Implementing advanced fetal heart rate monitoring interpretation into your practice

Transcript (edited for clarity):

Sean Esplin, MD:

My name is Sean Esplin. I'm a maternal fetal medicine physician, and I'm the senior medical director for women's health, at Intermountain Health and a professor in the Department of OBGYN at the University of Utah.

Contemporary OB/GYN:

Can you recap your session at the 2023 Society of OB/GYN Hospitalists Annual Clinical Meeting?

Esplin:

I've personally been really taking a deep dive into the interpretation of the fetal heart rate during labor for the past 15 years. In fact, I've been coming to this conference every year, and we do a session like the one we've done today, called “Advanced Interpretation of the Fetal Heart Rate,” and I've had people say, “well, what do you mean by advance interpretation?” Really, what it means is, in order to interpret and intervene in an effective way, you need to understand the underlying physiology that causes the changes that we see in the heart rate and be able to use your knowledge to predict whether the baby's going to become academic or not. We’re trying to avoid hypoxic injury to the baby, so if we can identify problems early, and intervene in a way that restores oxygen flow to the baby or intervene by delivering the baby early, we can prevent these kinds of lifelong injuries that happen to babies. This is the most common procedure that we perform as obstetricians. We're constantly looking at these tracings and interpreting them and it's the most common source of litigation, when there are problems. So, eliminating the variability, really having a deep understanding of what you're trying to interpret and having an organized approach, the way that you tried to intervene is very helpful. It makes it a better tool, this is still not a great tool for predicting the baby's outcome, but I think it gets better, the more we understand it, and the more we apply it in a in a standardized fashion.

Contemporary OB/GYN:

What has changed over the last several years regarding advanced fetal heart rate interpretation?

Esplin:

Unfortunately, things haven't changed a lot over the last 15 or 20 years, we're still doing what we were doing when I was a medical student, I won't say how long ago that was. I think there are data to help us from animal models and human data to help us understand a little bit better how to interpret the NICHD came out in 2008, with their recommendations about standardizing the way we talked about tracings, standardizing definitions, and some of the interpretation. That was a springboard that kind of allowed us to take a deeper dive into those things. Today I'm talking about the fact that we've used this algorithm that we're that we're teaching on 35,000 births in our system, and to be able to study this and see how you can affect outcomes is part of the process of making it better. There are several different algorithms that people have suggested, and we talked about all those today. But they're all kind of on the same basic understanding and the same knowledge that comes from understanding what causes the changes in the fetal heart rate tracing.

Contemporary OB/GYN:

What do you like about the Society of OB/GYN Hospitalists Annual Clinical Meeting?

Esplin:

I think this is a great conference, because it's focused on the OB/GYN hospitalists, who are the people on the frontline on labor and delivery and in our hospitals. I love the simulations that they do. I think that when you're firing line right there in the frontline, you don't have a lot of time to think, and you have to have a repertoire of skills that allows you to address any problem. So, shoulder dystocia, postpartum hemorrhage, uterine rupture, fetal distress, need for an emergency cesarean section, vacuum or forceps-assisted deliveries; these are skills that in some places that we're losing, because people aren't getting that kind of experience in their residency. To have experts that are working in our hospitals and that their job to maintain this set of skills I think, is really important. The thing I've loved about this conference is that they really take their simulation seriously and they they're all about help people get hands on experience. I’m trying to teach an advanced fetal heart rate monitoring course that's like a simulation that gives them the skills that they need the knowledge that they need, in a moment when someone says “will you look at this fetal heart rate tracing and telling me what to do?” [Then], you know how to approach that. It's kind of ingrained in your memory like muscle memory. You don't have to sit and wonder “what am I going to do,” you got an approach that’s there in your mind. So, I've come back each year and we talk about different parts. This year, we talked about significant deceleration. So variable and lately celebrations last year, we talked about tachycardia, the year before we talked about no variability, and those different components are part of the interpretation, but you have to have a real deep understanding of each of those, each of those things. I love the society, I love the fact that everybody comes here to try to get this knowledge, and I think it's super important to have it on our labor and deliveries across the country.