An increase in the number of pregnant women requiring cardiac monitoring was observed in a level III labor and delivery (L&D) unit. While fetal heart rate (FHR) monitoring is routine, continuous monitoring of the maternal heart rate (MHR) is not as common and equipment to observe and record maternal electrocardiogram (ECG) tracings is not as readily available. The ability to provide continuous maternal ECG monitoring, while simultaneously allowing the pregnant patient to remain in L&D, where a delivery could be performed in a timely fashion, was needed. A flexible cardiac monitoring system was implemented to meet this need.

Supraventricular tachycardia, atrial fibrillation, valvular stenosis, and myocardial infarction are examples of cardiac conditions in pregnancy that require cardiac monitoring in L&D. The prevalence of cardiac disease in pregnancy is approximately 1%-4%, with congenital and acquired cardiac conditions being the most common type (Arafeh & Baird, 2006; Martin & Foley, 2006). The incidence of acquired cardiac lesions from rheumatic heart disease has decreased since the introduction of penicillin. At the same time, technological advances have led to an increase in women with congenital heart defects reaching childbearing age, making pregnancy a possibility for women who would have previously been advised to avoid or terminate pregnancy (Siu et al, 1997). Additionally, the risk of coronary heart disease increases with age and there is a trend showing an increase in women with advanced maternal age (>35) who are becoming pregnant (Blackburn, 2007). Cardiac monitoring may also be indicated for the administration of critical medications that have the potential to cause profound alterations of the MHR and rhythm. Labetalol and Hydralazine are two such medications, used to treat hypertensive crisis in pregnancy, that require the ability to directly observe and monitor the MHR and rhythm.

Bedside cardiac monitors can provide visualization of the ECG by the nurse while in the patient’s room, but a surveillance system, similar to a fetal surveillance system, would ensure that the maternal ECG would be observed at all times. The solution was to install a system, whereby an ECG signal is transmitted by telemetry to a centralized room where trained technicians continuously visualize and interpret the tracings. Abnormal ECG tracings are communicated to the nursing staff caring for the patient by the use of dedicated phone lines. Direct visualization of the ECG tracing can be performed by the bedside nurse via a remote monitor located on the nursing unit or directly from the Micropaq transmitter worn by the patient.

An added bonus resulting from this program was an increase in staff satisfaction. L&D nurses are highly skilled at interpreting FHR patterns, but are less comfortable with the interpretation of complicated maternal ECG tracings. Knowing that a trained technician is available to continuously observe the tracings alleviated fears that a potentially lethal ECG rhythm would be missed. This poster will illustrate how a flexible cardiac monitoring program optimized patient safety by providing a means for continuous cardiac monitoring of the pregnant patient in L&D.