1. sonicaid – monitoring fetal and maternal wellbeing sonicaidTrend Intrapartum FHR parameter trending Presented by: David Stanger Global Business Unit Manager Obstetric Systems

2. Intrapartum FHR Parameter Trending sonicaid – monitoring fetal and maternal wellbeing Unique new Dawes and Redman Intrapartum FHR analysis system For use during the first stage of labour

3. Intrapartum FHR Parameter Trending sonicaid – monitoring fetal and maternal wellbeing Based on further development of the Care (System 8000/8002, FetalCare) Antepartum CTG analysis originated by Professor Dawes, Professor Redman and Mary Moulden at the John Radcliffe Hospital, Oxford

4. Intrapartum FHR Parameter Trending sonicaid – monitoring fetal and maternal wellbeing The effectiveness of fetal monitoring is often limited by the clinicians level of ability of visual interpretation The Intrapartum FHR Parameter Trending of essential parameters can not advise on the fetal condition

5. Intrapartum FHR Parameter Trending sonicaid – monitoring fetal and maternal wellbeing Can help to remove the subjective element of visual interpretation on some key fetal heart rate parameters Baseline Heart Rate Short Term Variability (STV) Decelerations

6. Intrapartum FHR Parameter Trending sonicaid – monitoring fetal and maternal wellbeing The analysis provides measurement of fetal heart rate parameters at regular intervals offering a new way of describing the attributes of the intrapartum CTG trace that is quantitative not qualitative

7. Intrapartum FHR Parameter Trending sonicaid – monitoring fetal and maternal wellbeing Note - It is not intended as a replacement for skilled visual interpretation of the CTG trace.

8. Intrapartum FHR Parameter Trending sonicaid – monitoring fetal and maternal wellbeing With continuous fetal monitoring, it allows the clinician to assess long-term changes in the fetal heart rate pattern.

9. Intrapartum FHR Parameter Trending sonicaid – monitoring fetal and maternal wellbeing No guidelines on interpretation or limits of normality are provided Instead, the clinician can use the numeric values to identify and quantify the relative changes in fetal heart rate parameters over a period of time Some French clinical papers are now available describing it’s use

10. A numerical description of the CTG trace enables better quantitative communication between colleagues and direct comparison between different traces It also provides training support for trace interpretation, and readily available data for clinical research projects Intrapartum FHR Parameter Trending sonicaid – monitoring fetal and maternal wellbeing

11. Intrapartum FHR Parameter Trending sonicaid – monitoring fetal and maternal wellbeing Analysis is performed every 15 minutes and calculates the following parameters: Baseline heart rate (bpm) for the last 60 minutes Baseline heart rate (bpm) for the last 15 minutes Short Term Variation (msecs) for the last 60 minutes Deceleration size (beats) for the last 60 minutes Deceleration size (beats) for the last 15 minutes Note - The ‘Deceleration size’ parameter is only available when selected.

12. Confidence Indicator The analysis provides a High ‘H’, Medium ‘M’, or Low ‘L’ confidence level as an indicator of the reliability of the analysis results Mainly associated with the baseline fitting, can also be affected with high signal loss Intrapartum FHR Parameter Trending sonicaid – monitoring fetal and maternal wellbeing

13. When an analysis has been performed, the results and the confidence indicator are printed on the contractions section of the CTG trace. A key to the parameters is printed on the CTG header, and again three minutes before the end of each 60 minute period. sonicaid – monitoring fetal and maternal wellbeing Intrapartum FHR Parameter Trending

14. The analysis results are printed on the CTG every 15 minutes. In this example the deceleration parameter is not enabled. sonicaid – monitoring fetal and maternal wellbeing Intrapartum FHR Parameter Trending

15. Following each 15 minute analysis the monitor will display the results from that last analysis. This will revert back to the normal FHR display after two minutes, or when EXIT is selected TIME21:06 60 MIN BASELINE 139 15 MIN BASELINE 144 60 MIN STV 7.8 60 MIN DECEL 350 15 MIN DECEL 90 CONFIDENCE H Note - The deceleration parameters are only present if this have been enabled. sonicaid – monitoring fetal and maternal wellbeing Intrapartum FHR Parameter Trending

16. Display Results Both display screens are available to user interrogation at any time during the analysis Note - The graphical CTG display facility on Team is not available when using the IP Trend analysis sonicaid – monitoring fetal and maternal wellbeing Intrapartum FHR Parameter Trending

17. When monitoring twins, both fetal heart rate channels are analysed simultaneously The results for both twins are printed on the CTG and the results for the selected audio channel will be displayed Note – On Team with no audio selected the display defaults to showing results for channel 1 (Yellow). sonicaid – monitoring fetal and maternal wellbeing Intrapartum FHR Parameter Trending

18. Parameters Not Available When a calculated value is not available the following symbols are used on both the printed CTG and the results displays: NAIf not enough time has elapsed for a parameter value to be calculated. SLIf there is too much signal loss (>50%) for a parameter to be calculated. sonicaid – monitoring fetal and maternal wellbeing Intrapartum FHR Parameter Trending

19. Selecting TREND from the menu will access another display containing the results from that last analysis and those for the previous three hours. TIME 21:06 22:06 23:06 00:06 60 MIN BASELINE139 141 143 138 60 MIN STV 7.8 8.6 8.1 8.0 60 MIN DECEL 280 290 310 350 CONFIDENCE M H H H Note -The deceleration parameter is only present if this is enabled. sonicaid – monitoring fetal and maternal wellbeing Intrapartum FHR Parameter Trending

20. Printer Stop When the printer is switched off the monitor unit will display the following message: PRINTER SWITCHED OFF CONTINUE PRINT & ANALYSIS? sonicaid – monitoring fetal and maternal wellbeing Intrapartum FHR Parameter Trending

21. Summary of Benefits Trend analysis is a valuable new objective aid to assist visual interpretation of the intrapartum CTG Provides reliable, quantitative measurements of fetal heart rate baseline and variability Allows an objective method of identifying and quantifying relative changes in fetal heart rate parameters over time sonicaid – monitoring fetal and maternal wellbeing Intrapartum FHR Parameter Trending

22. Summary of Benefits Enables better quantitative communication between colleagues through numeric analysis of results Prints analysis results on the CTG trace Displays 4 hour trended results on the monitor Supports training in trace interpretation Gives easy access to data for clinical research projects sonicaid – monitoring fetal and maternal wellbeing Intrapartum FHR Parameter Trending