The well being of the baby during labor is assessed by recording the fetal heart rate and maternal uterine contractions during labor. The uterine contractions are recorded using a simple gadget called as a tocodynamometer, which is shown below.
The transducer used for this is strapped to the patient's abdomen over the upper part of the uterus. It has a disk projecting out from the middle of the maternal surface. There is a spring under the disk. When the uterus contracts, it rises forwards and compresses the spring. This mechanical energy is converted into an electrical signal, which is carried through a cable to the recorder, which writes on a moving strip of paper. The fetal heart rate is recorded on the same paper using another device.
The job of fetal heart rate monitoring is usually done by the Resident Doctors. Actually all transducers have to be strapped to the patient's abdomen, so that they do not fall down. They break if they fall down. Another reason for strapping the tocodynamometer is that the spring has to be compressed to a fixed level when the uterus is relaxed, and only then it can give an idea about the force and duration of the uterine contractions.
Once we were taking a round of the labor ward. I found a patient connected to a monitor there. The patient was holding the tocodynamometer with her hand, while the heart rate transducer was strapped with a belt. The Resident Doctor who was doing the monitoring was with another patient.
"May I ask why the transducer is not strapped to the patient's abdomen?" I asked.
She promptly replaced the patient's hand with her own. "The other transducer is strapped" she said.
I took the transducer from her and asked her if it was recording uterine contractions well. She said it was. I held the disk over the spring facing away from her and pressed it. The record immediately showed a powerful contraction which just would not go away, because I kept pressing on the disk.
"What a strong and long uterine contraction!" I said.
She looked suspiciously at my hand. "You are pressing on the disk" she said accusingly.
"Exactly" I said. "The same thing can happen when the patient gets a painful uterine contraction, or just holds the transducer tightly. She might let the grip become loose, which will result in loss of recording of the contraction. If you are holding it and someone calls you, you turn around and the hand presses the transducer on the patient's abdomen. That produces a false record of a contraction." I demonstrated what I meant. It did what I had just said it would do.
"Now I hope you understand why both the transducers should be strapped to the patient's abdomen."
I hope she understood it. I am hoping against hope she will do what I told her to do - after all there are many reasons for not following standard operating procedures.
The job of fetal heart rate monitoring is usually done by the Resident Doctors. Actually all transducers have to be strapped to the patient's abdomen, so that they do not fall down. They break if they fall down. Another reason for strapping the tocodynamometer is that the spring has to be compressed to a fixed level when the uterus is relaxed, and only then it can give an idea about the force and duration of the uterine contractions.
Once we were taking a round of the labor ward. I found a patient connected to a monitor there. The patient was holding the tocodynamometer with her hand, while the heart rate transducer was strapped with a belt. The Resident Doctor who was doing the monitoring was with another patient.
"May I ask why the transducer is not strapped to the patient's abdomen?" I asked.
She promptly replaced the patient's hand with her own. "The other transducer is strapped" she said.
I took the transducer from her and asked her if it was recording uterine contractions well. She said it was. I held the disk over the spring facing away from her and pressed it. The record immediately showed a powerful contraction which just would not go away, because I kept pressing on the disk.
"What a strong and long uterine contraction!" I said.
She looked suspiciously at my hand. "You are pressing on the disk" she said accusingly.
"Exactly" I said. "The same thing can happen when the patient gets a painful uterine contraction, or just holds the transducer tightly. She might let the grip become loose, which will result in loss of recording of the contraction. If you are holding it and someone calls you, you turn around and the hand presses the transducer on the patient's abdomen. That produces a false record of a contraction." I demonstrated what I meant. It did what I had just said it would do.
"Now I hope you understand why both the transducers should be strapped to the patient's abdomen."
I hope she understood it. I am hoping against hope she will do what I told her to do - after all there are many reasons for not following standard operating procedures.
