June 13th, 2018 by pamelaparker

What do you do if you are on the labour ward, you have no way to continuously monitor a baby unless someone stands there holding a Doppler for hours (not going to happen) and you have no way of tracing uterine contractions? It is not that Kiwoko wasn’t given 10 lovely machines do to all that. BUT, they have no paper, the parts are obsolete, and cords don’t fit and cannot be replaced…..I felt very sad looking at these useless monitors sitting high on a shelf, never to be used. HOW are we ever going to know the difference between accelerations and deceleration and what KIND of deceleration, AND how is the variability? FEAR NOT. Dr. Bravado to the rescue. You might be thinking of a hunky physician that looks like someone from Gray’s Anatomy TV series. But alas, “he” is only a mnemonic but a very useful one for answering these questions. What does it mean?

DR: define risk – is this someone with a prior cesarean scar, twins, vaginal bleeding, history of fetal demise, etc.

BR: what is the baseline fetal heart rate (110-160 is acceptable)

A: are there accelerations in response to vaginal exams or fetal movement? If so then baby is most likely ok.

VA: What is the variability? There should be at least 5 beats per minute of variability (you can hear it and the Doppler will record this). If less than 5 bpm over 30 minutes, the baby is NOT ok – flat tracing.

D: If there are deceleration, where do they fall? For this, one must palpate the abdomen during uterine contractions AND measure FHT simultaneously. If the deceleration is congruent with the contraction, it is probably an early deceleration or even a variable. If it follows the contraction it is a late deceleration. Early is good; Variable bears watching depending on how low the HR goes and Late is bad.

O: Overall assessment? Very simply, fine or not fine. If not fine the midwife will call the house officer and most likely proceed to cesaer.

All labors are attended and monitored by the midwives for the most part, including twins and breech presentation. I have been continually amazed at the assessment skills of the people who work here. House officers are doing cesareans despite no specific OB training. They are tapping joints and chests and have to have stellar diagnostic skills since the MRI and CT scanner are nowhere near, and not available because of cost and distance. I think in the USA we become lazy since there are check sheets, and multiple layers of people overseeing medical diagnostic activities. I feel humbled in their presence. And I am very happy to make the acquaintance of Dr. Bravado! ???? Namaste