NICHD Consensus Development Task Force report: Predictors of intrapartum fetal distress—the role of electronic fetal monitoring

This chapter contains details of methods used for screening and diagnosis of fetal anomalies using antenatal blood tests, ultrasound scanning, chorionic villous sampling, amniocentesis, and fetal blood sampling. There are sections on pre-existing maternal diseases presenting risks to the fetus including maternal diabetes, systemic lupus erythematosus, thrombocytopenia, and neuromuscular disease, as well as those specific to pregnancy—pre-eclampsia, HELLP syndrome, and eclampsia. Intrauterine growth restriction and monitoring is covered in detail. The increased fetal risks of multiple birth due to twin-to-twin transfusion syndrome and other pregnancy complications are described, with detail on oligohydramnios, polyhydramnios, antepartum haemorrhage, preterm prelabour rupture of membranes, cord prolapse, preterm labour, and breech presentation. Intrapartum fetal assessment using electronic fetal monitoring and fetal blood sampling to diagnose fetal distress is covered to enable health professionals involved in care of the newborn to understand events which may have resulted in a baby born in poor condition.

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What Do Women Want? Consent for the Use of Electronic Fetal Monitoring

International Journal of Childbirth ◽

10.1891/ijcbirth-d-20-00044 ◽

2021 ◽

Vol 11 (3) ◽

pp. 145-153

Author(s):

Sonya Dal Cin ◽

Lisa Kane Low ◽

Denise Lillvis ◽

Megan Masten ◽

Raymond De Vries

Keyword(s):

United States ◽

Healthcare Providers ◽

Fetal Monitoring ◽

Healthcare Setting ◽

Professional Associations ◽

The United States ◽

Cesarean Birth ◽

Electronic Fetal Monitoring ◽

Risk Patients

BACKGROUNDGuidelines published by professional associations of midwives, obstetricians, and nurses in the United States recommend against using continuous cardiotocography (CTG) in low-risk patients. In the United States, CTG or electronic fetal/uterine monitoring (EFM) rather than auscultation with a fetoscope or Pinard horn is the norm. Interpretation of the fetal heart rate (FHR) and uterine activity (UA) tracings provided by continuous EFM may be associated with the decision for a cesarean birth. Typically, consent is not sought in the decision about type of monitoring. No studies were identified where women's attitudes about the need to consent to the type of fetal monitoring used during labor have been explored. Therefore, the purpose of this research was to examine women's attitudes about the use of EFM in a healthcare setting.METHODSWe asked a sample of women aged 18–50 years to respond to one of three monitoringscenarios. The scenarios were used to distinguish between attitudes about monitoring in general, monitoring the health of a mother in labor, and monitoring the health of the fetus during labor. Wemeasured their level of interest in being monitored and their opinions about whether healthcare providers should be required to obtain consent for the monitoring described in the scenario.RESULTSInterest in receiving monitoring (across all three scenarios) was moderate, with the highest level of interest in monitoring the fetus during labor and the least interest in monitoring a general health context. Across all scenarios, 82% of respondents believed that practitioners should obtain consent for monitoring, 14% were unsure, and 4% said there should not be a requirement for consent. While low (6%), the percentage responding that consent was not needed was highest in monitoring a fetus in labor.CONCLUSIONSWomen in our study expressed a strong preference for the opportunity to consent to the use of monitoring regardless of the healthcare scenario. There is findings suggest the need for further research exploring what women do and do not know about CTG and what their informed performance are a pressing need to rethink the role of a pressing need to rethink the role of shared decision-making and informed consent about the type of monitoring use during labor.

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A synthesis of pathways linking diet, metabolic risk and cardiovascular disease: a framework to guide further research and approaches to evidence-based practice

Nutrition Research Reviews ◽

10.1017/s0954422421000378 ◽

2021 ◽

pp. 1-72

Author(s):

Marjorie Lima do Vale ◽

Luke Buckner ◽

Claudia Gabriela Mitrofan ◽

Claudia Raulino Tramontt ◽

Sento Kai Kargbo ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Task Force ◽

Analytical Models ◽

Current Evidence ◽

Task Force Report ◽

Selection Of Variables ◽

Incidence And Mortality ◽

Emerging Risk

Abstract Cardiovascular disease (CVD) is the most common non-communicable disease occurring globally. Although previous literature have provided useful insights on the important role that diet play in CVD prevention and treatment, understanding the causal role of diets is a difficult task considering inherent and introduced weaknesses of observational (e.g., not properly addressing confounders and mediators) and experimental research designs (e.g., not appropriate or well-designed). In this narrative review, we organised current evidence linking diet, as well as conventional and emerging physiological risk factors with CVD risk, incidence and mortality in a series of diagrams. The diagrams presented can aid causal inference studies as they provide a visual representation of the types of studies underlying the associations between potential risk markers/factors for CVD. This may facilitate the selection of variables to be considered and the creation of analytical models. Evidence depicted in the diagrams was systematically collected from studies included in the British Nutrition Task Force report on Diet and CVD and database searches, including Medline and Embase. Although several markers and disorders linked to conventional and emerging risk factors for CVD were identified, the causal link between many remains unknown. There is a need to address the multifactorial nature of CVD and the complex interplay between conventional and emerging risk factors with natural and built environments, while bringing the life course and the role of additional environmental factors into the spotlight.

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