Low Fetal Heart Tone

[Ouroboros]

I'm new to the forum. I am a dispatcher - I dispatch law only, but we dispatch police/fire/EMS at our center and we are all also 911 calltakers. I am also a former EMT (10 years ago - in high school).

Anyway, I took a call last night from a midwife's assistant calling from a home birth. She was relatively calm and said that the midwife wanted the patient transported because the fetal heart tone was below 80.

Other information I asked her for: patient is 26 year old female, conscious, normal breathing, contractions less than 2 minutes apart, full-term pregnancy,4th child, no bleeding.

The location of this call was in a rural area about 15 minutes away from the largest hospital in our county, which is not that large. The ambulance was near the hospital, so about 30 minutes total drive-time.

It also seemed to me like the ambulance took longer than normal to get there, watching its route on the GPS map. This is a call that the ambulance would normally respond priority to, right?

The more I think about this call, the more I keep wondering what happened to the mother / baby.

For whatever reason, whether because I am the age where my friends and family are having kids left and right, or just because I don't like unanwered questions, this sticks in my mind. I am wondering what this call would be like to respond to? How bad is this scenario, all things considered?What kind of things would you be thinking about when responding? What are the likely outcomes of this kind of call?

Thanks, and thanks for everything that you do. Be safe out there!

 

[JPINFV]

For whatever reason, whether because I am the age where my friends and family are having kids left and right, or just because I don't like unanwered questions, this sticks in my mind. I am wondering what this call would be like to respond to? How bad is this scenario, all things considered?What kind of things would you be thinking about when responding? What are the likely outcomes of this kind of call?

Thanks, and thanks for everything that you do. Be safe out there!

Ideally peripartum fetal heart rate monitors would include a uterus pressure monitor that would tell who ever is delivering the baby what type of deacceleration it is. Regardless, a long term (i.e. minutes) of a fetal heart rate that low would be termed "non-reassuring heart rate" and would very likely generate a "crash c-section" in a hospital. A crash c-section is exactly what it sounds like. Everyone runs (no, seriously... running is involved), scrubs as fast as they can, gloves and gowns themselves, and cutting starts as soon as the anesthesiologist has the mother intubated. It doesn't matter who else is ready or not ready (scrub tech, NICU, circulating nurse). As soon as cutting can begin, it's done and the baby is delivered in a matter of seconds.

What we don't know is if the decelerations (general term for a fetal heart rate that is lower than the baby's baseline (normally 120-160 bpm)) were early, late, variable, or if they were prolonged. Early decelerations begin with contractions (hence why being able to monitor contractions is important, especially since not all contractions are necessarily felt or communicated) and are a normal response. Late decelerations (starts after the peak of contraction) indicates placental insufficiency. Variable decelerations (various times) indicates umbilical cord compression.

Prolonged, especially if large (40 bpm difference, given the lower range of normal, is a big jump) indicates some sort of fetal distress that needs immediate intervention. The one thing that needs to be checked first, though, is that the baby is being monitored by the doppler (fetal heart monitors are dopplers... and the peripartum ones that get strapped on are just fancy ones) and not the mother. It's not particularly difficult for hte doppler to register one of the mother's arteries, however that's more of an issue for early prenatal visits when the baby's heart is below the mother's umbilicus when using the small handheld dopplers.


TLR: Yes, this is an emergency transport.

 

[bbmtnbb]

"Everyone runs (no, seriously... running is involved),"
^
This is true-interned a rotation at L & D and on a case like mentioned above you see team work. People flying, running and Code C (for C sec), all of a sudden a dozen people are there and bed is flying down the hall to OR-RUNNNING. Once a code C is called all heck breaks loose. I've seen the dads press themselves up against the wall hoping to disappear into it to get out of the way. Can't help baby in mama but can out of mama.
Yes
This is a priority call.

 

[FLdoc2011]

Ideally peripartum fetal heart rate monitors would include a uterus pressure monitor that would tell who ever is delivering the baby what type of deacceleration it is. Regardless, a long term (i.e. minutes) of a fetal heart rate that low would be termed "non-reassuring heart rate" and would very likely generate a "crash c-section" in a hospital. A crash c-section is exactly what it sounds like. Everyone runs (no, seriously... running is involved), scrubs as fast as they can, gloves and gowns themselves, and cutting starts as soon as the anesthesiologist has the mother intubated. It doesn't matter who else is ready or not ready (scrub tech, NICU, circulating nurse). As soon as cutting can begin, it's done and the baby is delivered in a matter of seconds.

What we don't know is if the decelerations (general term for a fetal heart rate that is lower than the baby's baseline (normally 120-160 bpm)) were early, late, variable, or if they were prolonged. Early decelerations begin with contractions (hence why being able to monitor contractions is important, especially since not all contractions are necessarily felt or communicated) and are a normal response. Late decelerations (starts after the peak of contraction) indicates placental insufficiency. Variable decelerations (various times) indicates umbilical cord compression.

Prolonged, especially if large (40 bpm difference, given the lower range of normal, is a big jump) indicates some sort of fetal distress that needs immediate intervention. The one thing that needs to be checked first, though, is that the baby is being monitored by the doppler (fetal heart monitors are dopplers... and the peripartum ones that get strapped on are just fancy ones) and not the mother. It's not particularly difficult for hte doppler to register one of the mother's arteries, however that's more of an issue for early prenatal visits when the baby's heart is below the mother's umbilicus when using the small handheld dopplers.


TLR: Yes, this is an emergency transport.

Agree with everything above. You must've been paying attention during OB month.

I remember on OB/GYN those crash cesareans were complete organized chaos and was amazed when I saw my first one how quickly they got that baby out.

 

[JPINFV]

Agree with everything above. You must've been paying attention during OB month.

First day on L&D and we had one. I was still outside trying to get the knee high booties on when the baby was delivered.

 

[VFlutter]

First day on L&D and we had one. I was still outside trying to get the knee high booties on when the baby was delivered.

Exact same thing happened to me. Those things do not go over fat, ugly, new balance shoes very well.

I spent the majority of my OB rotation with the NICU team so I was able to see a few planned and crash C-sections. I was amazed how quickly they had the babies intubated and suctioned after meconium births.

 

[Household6]

What we don't know is if the decelerations (general term for a fetal heart rate that is lower than the baby's baseline (normally 120-160 bpm)) were early, late, variable, or if they were prolonged. Early decelerations begin with contractions (hence why being able to monitor contractions is important, especially since not all contractions are necessarily felt or communicated) and are a normal response. Late decelerations (starts after the peak of contraction) indicates placental insufficiency. Variable decelerations (various times) indicates umbilical cord compression.

I agree...

There's too many unknowns given the information posted.. HOWEVER...

..if a midwife calls and asks for an ambulance, they need to put the hammer down... IMO and limited experience, working with midwives and doulas, they're a group of highly educated professionals. They don't ask for ambulances unless they believe their patient needs a surgeon..

 

[JPINFV]

They don't ask for ambulances unless they believe their patient needs a OB/Gyn..

FTFY

The one interesting thing about OB/Gyn is the fact that they handle every thing... including all of the surgeries.

 

[abckidsmom]

FTFY

The one interesting thing about OB/Gyn is the fact that they handle every thing... including all of the surgeries.

If a midwife can't facilitate a vaginal delivery, you think an OB/gyn can?

Tell me you ever saw a failed home birth go to the hospital and not end up as a c-section. I sure haven't.

 

[FLdoc2011]

If a midwife can't facilitate a vaginal delivery, you think an OB/gyn can?

Tell me you ever saw a failed home birth go to the hospital and not end up as a c-section. I sure haven't.

I have.

 

[JPINFV]

If a midwife can't facilitate a vaginal delivery, you think an OB/gyn can?

Tell me you ever saw a failed home birth go to the hospital and not end up as a c-section. I sure haven't.

That's not the point. General surgeons don't perform c-sections... OB/Gyns do. At the hospital I did my peds rotation at and at the different hospital that I did my OB/Gyn rotation at, there were surgical suites in labor and delivery for OB/Gyn procedures.

 

[abckidsmom]

That's not the point. General surgeons don't perform c-sections... OB/Gyns do. At the hospital I did my peds rotation at and at the different hospital that I did my OB/Gyn rotation at, there were surgical suites in labor and delivery for OB/Gyn procedures.

I realized that well after I posted and hoped you wouldn't notice my randomness. My apologies, you're totally right on that point.