort, distractions are kept to a minimum and time is allowed for the procedure. Fetal heart rate patterns were identified and some recognized as resemble Type II dips. In addition, relationships were demonstrated between the two indicators (tachycardia and fetal heart rate patterns resembling Type II dips) and Apgar rating one minute after birth. The association of tachycardia and appearance of patterns resembling Type II dips with low Apgar rating of the newborn supports the findings of Caldeyro-Baarcia.