Using Intelligent Electronic Fetal Monitoring Software to Reduce Iatrogenic Complications of ...

Using Intelligent Electronic Fetal Monitoring Software to Reduce Iatrogenic Complications of ...

6 Pages · 2014 · 315 KB · English

In a hectic labor and delivery (L&D) environ- ment, when nurses are tending to mul- tiple patients at various stages of labor, it can be difficult to quickly spot these non- reassuring trends using conventional EFM technology. Although the actual number of injuries incurred with UT is small, the co

Using Intelligent Electronic Fetal Monitoring Software to Reduce Iatrogenic Complications of ... free download


INNOVATIONS IN HEALTH IT Using Intelligent Electronic Fetal Monitoring Software to Reduce Iatrogenic Complications of Childbirth A Case Study By Samuel Smith, MD; Kari Bunting, MS, RNCOB, CEFM; and Emily Hamilton\ , MDCM O XYTOCIN (OFTEN referred to by the brand name Pitocin ®) is a drug used in more than half of all US births to enhance labor by inducing or augmenting uterine contractions 1 Conditions that may neces sitate induction include (but are not limited to) hypertensive disorders of pregnancy, preeclampsia or eclampsia, maternal medi cal conditions such as diabetes mellitus or chronic hypertension, severe intrauterine fetal growth restriction, and postterm pregnancy 2 Oxytocin is used to induce labor when the benefits of earlier delivery outweigh the risks of continuing the pregnancy for either the woman or the fetus Oxytocin is also used to augment a labor when inadequate uterine contractions have failed to result in progressive cervical dilation or descent of the fetus 2 In these cases, the goal is to avoid a costly and riskprone cesarean section by enabling a lowerrisk vaginal birth Whether used for induction or augmen tation, oxytocin is normally administered without incident and its laborenhancing properties are generally beneficial How ever, more than one of five women will develop uterine tachysystole (UT), which is defined as 5 or more contractions in a 10minute window, averaged over 30 min utes 3 These overly frequent contractions can decrease the flow of oxygen to the fetus due to long contractions and inadequate relaxation time between contractions 4 While most babies can tolerate brief FALL 2014 n VOLUME 28 / NUMBER 4 n wwwhimssorg 28 FOCUS FOCUS: INTELLIGENT ELECTRONIC FETAL MONITORING SOFTWARE incidences of UT, a very small number will develop permanent brain injury from oxygen deprivation during labor CLINICAL RISKS AND MALPRACTICE CLAIMS CONSEQUENCES Problems resulting from UT occur when an unintended reaction to oxytocin is coupled with a failure by clinicians to recognize and act on it This scenario is driven in part by the nature of oxytocin and the variation in how mothers and babies respond to it While there are wellestablished protocols for the administration of oxytocin dur ing labor, they often form only a starting point; individual reactions vary widely As a result, administration of oxytocin must be watched and managed more closely than most other drugs, such as antibiot ics, where there is fixed dosage for all In a hectic labor and delivery (L&D) environ ment, when nurses are tending to mul tiple patients at various stages of labor, it can be difficult to quickly spot these non reassuring trends using conventional EFM technology Although the actual number of injuries incurred with UT is small, the consequenc es for families, clinicians, and hospitals are severe Of all the legal claims related to labor induction or augmentation with oxytocin opened by the Canadian Medical Protective Association between 2002 and 2012, 75 percent of those were closed with a settlement More than 70 percent showed a failure to appreciate and act on severity of EFM abnormalities with or without UT 5 Other studies point to similar findings Excessive use of contractionsimulating drugs was found to be the underlying problem in 45 percent of hypoxic brain injury claims 6 Incautious use of oxy tocin was shown in 71 percent of births where legal action was sought after severe asphyxia, 7 and oxytocin misuse was found in 47 percent of babies born with metabolic acidosis 8 Overall, obstetrics claims represent the ABSTRACT Oxytocin, a drug that stimulates uterine contractions, is used in over h\ alf of US births to induce or augment labor Despite its widespread use, however, it is critical to note that more than one in five women who receive oxytocin will develop uterine tachysystole (UT)—overly

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