Something I Learned Today: Fetal Heart Tones

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One of the things that obstetricians (doctors who deliver babies) use to decide whether or not a mother might need a C-section delivery (read my post yesterday for a bit of background on that) is by looking at a monitor that looks very much like the picture above. If you've ever been in a labor and delivery unit, you've probably seen something that looks very similar to this on some of the screens around the unit. These monitors measure what we in medicine call "Fetal Heart Tones", and it gives us an imperfect but useful perspective into how a potential newborn is handling the course of labor. In this post, I'll give you a brief overview of what this means, because I just learned about it formally for the first time this week.

In the picture above, you can appreciate two different "tracings" or graphs. The top graph is a tracing of the fetal heart rate as time goes along. On the units, we read this graph (and essentially every other graph in medicine with a few exceptions) from left-to-right, with the earlier values on the left and the newer values towards the right. The bottom graph (with the three bigger peaks) shows measurements from something called a tocometer. A tocometer measures the pressure generated by the mother's contractions as she progresses through labor. The peaks, unsurprisingly, correspond to increasing pressure generated by the contractions. Generally, these contractions that we measure tend to get stronger and more frequent as the mom is closer to delivering her child. Because these contractions are quite literally squeezing the baby inside the mother's abdomen, the baby can actually start to be "stressed". By "stressed", I mean that the baby isn't getting the proper amount of oxygen from the blood flow it's receiving from their mom.

As the baby gets more "stressed", its heart rate tends to slow down. This is actually a bit backwards compared to what happens to a people get stressed in real life, but it has more to do with complicated relationships between the baby's oxygen status and how the brain and heart respond to low-oxygen states. That's another topic for another day. For our purposes in this post, just knowing that the heart rate slows when the baby is squeezed helps us appreciate that being able to measure these contractions and monitor the fetus' heart rate is important. We can actually estimate which part of the baby is being squeezed too hard by how their heart rate changes in relation to when the contractions happen.

For example, if the heart rate slows down in a way that mirrors the contraction (see below), we call that an "Early Deceleration". That type of fetal heart tone suggests that the baby's head is being squeezed a bit, but THAT IS ACTUALLY OKAY! This is a completely normal response from the baby, and it's actually an unconcerning reading. The heart rate will drop briefly, but will return to a completely normal reading when the contraction stops.

A different type of reading is one where the heart rate slows down in a way that lags slightly behind the time when the contractions happen. We call these "Late Decelerations". Take a look below to see how this differs from the first type I described.

Looks pretty similar, but slightly different, right? From a doctor's perspective, this reading tells a completely different story than the previous one. This pattern corresponds to an issue we call "uteroplacental insufficiency". In short, uteroplacental insufficiency means that there is a major issue with blood flow through the placenta. The placenta is the site where blood flows from the mother to the baby, allowing for the baby to have enough oxygen to survive and grow even though it's sitting in a pool of liquid not breathing real air. If the placenta isn't working, the baby is in serious trouble. When we see late decelerations, we need to change something. Whether it's just repositioning how the mom is sitting/laying down or heading straight to the operating room for an emergent C-section delivery, we as L&D physicians/med students treat this reading as somewhat of an emergency.

There's more to talk about on this topic, but I won't bore you with a lengthy, lengthy post. I just wanted to illustrate that a really small difference seen on a monitor can make a HUGE difference in how we handle a patient's labor from an obstetric perspective. Now, since you've read this, you're essentially certified to help manage a baby's Fetal Heart Tones if you ever randomly find yourself waltzing through a Labor and Delivery department!

Well, maybe not, but you DO know more about this topic than I did before this week started!

Cogito Ergo Cogito's College Football Picks: 2022 Week One

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We are so back. The first official week of the best sport in the world kicks off this evening with a slate of games leading into a tremendous first week of action. Our panel of college football experts here at Cogito Ergo Cogito have you covered with a slate of picks for the weekend's biggest games. We're not a betting site, but we're betting you can glean some valuable insight from a few of the brightest minds in CFB analysis.

The Expert Picks

	Jake	Taylor	Josh
Penn State vs. Purdue
West Virginia vs. Pittsburgh
Cincinnati vs. Arkansas
Georgia vs. Oregon
Utah vs. Florida
Notre Dame vs. Ohio State
Houston vs. UTSA
North Carolina vs. Appalachian State
Rutgers vs. Boston College
LSU vs. Florida State

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What The Experts Are Saying About Their Picks

Josh Hunter-Spent multiple months in SEC country this summer

About Cincinnati versus Arkansas:

"Arkansas by 28. SEC for life."

Taylor Hunter-Has attended multiple college football games in-person

🚨 DISHONESTY ALERT 🚨

Taylor said this exact quote last season, yet picked UNC to win this week????

"I don't like North Carolina's uniforms, so I refuse to pick them ever."

About West Virginia versus Pittsburgh:

"West Virginia MOUNTAIN MOMMA TAKE ME HOME DOWN COUNTRY ROADS."

About West Virginia versus Pittsburgh:

"Arkansas. Cinci had their year. Also, feral hogs are very scary and I'm like 70% sure bearcats aren't a real thing."

Jake Hunter-Is dedicated enough to this sport to stay up until after midnight watching Vanderbilt beat Hawaii 63-10 just for the love college football

About Notre Dame versus Ohio State:

"CJ Stroud. Jaxon Smith-Njigba. Treveyon Henderson. Ohio State by four scores."

About North Carolina versus Appalachian State:

"Why on earth was UNC okay with playing this game on the road? They also struggled to beat a depleted Florida A&M at home last week. This is a soft team that is absolutely capable of losing to a strong G5 program like App State. I honestly wouldn't even consider this a significant upset if App State won."

Each Expert's Picks Record So Far This Season:

Taylor: 0-0

Josh: 0-0

Jake: 0-0

Something I Learned Today: Cesarean-Sections Are CRAZY Cool

Don't worry. This isn't a picture of the baby we delivered this morning.

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If you listened to our most recent podcast episode, you would have heard that I just recently finished my two-month surgery rotation during my third year of medical school. Since then, I've had the pleasure of starting my first week of my Obstetrics and Gynecology (or OB/GYN) rotation. My first few weeks on this rotation will be spent doing Labor and Delivery (L&D) shifts, which means I'll get the opportunity to watch and, if the opportunity presents itself, help actually deliver newborn babies. Since the schedule is a little more manageable than surgery tended to be, I thought I'd start sharing some brief stories/thoughts on things I'll be learning throughout my time on this rotation!

Today was actually my first L&D shift of the rotation, and the very first thing I was told when I reported to the unit this morning was, "We have a C-section in about an hour." For those of you not supremely invested in the medical field, a Cesarean section or "C-section" is an alternative way of delivering a newborn baby compared to how most babies tend to be born. To avoid being overly graphic, I'll just say that a C-section involves making an incision (or cut) into the mother's stomach and delivering the baby through that opening. That's about the most G-rated way to describe it. The C-section is revered amongst medical students as one of, if not the most barbaric-looking procedures we'll ever have the pleasure of seeing during our medical careers. It's a very safe procedure when performed, don't worry, but like any other surgical procedure, it comes with some risks. It's because of this that, in the modern day, it's generally reserved for babies/mothers with some serious issue at hand that would prevent the baby from being able to be delivered normally.

As someone on my very first L&D shift who had never seen a baby delivered, whether normally or by C-section, having my very first witnessed delivery be via C-section was somewhat akin to attending an amusement park for the first time in your life and immediately jumping in line for the Kingda Ka. It was a few minutes later that I found out I not only would be in the room, but that I would be the primary assistant to the doctor for the whole procedure.

A mere 90 minutes later, I was standing at the side of the operating table, helping prep the site for the initial incision. All gowned and sterile. I noted that, as is actually quite common during C-sections, the mother was awake on the other side of our sterile drape. There were about 15 people in the room at the time, but somehow I was the one who had the privilege to be standing directly across the table from the doctor as they made the first cut. The next five minutes were an absolute blur. As the primary or "first" assistant on C-sections (or most surgeries in general), your job is to move everything to make the surgeon's line-of-sight as optimal as possible. Whether that means pulling a flap of skin back, holding a light, or literally pulling someone's abdominal muscles apart, your job is to make the surgeon see what they need to see.

So that's what I did.

As I've said, I just recently finished two months on surgery. I've seen tons of procedures, from the a basic gallbladder removal to the most precise microvascular repair of facial arterial vessels during a facial reconstruction following removal of a golf-ball sized tumor in a patient's jaw. This procedure, more than any other, absolutely took my breath away.

Part of the shock was the rapidity of the delivery. Once a few key incisions are made mere minutes into the procedure, the baby is instantly ready to come out. I was just getting acquainted with the tools we were using to spread the skin, etc. when suddenly I was looking into the amniotic sac (a pool of fluid around the baby). Next thing I knew, the doctor was telling me to push on the mother's stomach. The instant I pushed, a small tuft of hair appeared in the area we'd opened up. I pushed a little harder, and an entire head emerged. Ten seconds later, there's a newborn infant lying next to my hand on the table, taking in it's first breath and letting out an all-too-adorable first cry on this planet.

It's definitely one of those experiences that's very hard to put into writing because of the sheer sensory overload of the moment. If you have any interest in knowing more specifically what happens in a C-section, this video right here can help give you an actual idea.

Having my very first delivery be via C-section was absolutely eye-opening. The relative ferocity of the techniques used are alarming at first, but I've realized quickly that that's ultimately the nature of childbirth in general. Most importantly, though, I found that being a contributing member of the team tasked with bringing a child into the world for the first time in their lives was supremely gratifying, and I'm immensely thankful for the opportunity I had to take that in today. I certainly won't forget it anytime soon.