DOI

10.21007/con.dnp.2025.0105

Faculty Advisor

Kate Fouquier, CNM, PhD, FACNM

Document Type

Poster

Publication Date

Spring 4-17-2025

Disciplines

Health and Medical Administration | Investigative Techniques | Maternal, Child Health and Neonatal Nursing | Medicine and Health Sciences | Nursing | Nursing Midwifery | Obstetrics and Gynecology | Other Analytical, Diagnostic and Therapeutic Techniques and Equipment | Quality Improvement

Abstract

Purpose/Background

The purpose of this scoping review is to review the use of an algorithm in evaluating continuous external fetal heart rate (FHR) monitoring in labor as opposed to clinician judgment for improved fetal outcomes, including earlier recognition of abnormal tracings (Clark et al., 2017). FHR monitoring was created to evaluate for fetal hypoxia in labor and has become standard practice (Gyllencreutz et al., 2018). One of the goals of the use of cardiotocography is to decrease hypoxia-induced fetal metabolic acidemia and neurologic injury. There are multiple options for individual or computer-based algorithms in evaluating FHR to reduce fetal acidemia rates. A scoping review was used to synthesize the data and review the potential implications.

Methods

The information sources for this scoping review included PubMed at UTHSC, as well as CINAHL and Google Scholar from October 2023 until November 2024. After narrowing the criteria applied, the articles were reviewed to consider relevance and application.

Results

The use of standardized algorithms increased the identification of abnormal FHR patterns while identifying fetal hypoxia-induced fetal metabolic acidemia. However, it did not show any association with improved fetal outcomes, namely the identification of low APGAR score or rates of Cerebral Palsy. The use of the algorithm increased interrater reliability and resulted in decreased time from the abnormality visualized to the delivery time.

Implications for Nursing Practice

FHR is a key assessment tool used nationwide in hospital labor and delivery units with a need for further investigation into which specific algorithm to use and further of how to improve outcomes. There is a nationwide initiative to decrease the rates of primary cesarean section delivery with a needed risk-benefit analysis of expedited delivery and outcomes. The use of a standard algorithm in the evaluation of electronic fetal monitoring shows potential for finding a solution to adverse neonatal outcomes.

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