A Standardized Approach to Electronic Fetal Monitoring in Critical Care Obstetrics

From the periphery, pregnancy is a common event in women of childbearing age. Normal anatomic and physiologic adaptations occur and, in most cases, will result in ideal maternal-fetal outcomes. Yet, every day, obstetric clinicians are facing complex pregnancies with complicated life-threatening conditions or coexisting medical and surgical problems that not only alter maternal physiology but also impact fetal survival. A challenge in this population is individualizing maternal-fetal care in critical care women while integrating medical-surgical specialties in creating an interdisciplinary team with similar management goals. Questions frequently arise concerning admission criteria, location of care, as well as type and mix of personnel. Furthermore, how to simultaneously manage a critically ill parturient while monitoring a viable fetus is often obscured. This article focuses on crucial fetal monitoring concepts using a standardized approach to interpretation and management in pregnancies managed in an intensive care environment. Application of fetal monitoring during surgical procedures, during perimortem cesarean birth, and in women who have irreversible loss of brain function is included.