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Table 4 Clinical information and outcomes of FHR changes identified by monitoring. Abbreviations: see list

From: Monitoring intrapartum fetal heart rates by mothers in labour in two public hospitals: an initiative to improve maternal and neonatal healthcare in Liberia

Maternal age group (years)

Parity

Change in FHR identified

Action taken

Apgar scores at 1 and 5 min

Resuscitation given

Maternal comment

29–39

G5P2

By mother. FHR 115 with meconium Confirmed by MW

Lateral tilt and intravenous cannula with NS bolus Vacuum delivery

9 and 10

No

According to patient she lost her fetus during past pregnancy. Here she was happy when she noticed her fetal heart beat was dropping and the quick response that was processed

29–39

G3P2

By MW and mother during training in the use of the sonicaid at time of admission. No FHR was identified and there was 3+ meconium

Ultrasound confirmed IUFD. Vacuum delivery was undertaken

NA

NA

NA

17 and below

G2P0

By mother at 46th contraction FHR 109 with meconium

Cervix fully dilated and urged to push.

NVD occurred.

4 and 7

Yes. Bag and mask ventilation, adrenaline and chest compressions for 10 min. Admitted to the NNU for post resus care and close monitoring

Developed convulsions due to HIE and treated successfully with phenobarbital and recovered and was feeding normally at discharge home aged 7 days.

Listening to my baby heart was good. It help me to know that something was happening to her. No problem with it. Thank you.

18–28

G2P0

By mother FHR 119 at 49th contraction. There was + meconium present

Vacuum delivery

7 and 10

No

I like the thing I was doing but it was hard to do because of the pain.

18–28

G2P1

By mother FHR 119, 117, 116. No meconium. Patient was not progressing at this stage. 2 cm cervical dilatation with mild contractions.

MW/OC took over the monitoring due to the bradycardia. Doctor contacted. Patient was laterally tilted, given oxygen, D50%, hydrated and rushed to the OR for CS.

7 and 10

No

Thank you for this program. If not so my baby was going to die. The only thing that the pain.

18–28

G2P1

No previous CS

By mother FHR 163–165 with meconium. Signs of Bandl’s ring and obstructed labour with haematuria identified.

Not receiving oxytocin. Emergency CS

9 and 10

No

Thank you for saving my life and my baby. It really helpful to listen to my baby heart to know what was happening to me.

18–28

G3P2

By mother FHR 119,110,118. No meconium.

OC and doctor contacted and confirmed bradycardia

Given facial oxygen, lateral tilt, N/S and D50%. Patient was 6 cm dilated at this stage. Emergency CS

8 and 10

No

I feel good when I was listening to my baby heart. It help me to know what happen to my baby.

18–28

G1P0

By mother at 46th contraction FHR 117, then 114, then 116, then 113. No meconium. Fully dilated but descent only minus 2

Lateral tilt, D50%, oxygen, NS and FHR still below 120 She sat on birthing chair for 10 min and when head reached below 0 station (re: ischial spines) vacuum delivery was successfully undertaken

7 and 10

No

Thank you for what you bringing because when it was not because of it I was not coming to know say my baby heart was not beating good. That just the pain was giving me hard time thank all.

17 and below

G1P0

FHR found to be 95–100 by mother, FHR was repeated by midwife and confirmed low, 95–98, and Doctor on call was also informed.

Patient was placed in a left lateral tilt position Patient was reviewed and decision to CS was taken for fetal distress plus prolonged labour

6 and 9

None

Not requested at this stage in programme

18–28

G3P1

Mother reported a change in FHR but when checked by MW found FHR to be normal at 142. Meconium was present

Doctor informed but no action was considered necessary

6 and 10

None

Not requested at this early stage in programme

17 and below

G1P0

On 11th contraction mother reported slow heart rate. MW was contacted but she found FHR was 153. There was no meconium the OC was contacted.

Mother’s membranes were ruptured and vacuum delivery undertaken

7 and 10

None

Not requested at this early stage in programme

17 and below

G1P0

Mother noted change in FHR and contacted MW on 15th contraction. MW noted FHR 118 and informed OC. Meconium was present repeat fetal heart rate was 105.

Mother put in lateral tilt position and informed Dr. who reviewed patient and found fetal heart rates 110, 105, and 108. Emergency CS was performed

8 and 10

None

Not requested at this early stage in programme

18–28

G2P1

On 11th contraction mother noticed bradycardia. Midwife confirmed FHR 118 Grade 3 meconium was present. Patient placed in left lateral position and called OC. OC found FHR to be 110.

Left lateral tilt. Cervix was fully dilated and vacuum delivery was undertaken.

6 and 9

Bag and mask ventilation. Admitted NNU for 5 days and treated for sepsis.

Not requested at this early stage in programme

18–28

G1P0

Yes - by MW following being declined by mother FHR 95–100 on two successive occasions

Lateral tilt and subsequent CS for non-reassuring FHR

5 and 7

Bag and mask ventilation and admitted to NNU. No HIE and went home.

Following initial consent, patient later declined to monitor her FHR. Says she was tired of monitoring.

18–28

G3P2

Mother on 14th contraction noticed change in FHR to 102. And complained of weakness. She called for help and FHR was102. No meconium was present.

OC contacted, lateral tilt and intravenous (IV) cannula with 500 ml of Ringer Lactate given. Normal vaginal delivery followed.

6 and 10

This baby was resuscitated for 5 min with bag and mask ventilation and then transferred to the NNU where he was immediately placed on nasal CPAP and an IV line was opened to serve antibiotics because amniotic fluid was also purulent and foul smelling. IV fluid (Dextrose 10%) was set up. Baby was managed for 7 days in the NNU and was discharged home with good outcome.

According to mum monitoring is hard at certain times. She knew her baby's heart rate was low and we took quick action and now the baby is in her hands so she thank the organisation.

17 and below

G1P0

On the 14th contraction the mother called the MW because the FHR was low. The MW confirmed FHR 98, called for help and undertook lateral tilt. Meconium was present.

The OC was contacted. She opened IV line and gave R/L 1000 mL, informed the doctor on call. The doctor came and assessed the patient and said we should prepare patient for CS. CS was done for prolonged labour and abnormal FHR.

5 and 10

Neonate was resuscitated for 7 min by bag and mask ventilation before transferring to the NNU. She was placed on nasal CPAP for 24 h and was also managed for risk of sepsis. Neonate improved after 8 days and was discharged.

According to mum it is okay because this help the doctor nurses to take quick action

17 and below

G1P0

On the 7th contraction, mother detected fetal bradycardia 105 bpm. MW called and checked and confirmed FHR 105. Meconium was present. Grade 3 OC was called.

Lateral tilt was undertaken and fast vaginal delivery arranged as 9 cm cervix dilated. Birth weight 1.9Kg small for dates.

7 and 10

Baby was resuscitated for 2 min by bag and mask ventilation and then transferred to NNU. She was placed on nasal CPAP for 24 h and patient condition improved. Baby was also managed for risk of neonatal sepsis because mother’s amniotic fluid was purulent, foul-smelling during delivery. The baby was discharged home after 10 days with a weight of 2.3 kg

Patient initially declined procedure but later on she was encouraged to do it herself and everything went well

18–28

G5P4

On 6th contraction, mother detected bradycardia 108 bpm. MW confirmed FHR 108. Meconium was present.

OC contacted. Lateral tilt performed. IV cannula inserted and given NS 500 ml. Normal vaginal delivery occurred.

5 and 8

Male

Bag and mask ventilation given. No HIE occurred but he needed 5 days of antibiotics for umbilical infection.

Patient worry when the heart rate was reducing but at last she was happy because her baby came through

29–39

G5P3

On 2nd contraction monitored mother identified rapid heart rate. MW confirmed FHR 190 and called for help,

Doctor called and attended. Lateral tilt and IV cannula and N/S 500 ml set up.

Vacuum delivery was undertaken.

6 and 8

Neonatal clinician was called and baby resuscitated with bag and mask ventilation and recovered within 1 min. Responded well and taken to NNU for suspicion of sepsis. No HIE.

Mother said she was happy with the monitoring because she could have had a dead baby if she didn’t monitor. She’s also asking other mothers to accept and be part of the process

17 and below

G2P1

On 6th contraction, Mother reported fall in HR. MW confirmed FHR 109 Meconium present.

Lateral tilt applied and IV cannula inserted with R/L 500 mls plus Dextrose 50% 30 ml. OC contacted and quickly delivered the baby vaginally.

6 and 7

Mildly depressed but no resuscitation needed. Neonatal clinician continued monitoring and care.

Patient was very happy because she call for help and action was taken quickly by the OB clinician and her baby was save.

18–28

G3P0

On 27th contraction, Mother detected slowing of FHR. MW confirmed FHR 109. Grade 2 meconium was present. Dr. on call contacted.

Lateral tilt and IV cannula inserted. R/L 500 mls given IV. Doctor arrived and undertook CS.

7 and 10

Resuscitated for 2 min with bag and mask ventilation.

According to mother she was very happy, and she told everybody thanks because of the monitoring her baby was saved

17 and below

G1P0

On 7th contraction mother noted fast heart rate. MW confirmed FHR 167. Patient came in fully dilated but evidence of obstructed labour due to persistent occipito-posterior malposition.

Lateral tilt and IV cannula inserted. NS 500 mls given IV. Doctor arrived and undertook CS.

9 and 10

None needed

Mother was happy to hear her baby heart beat because she stay in labour for long and worry about her unborn baby

40 and above

G9P8

On the 7th contraction mother with MW noted a slow heart rate FHR 102. Meconium was present and a cord prolapse identified.

The OC was notified and implemented knee chest position and inserted NS 300mls into the bladder to reduce cord compression. IV cannula was inserted and NS 500 mls given. A CS was then undertaken.

6 and 10

Depressed breathing.

Resuscitated for 1–3 min with bag and mask ventilation. Taken to NNU as 1.7 Kg and 30 weeks’ gestation No HIE. Home after 14 days

According to mother monitoring is good but she cannot continue it herself due to pain. At last she said it help her with a live neonate

17 and below

G2P1 previous CS

On 12th contraction, Mother reported slowing and with MW reported a FHR 124. Meconium present Grade 3 Then FHR dropped to 119 bpm

OC was called and after lateral tilt established IV line and gave 500 ml NS. A CS was then undertaken.

7 and 8

No resuscitation needed but foul-smelling amniotic fluid at CS led to NNU admission and IV antibiotics.

Mother agreed to the process, she started it but discontinue due to pain and was helped by midwife and OB clinician. Mother said it’s a good thing, it help her have a live baby

29–39

G1P0

Induced for post date. On the 8th contraction mother noted a slow heart rate. MW contacted and confirmed FHR 110. Meconium was present. OC informed and FHR was 112. Cervix fully dilated.

Lateral tilt and placed in delivery room for vacuum delivery. However, within 5 min delivered NVD spontaneously. A very short umbilical cord was present.

5 and 7

Depressed breathing

Resuscitated for 5 mins with bag and mask ventilation and taken to NNU and given antibiotics. Later became stable and discharged.

The monitoring was good, it is a good idea and I hope it will continue because it will save a lot of babies as it did mine. Sometimes the midwives are busy so this will help them and help us the mothers too. Mother was hospital medical director ‘s sister in-law

29–39

G5P4

On the 30th contraction mother noted a slow heart rate. MW confirmed FHR 118.

MW performed lateral tilt and informed the OC and set up IV infusion of R/L 500 ml. Dr. ordered repeat and FHR 106. Cervix only 4 cm dilated. Descent 3 / 5. Discussion for CS was done but no CS materials available, so patient was referred to another hospital.

8 and 9

None needed after CS at referral hospital

I like listening to my baby heart but I don’t know if my baby will live again now that I am going to a different hospital.

Outcome at second hospital after CS was good for mother and baby.

18–28

G1P0

On the 20th contraction OC and student MW confirmed a slow FHR 105. No meconium seen.

Lateral tilt was undertaken. The cervix was already 10 cm dilated and there were poor maternal efforts. An IV cannula was inserted and she was given 30 ml dextrose 50%. Baby was delivered by vacuum.

5 and 6

Yes, by neonatal clinician bag and mask ventilation for 5–10 min. Admitted to NNU for neonatal depression. Neonate recovered quickly on nasal CPAP. Improved and went home well.

Mother had declined monitoring but this was done by student MW.

18–28

G1P0

On 30th contraction mother noted slowing of FHR. There was no meconium at this time. MW and OC identified FHR of 115, 118,122.

Lateral tilt and Doctor notified. An IV cannula inserted and given N saline 500 ml plus Dextrose 50% 30 ml. The cervix was 10 cm dilated. OC did vacuum with Dr. present but failed 3 times. Dr. and OC proceeded to immediate CS. Intraoperative meconium was present

5 and 7

Bag and mask ventilation for mild respiratory depression. Recovered rapidly and went home.

The monitoring is good but I was not able to do it all by myself because of the pain and my foot pain. Yes my baby is living so it help. No problem with it but the pain can be too much.

18–28

G4P0

On 51st contraction mother noted slowing of fetal heart rates. MW recorded FHR 109, 178,120,110,181,102,130

Meconium was present

Lateral tilt was performed, and OC notified. IV fluids were started, and 30 ml of 50% dextrose given IV. The doctor was also called and due to FHR changes, high station on vaginal examination, and bad obstetric history (G4P0) proceeded with the OC to CS.

8 and 10

No

The monitor help me to inform the midwife that my baby was not breathing good. So I see it to be good for all the big belly with stomach hurting pain.

  1. Abbreviations are defined in the list given earlier in the manuscript