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Blog posts of '2015' 'August'

Why Do We Use Fetoscopes?

 

Fetoscopes have been in use since the 19th century. Midwives and others worldwide continue to use fetoscopes for listening to fetal heart tones. The United States is one of the few countries where the Doppler has replaced the fetoscope. Though there are many types of fetoscopes available, the most commonly used in the Allen Type.

Fetoscopes are designed to listen to the heartbeat of unborn babies. Fetal heart tones can be detected as early as 18 weeks, but in most cases a fetoscope is most effective after 22 weeks. When using a fetoscope, you will note that the sound is very soft and far different than the amplified sound provided by a Doppler.

According to Penny Simkin, using a fetoscope is especially useful for determining fetal position.

In most fetuses near term, the loudest sounds of the fetal heart are heard through the fetal back, at approximately the level of the scapula or shoulders. Locating this PMI [point of maximum intensity] of the fetal heart tones helps determine the orientation of the fetal back - either anterior or posterior. The best tool for this purpose is a fetoscope…which allows for the direct auscultation of the fetal heart…1

HISTORY

During the 19th century, the Pinard Horn was designed by French obstetrician Adolphe Pinard, to listen to the heart rate of a fetus. The Pinard Horn is a cone shaped fetoscope that amplifies the sound of the fetal heart beat, and has been described as a type of ‘ear trumpet’. The monaural – meaning it only requires one ear for use - design “rapidly became the fetal stethoscope of choice because the widely faring bell prevented rocking on the mother's abdomen during auscultation.”2 The Pinard Horn is often made of wood or aluminum – the wooden style still popularly used amongst midwives, especially in developing countries where metal instruments are not always welcomed due to cultural superstitions.

The binaural fetoscope design that allows users to hear the heart beat through both ears is most commonly used today. The first binaural fetoscope was originally described in 1917 by David Hillis, and then later by his supervisor Joseph DeLee in 1922, who apparently claimed credit for its creation.3 As a result, the first binaural fetoscope eventually became known as the DeLee-Hillis Fetoscope.

Choosing between the monaural design of a Pinard Horn and binaural fetoscope designs really comes down to personal preference. Here is a synopsis of the different types of fetoscopes along with their corresponding features.

 ‘Ear Trumpets’ – PINARD HORNS

Pinard Horns are the oldest form of fetoscope, offering the same effectiveness as the popularly used Allen Type Fetoscope and is useful for determining fetal position.  

Although it is less commonly used than the modern binaural fetoscope designs, the Pinard Horn is still commonly used by midwives in a variety of countries. It is offered in both wooden and aluminum designs - the wooden option being most popular as it absorbs sound rather than reflecting sound like aluminum.

Not everyone is comfortable using the Pinard Horn because it requires a high level of spatial intimacy between the mother and practitioner. More modern binaural designs have a long tube between the earpieces and the horn to allow for more personal space if/when it is desired.

‘Get Your Head in the Game’ – DELEE-HILLIS FETOSCOPE

As mentioned earlier in this article, the DeLee-Hillis is one of the earliest fetal stethoscope designs. What makes this style unique is the headband that offers a hands-free option to practitioners. The fetoscope horn is strapped to the headband and much like the Pinard Horn, it allows you to slowly and consistently apply pressure to the belly for greater amplification of the FHR by using your head.

‘Home is Where the Heart Beat Is’ – ALLEN TYPE FETOSCOPES

Designed after the exceptionally popular - but unfortunately discontinued – Allen Series 10 Fetoscope, the Allen Type Fetoscope is our best selling fetoscope. It could be that it’s so affordable or it could be that it’s the only fetoscope available in purple – the official color of midwifery. Or it simply could be both!

The Allen Type Fetoscope has a longer 22” tube that allows mothers to listen to their own bellies. The tubing can also easily be trimmed for practitioners who want a shorter tube for better audio clarity. This design feature makes it ideal for anyone to use, whether for professional or personal use.

Unlike the DeLee-Hillis and Pinard Horn Fetoscopes, the Allen Type Fetoscope has a horn at the end of the 22” tubing that allows you to apply pressure with your hand or forehead. The design allows for more flexibility for positioning the fetoscope and is perfect for mothers who are looking for an inexpensive fetoscope that is long enough for them to hear the fetal heart beat at home on their own.

‘Big Bells’ - LEFF FETOSCOPE

Pricier than most, but definitely worth the investment, the Leff Fetoscope goes above and beyond the capabilities of other fetoscopes. The Leff features an unusual conductor that blocks external noise to isolate heart tones as well as cord and placental pulses. It has a very large, heavier bell that allows for superb sound quality, rivaling that afforded by medical Dopplers.

The Leff Fetoscope works best after 17 weeks and can effectively be used throughout pregnancy, labor, through contractions and even under water. The weight of the bell takes some getting used to and is best to warm up first in your hands before applying to a mother’s belly – simply for comfort.

As you can tell, each fetoscope offers a unique selection of features. When it comes time to choose one, there are a few things you can consider before making a decision. What will its main purpose be for - will it be used infrequently as a backup instrument, or regularly throughout pregnancy and labor? What works best for your client base - are they comfortable with close proximity examinations? Are there any cultural barriers that might make them uncomfortable with a specific style of instrument? And lastly, what are you comfortable with – do you need the option to choose from smaller or larger ear tips? Do you want to offer families a chance to use the fetoscope as a bonding instrument that anyone can use to hear the fetal heart beat?

If you enjoyed this post, the topics covered in the following blog posts may also be of interest to you: 'How to Choose the Right Doppler', and 'Why Do We Use Plastic Cord Clamps?', 'The Importance of Newborn Pulse Oximeters'. Click the post title to view the full article, or scroll through our complete archive of posts by clicking here.

Written By: Samantha Darling for Cascade HealthCare Products

 

Resources

Fetoscopes: http://www.1cascade.com/c/10523/fetal-heart-rate-fetoscopes

1Penny Simkin, The Labor Progress Handbook: Early Interventions to Prevent and Treat Dystocia: http://www.1cascade.com/p/53167/labor-progress-handbook-3rd-edition-penny-simkin-ruth-ancheta

2The Monaural Stethoscope: http://www.antiquemed.com/monaural_stethoscope.htm

3Fetal Stethoscope History, Center for Experiential Learning: http://utilis.net/fhm/2465.htm

How to Properly Clean and Sterilize Your Instruments

When working in any environment where surgical instruments are required, knowing how to clean and care for them properly is vital. For midwives and small centers on a budget, we have some great tips for getting back to the basics for sterilization.

The best part about proper care of your instruments is that it will increase their life expectancy significantly. Even the highest quality stainless steel instruments, from brands like Miltex, are vulnerable to wear and tear if not cared for properly. Here are some important pointers to always keep in mind when caring for your instruments. Print this list off, keep it close-by or tucked into your equipment bag for easy access.

                

Keeping It Clean

1. Rinse or soak instruments in sterile water immediately after use with an enzymatic detergent. Never let soiled instruments dry before cleaning. Dried body fluids and tissue cause pitting and staining on the metal. Enzymatic detergents are great for breaking down the organic residue on instruments to make washing them with detergent easier.

Instruments should never be soaked in saline or sodium hypochlorite (bleach). Chloride ions are highly corrosive and can eat away at the finishes and metal on your instruments.

2. If you don't have the time to rinse or soak your instruments right after use, wrap them in a cold damp towel.

3. When choosing your cleaning detergent or disinfectant, select an option with a pH between 7 and 10. Detergents with a pH that is higher than 7 are generally more effective when it comes to removing organic debris like blood, feces or fat.

Never use antimicrobial solutions that are used for skin antisepsis when cleaning your instruments.

Remember, when in doubt, check the manufacturer's instructions for the type of detergent to use. Here are some characteristics of an ideal detergent:

  • Minimal suds or foaming
  • Rinses off easily
  • Nontoxic
  • Biodegradable
  • Can disperse organic debris
  • Nonabrasive

4. When using an instrument cleaning brush, keep this in mind: stainless steel brushes are designed to clean instruments with serrations, rasps, files and burs, while nylon brushes are excellent for cleaning instruments without scratching or harming delicate surfaces. Don't use abrasive scouring pads that can damage the finish of your instruments.

5. Rinsing is imperative after cleaning because any residual detergents or disinfectants that are not properly rinsed off can reduce the efficacy of the sterilization process.

Got It Clean? Make It Sterile

1. Before sterilizing your instruments, you want to make sure they are dried thoroughly.

2. Lubricate your instruments well with water-soluble lubricant.

3. There are a variety of options available for sterilization: heat or steam autoclaves, steam sterilizers, pressure cookers or conventional ovens.

4. If you are sterilizing with an autoclave, always use distilled water because tap water can discolor and damage the metal of your instruments.

5. Regardless of the method you use, it is imperative to wrap the instruments securely for sterilization. You can use self-sealing sterilization pouches, sterilization tubing, and for larger instruments use sterilization wrap or surgical towels. Everything needs to be secured with sterilization tape, except for the self-sealing pouches.

6. Remember to unlock and open any ratchets during high-pressure autoclaving, because the pressure may break them if they cannot move flexibly and openly.

7. Surgical towels are your best friend when it comes to instrument cleaning and sterilization. These 100% cotton towels can be used as a sterile surface for instruments where sterilizing a surface may not be possible (think home births, emergency births and midwives working in developing countries); they can be used as a damp wrap for instruments you can't clean immediately; use them to dry your instruments; and use/re-use them to wrap your instruments for sterilization.

Taking It Back To Basics - Oven Sterilization

If investing in a medical sterilizer or autoclave is not an option, you can always use an oven. Here are some simple steps for effective oven sterilization.

1. Set your oven to 225 degrees.
2. Place a pan of boiling water at the bottom of the oven.
3. Put your wrapped instruments on a clean rack - do not place them directly onto the oven rack.
4. Ovens range in temperature so watch the process carefully. If using sterilization pouches and the oven gets too hot, the pouches may burn.
5. When steam is generated, you know the sterilization process is in progress.
6. Use a clean utensil to remove the sterilized instruments and once cooled, place into a sterile towel or paper bag to store for future use.

*Note: sterilization tape will not change color in an oven as it is designed to do in an autoclave or sterilizer.

Proper instrument care may take a bit of time in the moment, but the long-term rewards are worth it.

If you enjoyed this post, the topics covered in the following blog posts may also be of interest to you: 'How to Choose Sutures', 'Measuring Up Infant Scales', and 'How to Choose the Right Doppler'. Click the post title to view the full article, or scroll through our complete archive of posts by clicking here.

Written By: Samantha Darling for Cascade HealthCare Products

 

Resources

Cascade HealthCare Instrument Care: http://1cascade.com/c/10893/surgical-instrument-care-sterilization

Miltex Instrument Care: http://1cascade.com/c/10899/miltex-instrument-care-products

Detergents/Lubricants: http://1cascade.com/c/10897/surgical-instrument-disinfectant-lubricant

All American Medical Sterilizers: http://1cascade.com/c/10880/all-american-portable-sterilizers

Sterilization Products: http://1cascade.com/c/10564/surgical-instrument-sterilization-products