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ACOG Issues New Guidelines On Fetal Monitoring To Resolve Inconsistencies In Interpretation
The American College of Obstetrics and Gynecology recently published new guidelines on electronic fetal monitoring in an attempt to increase consistency in the way physicians interpret and act on the results, the New York Times reports. Electronic fetal monitoring, which was introduced in the 1970s, is used during labor for more than 85% of the four million infants born alive in the U.S. annually, the Times reports. According to the Times, use of fetal monitors became standard obstetrical practice before it was known if the benefits outweighed the risks. The new guidelines refine the meaning of various readings from fetal monitors and could help doctors make better decisions about whether to intervene during labor.According to experts, the widespread adoption of fetal monitoring has produced both negative and positive consequences, including significant increases in caesarean deliveries and the use of forceps during vaginal deliveries. Monitoring has not been found to reduce the risk of either cerebral palsy or fetal death resulting from inadequate oxygen to the fetal brain, as it was intended to do. Furthermore, lawyers commonly use monitoring results to support malpractice cases that might have little merit, which in turn has driven rising malpractice insurance costs and prompted some obstetricians to stop delivering infants.The new guidelines divide monitor readings into three categories to help doctors interpret readings more consistently. The old guidelines had two categories -- reassuring and non-reassuring -- and it was up to the obstetrician to determine whether a non-reassuring reading required intervention. Under the new guidelines, the first category applies when tracings of the fetal heart rate are normal and no specific action is required. The second category is for indeterminate tracings that require evaluation, continuous surveillance and re-evaluation. Obstetricians treating patients in this category should consider other clinical factors that could affect the fetus and whether the patient could be safely moved to category one, according to Catherine Spong of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, which produced recommendations on which the guidelines are based. The final category is for abnormal tracings that require immediate evaluation and efforts to reverse the abnormal heart rate. The Times reports that more refinements to the guidelines are expected to be released in 2010 (Brody, New York Times, 7/7).

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Veterinarian Offers Advice On Evacuating With A Pet If Disaster Strikes

A veterinarian at Kansas State University"s College of Veterinary Medicine has advice for pet owners who want to consider how pets fit into their own household emergency plans -- especially if that includes evacuating. Dr. Marjory Artzer, professor of clinical sciences, suggests thinking about the supplies you"d ordinarily have on hand at home but may not have access to if forced to evacuate. This includes pet food, which can be bagged in easy to handle amounts, as well as bottled water, a leash, a pet carrier and an adequate amount of any medications your pet regularly takes. Artzer said heartworm medications and flea/tick preventatives are essential. Pet owners also may want to include bandaging material for wounds. Pets not of the canine or feline variety require considerations in addition to the basics like food and water. Artzer said owners should think about a safe means of transport and a way for environmental temperature control. Artzer also suggests bringing along paperwork like health records and registration. "It may make a difference in how the pet is handled," she said. Having pets properly identified can make an emergency or evacuation go more smoothly, too. "An ID tag on a collar is an easy way to see immediately, but they can get lost," she said. "A permanent way is microchipping." In an emergency, your pet"s nerves can be just as frayed as yours. To make animals more comfortable, Artzer suggests doing a pets" favorite activity every day, whether it"s walking, playing ball or just brushing its fur.The best time to think about an emergency or evacuation plan for your pet is before disaster strikes. Artzer suggests thinking of alternatives to evacuating with your pet ahead of time. "Have a backup plan for help, like a friend or boarding facility," she said. "It is important to think ahead." Kansas State University


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