Download Management of Ectopic Heartbeat or irregular Heart rate

Management of Ectopic Fetal Heart
Beats or Irregular Fetal Heart Rate
Specialty:
Author:
Date Approved:
Approved by:
Date for Review:
Maternity Services
Antenatal Forum
21st May 2014
W&CH Quality and Safety Committee
May 2017
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Management of Ectopic Fetal Heartbeat or Irregular Fetal Heart
Rate on Referral to Antenatal Day Assessment Unit
Take a detailed history and undertake a clinical assessment to
include:
 Full antenatal assessment to include baseline temperature,
pulse, blood pressure and urinalysis.
 Auscultation of fetal heart
 Cardiotocograph >26 weeks
 Ultrasound scan
USS RESULT
Women with a sustained arrhythmia with heart
rate of either above 180 or below 80 beats per
minute at all times, a referral to fetal cardiac
services in Cardiff is indicated. See flowchart
(working draft) Referral of women with
suspected/ confirmed fetal cardiac anomaly
Appendix A (flowchart) and B (referral form)
Abstain from smoking,
consuming stimulant beverages
containing caffeine and foods
containing excessive vanilla,
chocolate etc. Avoid stimulant
medications such as
Salbutamol, Ephedrine,
Otrivine, etc. Reduction of
maternal stress would suffice in
resolving these benign
arrhythmias in the majority of
foetuses.
If ectopic beats or irregular heart rate (without sustained
arrhythmia above 180 or below 80), twice weekly
auscultation by midwife and weekly ultrasound scan is
indicated to exclude development of sustained
arrhythmia or hydrops.
ADVICE TO WOMEN
Fetal Movements
Advice on the importance
of monitoring fetal
movements
FURTHER RECOMMENDATIONS FOR PRACTICE
 If the heart rate irregularity results in fetal compromise and hydrops, then a
cardiac specialist opinion should be sought.
 In such cases where there is genuine obstetric concern about the wellbeing of
the fetus or the mother, and in the case of sustained arrhythmia, the
obstetrician should ring the on call paediatric cardiologist to discuss further
management.
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Useful contact numbers:
Secretary to Dr Uzun: Tel: 02920744743 Fax: 02920744744
Paediatric cardiology department UHW: Tel: 02920 74474 Fax:02920 744744
Reference:
Fetal Cardiac service information letter. Dr Orhan Uzun Consultant Paediatric
Cardiologist.
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Maternity Services
Flowchart
Referral of women with suspected / confirmed fetal cardiac anomaly
Suspected / confirmed fetal cardiac anomaly
Midwife to telephone Dr. Uzun’s secretary to enquire on the availability of
appointment for fetal cardiology assessment and scan in UHW Cardiff:
Tel. 02920 744 743 (Angela Butters)
Complete and fax referral form: 029 2744 744.
Notify CARIS.
Cardiff Fetal Cardiology Appointment
Woman should be seen within three working days by a fetal cardiologist (ASW
Standard, 2010.)
Discussion may take place between Dr Uzun and his secretary re appointment.
Explain to woman that she may be contacted the next day re appointment.
Cardiff appointment WITHIN 3 working days
Midwife to contact woman with appointment
details.
Cardiff appointment NOT within 3 working days
Midwife to offer woman referral to:
St. Michael’s Hospital, Bristol:
Tel. 0177 342 5470
http://www.uhbristol.nhs.uk/patients-and-visitors/yourhospitals/st-michaels-hospital/what-we-do/fetal-medicineunit/
Consultant Appointment
Arrange consultant follow – up
appointment in ABMU local
hospital antenatal clinic.
If appointment NOT within
3 working days
Complete and fax referral form:
Fax: 0117 3425180
OR
King’s College Hospital
Harris Birthright Centre
Tel. 020 3299 3246
http://www.kch.nhs.uk/patientsvisitors
ANC Midwife to give appointment to woman and relevant
Patient Information Leaflet (includes directions etc).
Midwife to escalate to Senior Midwifery
Management Team.
Antenatal Screening Wales Policy and Standards (2010)
Following a confirmed fetal cardiac anomaly, the woman should be seen within
three working days by a fetal cardiologist. Minimum standard 90%
Available at: http://www.antenatalscreening.wales.nhs.uk/professional/document/180993
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Appendix B
University Hospital of Wales
Fetal Cardiology Unit
Heath Park, Cardiff CF14 4XW
Tel: 029 20 744 743 Fax: 029 20 744 744
REFERRAL FOR FETAL CARDIOLOGY
ASSESSMENT AND SCAN
Patient’s Name:
Gestation:
Date of Referral:
EDD:
DOB:
Pregnancy No:
Address:
Twin: Yes / No
Tel:
CONTACT DETAIL
Obstetrician:
Hospital:
Midwife Name:
Tel:
Name of Contact:
Tel of Contact:
Sonographer name:
Fax of contact:
Name of GP:
GP Surgery:
Antenatal Obstetric Scan:
Patient’s and Family History:
Reason for Referral:
Additional Information Comments and Requests:
Proposed appointment Date and time:
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Directorate of Women & Child Health
Checklist for Clinical Guidelines being Submitted for Approval
by Quality & Safety Group
Title of Guideline:
Management of Ectopic Fetal Heart Beats or
Irregular Fetal Heart Rate
Name(s) of Author:
Vicky Langford
Chair of Group or Committee
supporting submission:
AN Forum
Issue / Version No:
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Next Review / Guideline Expiry:
2017
Details of persons included in
consultation process:
All consultant obstetricians, antenatal working
party ‘Dr Uzun consultant Cardiff
Brief outline giving reasons for
document being submitted for
ratification
Referral process required review/updating for
health board approach following incident.
Name of Pharmacist
(mandatory if drugs involved):
nil
Please list any policies/guidelines
this document will supercede:
nil
Keywords linked to document:
Irregular fetal heartbeat
Date approved by Directorate
Quality & Safety Group:
21st May 23014
File Name: Used to locate where
file is stores on hard drive
Fetal, anomaly, irregular, Bristol, kings, London
* To be completed by Author and submitted with document for ratification to Clinical
Governance Facilitator
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