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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)ParityChange in FHR identifiedAction takenApgar scores at 1 and 5 minResuscitation givenMaternal comment
29–39G5P2By mother. FHR 115 with meconium Confirmed by MWLateral tilt and intravenous cannula with NS bolus Vacuum delivery9 and 10NoAccording 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
29–39G3P2By MW and mother during training in the use of the sonicaid at time of admission. No FHR was identified and there was 3+ meconiumUltrasound confirmed IUFD. Vacuum delivery was undertakenNANANA
17 and belowG2P0By mother at 46th contraction FHR 109 with meconiumCervix fully dilated and urged to push.
NVD occurred.
4 and 7Yes. 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.
18–28G2P0By mother FHR 119 at 49th contraction. There was + meconium presentVacuum delivery7 and 10NoI like the thing I was doing but it was hard to do because of the pain.
18–28G2P1By 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 10NoThank you for this program. If not so my baby was going to die. The only thing that the pain.
18–28G2P1
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 CS9 and 10NoThank you for saving my life and my baby. It really helpful to listen to my baby heart to know what was happening to me.
18–28G3P2By 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 CS8 and 10NoI feel good when I was listening to my baby heart. It help me to know what happen to my baby.
18–28G1P0By mother at 46th contraction FHR 117, then 114, then 116, then 113. No meconium. Fully dilated but descent only minus 2Lateral 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 undertaken7 and 10NoThank 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 belowG1P0FHR 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 labour6 and 9NoneNot requested at this stage in programme
18–28G3P1Mother reported a change in FHR but when checked by MW found FHR to be normal at 142. Meconium was presentDoctor informed but no action was considered necessary6 and 10NoneNot requested at this early stage in programme
17 and belowG1P0On 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 undertaken7 and 10NoneNot requested at this early stage in programme
17 and belowG1P0Mother 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 performed8 and 10NoneNot requested at this early stage in programme
18–28G2P1On 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 9Bag and mask ventilation. Admitted NNU for 5 days and treated for sepsis.Not requested at this early stage in programme
18–28G1P0Yes - by MW following being declined by mother FHR 95–100 on two successive occasionsLateral tilt and subsequent CS for non-reassuring FHR5 and 7Bag 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.
18–28G3P2Mother 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 10This 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 belowG1P0On 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 10Neonate 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 belowG1P0On 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 10Baby 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 kgPatient initially declined procedure but later on she was encouraged to do it herself and everything went well
18–28G5P4On 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
29–39G5P3On 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 8Neonatal 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 belowG2P1On 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 7Mildly 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.
18–28G3P0On 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 10Resuscitated 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 belowG1P0On 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 10None neededMother was happy to hear her baby heart beat because she stay in labour for long and worry about her unborn baby
40 and aboveG9P8On 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 daysAccording 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 belowG2P1 previous CSOn 12th contraction, Mother reported slowing and with MW reported a FHR 124. Meconium present Grade 3 Then FHR dropped to 119 bpmOC was called and after lateral tilt established IV line and gave 500 ml NS. A CS was then undertaken.7 and 8No 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
29–39G1P0Induced 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
29–39G5P4On 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 9None needed after CS at referral hospitalI 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.
18–28G1P0On 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 6Yes, 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.
18–28G1P0On 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 present5 and 7Bag 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.
18–28G4P0On 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 10NoThe 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