Intelligent Structured Intermittent Auscultation (ISIA): evaluation of a decision-making framework for fetal heart monitoring of low-risk women

BMC Pregnancy and Childbirth

Maralyn J Foureur¹  Joan P Skinner²  Robyn M Maude² 

[1] Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology, Sydney, Australia;Graduate School of Nursing, Midwifery and Health, Victoria University of Wellington, Newtown, PO Box 7625, Wellington, New Zealand

关键词: Mixed methods;    Knowledge translation;    Clinical;    Decision-making;    Fetal heart rate monitoring;    Intermittent auscultation;   

Others  :  1127274
DOI  :  10.1186/1471-2393-14-184

 received in 2014-01-27, accepted in 2014-05-27,  发布年份 2014

【 摘 要 】

Background

Research-informed fetal monitoring guidelines recommend intermittent auscultation (IA) for fetal heart monitoring for low-risk women. However, the use of cardiotocography (CTG) continues to dominate many institutional maternity settings.

Methods

A mixed methods intervention study with before and after measurement was undertaken in one secondary level health service to facilitate the implementation of an initiative to encourage the use of IA. The intervention initiative was a decision-making framework called Intelligent Structured Intermittent Auscultation (ISIA) introduced through an education session.

Results

Following the intervention, medical records review revealed an increase in the use of IA during labour represented by a relative change of 12%, with improved documentation of clinical findings from assessments, and a significant reduction in the risk of receiving an admission CTG (RR 0.75, 95% CI, 0.60 – 0.95, p = 0.016).

Conclusion

The ISIA informed decision-making framework transformed the practice of IA and provided a mechanism for knowledge translation that enabled midwives to implement evidence-based fetal heart monitoring for low risk women.

【 授权许可】

   
2014 Maude et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

【 参考文献 】

• [1]Feinstein N, Sprague A, Trépanier M: Fetal heart rate auscultation: comparing auscultation to electronic fetal monitoring. AWHONN Lifelines 2000, 4(3):35-44.
• [2]SOGC and BCPHP Fetal Health Surveillance: Antepartum and Intrapartum Consensus Guideline. Vancouver, Canada: BCPHP: British Columbia Perinatal Health Programme; 2008.
• [3]Tillett J: Intermittent Auscultation of the fetal heartbeat: can nurses change the culture of technology? J Perinat Neonatal Nurs 2007, 21(2):80-82.
• [4]Blix E, Reinar L, Klovning A, Øian P: Prognostic value of the labour admission test & its effectiveness compared with auscultation only: a systematic review. BJOG 2005, 112(12):1595-1604.
• [5]Gourounti K, Sandall J: Admission cardiotocography versus intermittent auscultation of fetal heart rate: effects on neonatal Apgar score, on the rate of caesarean sections and on the rate of instrumental delivery – a systematic review. Int J Nurs Stud 2007, 44:1029-1035. doi:10.1016/j.ijnurstu.2006.06.002
• [6]Gibb D, Arulkumaran S: Fetal Monitoring in Practice. 3rd edition. Oxford: Elsevier Ltd; 2008.
• [7]Hindley C, Hinsliff S, Thomson A: English midwives’ views & experiences of intrapartum fetal monitoring in women at low obstetric risk: conflicts & compromises. J Midwifery Women’s Health 2006, 51(5):354-360. doi:10.1016/j.jmwh.2006.02.008
• [8]Altaf S, Oppenheimer C, Shaw R, Waugh J, Dixon-Woods M: Practices and views on fetal heart monitoring: a structured observation and interview study. BJOG 2006, 113:409-418. doi:10.111/j.1471-0528.2006.00884.x
• [9]Smith V, Begley C, Clarke M, Devane D: Professionals’ views of fetal monitoring during labour: a systematic review and thematic analysis. BMC Pregnancy Childbirth 2012, 12:166. http://www.biomedcentral.com/1471-2393/12/166 webcite
• [10]Hindley C, Thomson A: Intrapartum fetal monitoring and the spectre of litigation: a qualitative study of midwives’ views. Clin Gov 2007, 12(4):233-243. doi:10.1108/14777270710828900
• [11]American College of Nurse-Midwives (ACNM): Intermittent auscultation for intrapartum fetal heart rate surveillance. J Midwifery Women’s Health 2007, 52(3):314-319.
• [12]American College of Obstetricians & Gynecologists (ACOG): Intrapartum fetal heart rate monitoring. Practice Bulletin. Number 62. Obstet Gynecol 2005, 105(5 Pt 1):1161-1169.
• [13]National Institute for Health and Clinical Excellence (NICE): Intrapartum Care of Healthy Women and Their Babies During Childbirth. London: RCOG Press; 2007. [National Collaborating Centre for Women’s and Children’s Health]
• [14]New Zealand College of Midwives (NZCOM): Foetal Monitoring in Labour. Christchurch: NZCOM; 2005. [NZCOM Consensus Statement]
• [15]MIDIRS: Informed Choice for Professionals - Fetal Heart Rate Monitoring in Labour. Volume 2. Bristol, UK: MIDIRS; 2005. http://researcharchive.vuw.ac.nz/handle/10063/851 webcite
• [16]Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG): Intrapartum Fetal Surveillance. Clinical Guidelines. 2nd edition. Melbourne, Australia: RANZCOG; 2006.
• [17]Royal College of Midwives (RCM): Evidence Based Guidelines for Midwifery-Led Care in Labour. Midwifery Practice Guideline No. 1. London: RCM; 2005.
• [18]Royal College of Obstetricians and Gynaecologists (RCOG): The Use of Electronic Fetal Monitoring. The Use & Interpretation of Cardiotocography in Intrapaprtum Fetal Surveillance. London: RCOG Press; [Evidenced-Based Clinical Guideline Number 8]
• [19]Liston R, Sawchuck D, Young D: Fetal health surveillance: antepartum & intrapartum consensus guideline. J Obstet Gynaecol Can 2007, 29(9):S3-S56. Supp. 4
• [20]Landry R, Amara N, Pablos-Mendes A, Shademani R, Gold I: The knowledge-value chain: a conceptual framework for knowledge translation. Bull World Health Org 2006, 84(8):597-602.
• [21]Kripke C: Why are we using electronic fetal monitoring? Am Fam Physician 1999, 59(9):1.
• [22]Maude R: Intelligent Structured Intermittent Auscultation (ISIA): A Mixed Methods Evaluation of an Informed Decision- Making Framework for Fetal Heart Rate Monitoring. PhD thesis. NZ: Victoria University of Wellington, NZ; 2012.
• [23]Canadian Institute of Health Research (CIHR): About knowledge translation & commercialization. 2000. http://cihr-irsc.gc.ca/e/29418.html webcite
• [24]Graham I, Logan J, Harrison M, Straus S, Tetroe J, Caswell W, Robinson N: Lost in knowledge translation: time for a map? J Contin Educ Heal Prof 2006, 26(1):13-24. doi:10.1002/chp.47
• [25]Notice PMS: Notice Pursuant to Section 88 of the New Zealand Public Health & Disability Act, 2000. Wellington: Ministry of Health; 2007.
• [26]Cheyne H, Dunlop A, Shields N, Mathers A: A randomisedcontrolled trial of admission electronic fetal monitoring in normal labour. Midwifery 2003, 19:221-229. doi:10.1016/S0266-6138(03)00020-2/midw.2002.0355
• [27]Luyben A, Gross M: Intrapartum feta heart rate monitoring: do Swiss midwives implement evidence into practice? Euro J Obstet Gynecol Reprod Biol 2000, 96:179-182.
• [28]Goodwin L: Intermittent auscultation of the fetal heart rate: a review of general principles. J Perinat Neonat Nurs 2000, 14(3):53-61.
• [29]Rattray J, Flowers K, Miles S, Clarke J: Foetal monitoring: a woman-centred decision-making pathway. Women Birth 2010. doi:10.1016/j.wombi.2010.08.003
• [30]Albers L: Monitoring the fetus in labor: evidence to support the methods. J Midwifery Women’s Health 2001, 46(6):366-373.
• [31]Lewis L, Rowe J: Moving with the beat: fetal monitoring practice in low risk labour. Aust Midwifery J Aust Coll Midwives 2004, 17(1):23-26.
• [32]Lewis L, Rowe J: Focus on the beat: current fetal monitoring practice in low risk labour. Aust Midwifery J Aust Coll Midwives 2004, 17(4):6-10.
• [33]Maude R, Foureur M: Intrpartum fetal heart rate monitoring: using audit methodology to identify areas for research & practice improvement. NZ Coll Midwives J 2009, 40:24-30.
• [34]Baker L, Beaves M, Trickey D, Wallace E: Fetal Surveillance: A Practical Guide. Melbourne: RANZCOG; 2009.
• [35]Frøen JF, Heazell AEP, Tveit JVH, Saastad E, Fretts RC, Flenady V: Fetal movement assessment. Semin Perinatol 2008, 32(4):243-246. doi:10.1053/j.semperi.2008.04.004
• [36]Heazell AE, Green M, Wright C, Flenady V, Frøen F: Midwives’ and obstetricians’ knowledge and management of women presenting with decreased fetal movements. Acta Obstet Gynecol Scand 2008, 87(3):331-339. doi:10.1080/00016340801902034
• [37]Flenady V, MacPhail J, Gardener G, Chadha Y, Mahomed K, Heazell A, Frøen F: Detection and management of decreased fetal movements in Australia and New Zealand: a survey of obstetric practice. Aust N Z J Obstet Gynaecol 2009, 49(4):358-363.
• [38]Guba E, Lincoln Y: Effective Evaluation. San Francisco: Jossey-Bass; 1981.
• [39]Sandelowski M: The problems with rigor in qualitative research. Adv Nurs Sci 1986, 8(3):27-37.