Philips Series 50 (M1350) User manual

Series 50 XM (M1350B)
Series 50 XMO (M1350C)
Fetal/Maternal Monitors

INSTRUCTIONS FOR USE

M1350-9001S
Printed in Germany March 2002
Edition 1

Philips makes no warranty of any kind with regard to this material, including, but not limited
to, the implied warranties of merchantability and fitness for a particular purpose. Philips shall
not be liable for errors contained herein or for incidental or consequential damages in
connection with the furnishing, performance or use of this material.

The information contained in this document is subject to change without notice.
Philips assumes no responsibility for the use or reliability of its software on equipment that is

not furnished by Philips.

Responsibility of the Manufacturer

Philips only considers itself responsible for any effects on safety, reliability and performance of
the equipment if:

• assembly operations, extensions, re- adjustments, modifications or repa irs are carried out by
persons authorized by Philips, and

• the electrical installation of the relevant room complies with national standards, and

• the instrument is used in accordance with the Instructions for Use or User’s Guide.

Intended Use (M1350B)

The Series 50 XM Fetal/Maternal Monitor (M1350B) allows non-invasive or invasive
monitoring of an ambulant patient during both antepartum testing and labor and delivery in
that the monitoring of the fetal hear t rate (FHR) via ultrasound or direct electrocardiogram
(DECG), and uterine activity via an external Toco transducer or an internal intrauterine
pressure (IUP) transducer is possible, additionally it allows maternal heart rate recording via
the MECG transducer. Alarms are generated from maternal heart rate.

The Series 50 XM allows the non-invasive measurement of the Noninvasive Blood Pressure
and the Oxygen Saturation parameters, generate alerts, and the generation of alerts and
recordings on matern al patients.

The device is intended to be used in Labor-Rooms and Delivery-Rooms and in Antepartum­Testing-Areas. It is not intended to be u sed for transport monitoring and home use.

ii

Intended Use (M1350C)

The Series 50 XMO Fetal/Maternal Monitor (M1350C) allows non-invasive or invasive
monitoring of an ambulant patient during both antepartum testing and labor and delivery in
that the monitoring of the fetal hear t rate (FHR) via ultrasound or direct electrocardiogram
(DECG), and uterine activity via an external Toco transducer or an internal intrauterine
pressure (IUP) transducer is possible, additionally it allows maternal heart rate recording via
the MECG transducer. Alarms are generated from maternal heart rate.

The Series 50 XMO allows the non-invasiv e measurement of the Noninvasive Blood Pressure
and the Oxygen Saturation parameters, generate alerts, and the generation of alerts and
recordings on maternal patients. Additionally, the Series 50 XMO allows you to record fetal
pulse oximetry (FSpO

).

2

The device is intended to be used in Labor-Rooms and Delivery-Rooms and in Antepartum­Testing-Areas. It is not intended to be u sed for transport monitoring and home use.

The Series 50 XMO (M1350C) is not available in the U.S.A.

Conventions Used in This Guide

Warning
A warning alerts you to a potential serious outcome, adverse event or safety hazard.

Failure to observe a warning may result in death or serious injury to the user or patient.

Caution
A caution alerts you where special care is necessary for the safe and effective use of the
product. Failure to observe a caution may result in minor or moderate personal injury
or damage to the product or other property, and possibly in a remote risk of more
serious injury.

Note—A note

calls your attention to an important point in the text.

iii

On your monitor, this sign indicates that there is
detailed information in this book which you must read
before proceeding with your task

The monitor should only be used by, or under the direct supervision of, a licensed physician
or other health care practitioner who is trained in the use of fetal and maternal heart rate
monitors and in the interpretation of fetal and maternal heart rate traces. US law restricts this
device to sale by, or on the order of, a physician.

 2002 Philips Medizinsysteme GmbH

All rights are reserved. Reproduction in whole or in part is prohibited without the prior
written consent of the copyright holder.

iv

Contents

1. Safety. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

General Safety Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Electrical Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Maximum Input/Output Voltages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Service Socket for Upgrade Key . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Protective Earth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Environment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Spillage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Electromagnetic Compatibility (EMC). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

EMC Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

System Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Avoiding Interference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

ESU, MRI and Defibrillation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Leakage Current. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

2. Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

About This Guide. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

About the Monitors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Major Parts and Keys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Cardio, Toco a nd FSpO

Maternal Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Recorder Keys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Setting Keys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Channels. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

2

3. General Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Suspected Fetal Demise. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Fastening a Belt. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Clipping a Transducer to the Belt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Attaching a Patient Module to the Belt. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Connecting a Transducer or Patient Module to the Monitor . . . . . . . . . . . . . . . . . . . . 23

Signal Quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Input Channels at a Glance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Example Trace . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Marking an Event . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Contents v

4. Getting Started . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Before Connecting Power . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Switching On the Monitor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Loading Paper . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Switching on the Recorder. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Displaying the Time and Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Setting the Time and Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Choosing Paper Speed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Setting the Paper Speed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Switching Off After Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

5. Monitoring FHR and FMP Using Ultrasound . . . . . . . . . . . . . . . . 39

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

What You Need . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

Getting Started . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Fetal Movement Profile. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

FMP Statistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Switching FMP Off and On. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Using Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

Using the Barcode Reader . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

6. Monitoring FHR Using DECG . . . . . . . . . . . . . . . . . . . . . . . . . . . .47

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

What You Need . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

Getting Started . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Using the Traditional Open-wire Method to Monitor DECG . . . . . . . . . . . . . . . . . . . . 50

With DECG legplate M1357A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

With Patient Module M1364A or M1365A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

Using the DECG Adapter Cable M1362B to Monitor DECG. . . . . . . . . . . . . . . . . . . . . 53

With DECG Legplate M1357A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

With Patient Module M1364A or M1365A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

Monitoring DECG. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

Why use Arrhythmia Logic? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60

After Monitoring. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60

Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

Heart Rate Out of Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62

vi Contents

7. Monitoring Twin FHRs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

Things to Remember During Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

Monitoring Internally . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64

Monitoring Externally. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64

Separating Twin FHR Traces . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65

Twins Offset: On. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66

Twins Offset: Off. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67

Troubleshooting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67

8. Monitoring Uterine Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69

External Toco Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69

Internal Toco Monitoring (IUP Monitoring) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70

Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71

External Toco . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71

Internal Toco . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72

9. Fetal Pulse Oximetry. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73

Before You Start . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73

To Begin Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74

Understanding the Display. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75

Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77

Alarm Limits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77

Triggering an Alarm. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78

Acknowledging an Alarm. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78

Turning the Alarm On and Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78

Changing Alarm Limits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78

Inop Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79

Troubleshooting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80

Loss of Pulse Signal. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81

Inaccurate Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81

10. Monitoring Using External Devices . . . . . . . . . . . . . . . . . . . . . . 83

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83

Recording From an External Device . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84

What You Need . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85

Connecting the External Devices to the Monitor . . . . . . . . . . . . . . . . . . . . . . . . . . 85

Contents vii

Example Trace . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88

Trace Display on External Monitoring Systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89

Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90

FSpO

2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .90

External Devices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91

11. Recording Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93

Recording A Note. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93

Deleting a Barcode Note . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94

Recording Several Barcodes as One Note. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94

Recording Several Barcodes as Separate Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95

Recording a Patient’s Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96

12. Fetal Heart Rate Alerting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97

Alerts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97

Recognizing an Alert . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97

Acknowledging an Alert. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97

Turning Alerting ON or OFF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98

Changing Alert Limits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98

13. Non Stress Test Timer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99

Setting the NST Timer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99

14. Maternal Monitoring - Overview . . . . . . . . . . . . . . . . . . . . . . . . 101

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101

Maternal Parameters - Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102

Softkeys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103

Reset Key . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103

Power on Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104

To Begin Monitoring Immediately . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104

Maternal Main Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104

Returning to the Maternal Main Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106

Alarms - Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106

Acknowledging an Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106

Reviewing All Alarm Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106

Setting an Alarm. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107

viii Contents

Warning Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107

Acknowledging a Warning Message. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107

Volume and Contrast Control. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108

15. Non-invasive Blood Pressure Monitoring. . . . . . . . . . . . . . . . . 111

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111

To Begin Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111

Setup Screen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112

Measurement Modes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113

Changing Measurement Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114

Pulse Rate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115

Alarms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115

Turning Alarms On and Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116

Changing Alarm Limits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117

Recording. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118

Troubleshooting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118

Warning Messages. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118

Measuring Problems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119

Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120

16. Maternal ECG, Heart and Pulse Rate. . . . . . . . . . . . . . . . . . . . 121

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121

To Begin Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121

Connecting the Transducer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122

Applying the Electrodes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123

Using MECG transducer M1359A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124

Using a Patient Module (M1364A or M1365A) . . . . . . . . . . . . . . . . . . . . . . . . . . . 125

Cross-Channel Verification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125

Displaying the MECG Waveform. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126

Changing Display Speed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127

Freezing and Printing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127

Maternal Heartrate Source . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127

Alarm (MECG and SpO

Turning Alarms On and Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129

Changing Alarm Limits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130

Troubleshooting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131

). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128

2

17. Maternal Pulse Oximetry (SpO2) . . . . . . . . . . . . . . . . . . . . . . . 133

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133

To Begin Monitoring Immediately . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133

Contents ix

Alarm (SpO2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134

Turning Alarm On and Off. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134

Changing Alarm Limit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134

Alarm (Pulse rate). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135

Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135

Warning Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135

Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136

18. Maintenance and Performance Assurance . . . . . . . . . . . . . . . . 139

Preventive Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139

Visual Inspection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139

Routine Inspection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139

Mechanical Inspection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140

Calibration and Electrical Safety Checks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140

Disposal. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140

Care and Cleaning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141

Care of the Fetal Monitoring System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141

Monitor. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141

Transducers and Patient Modules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142

Adapter Cables. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143

Cleaning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143

Disinfecting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145

Sterilizing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146

Monitor, Patient Modules, Transducers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146

Adapter cables M1347A, M1362B. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146

Adapter cables M1362A, M1363A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146

IUP (1290C/CPJ840J5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147

IUP Transducer Adapter Cable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147

Belts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148

Reusable SpO

Non-invasive Blood Pressure Cuff . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148

Storing Recorder Paper . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148

Self Test. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150

Quick Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151

Parameter Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152

Testing Transducers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154

Toco . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154

Ultrasound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154

IUP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155

ECG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155

Replacing the Batteries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156

Replacing the Fuses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157

Transducers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148

2

x Contents

19. Troubleshooting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159

Error Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160

20. Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163

Standard Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163

Fetal Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163

Maternal Accessories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164

Documentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164

Optional Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164

Paper. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166

Gels. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166

Transducers and Patient Modules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167

MECG Electrodes and Cables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167

DECG Cables. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168

Disposable Scalp Electrodes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168

Fetal Oxygen Sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169

IUP Transducers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169

IUP Catheters. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169

Domes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170

IUP Transducer Holder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170

Maternal Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170

NIBP Accessories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170

SpO

Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171

2

Adapter Cables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171

Belts and Buttons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172

21. Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173

Patient Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173

Operating and Environmental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174

Fetal Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175

Maternal Non-invasive Blood Pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175

Maternal Pulse Oximetry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177

Maternal ECG and Heart Rate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177

Maternal Display Section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178

Numerical Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178

Maternal Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178

Mode Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178

Contents xi

Ultrasound, External and Internal Toco. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179

Recorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179

FHR (Cardio) Scales . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180

Testing Facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180

Declaration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181

22. Warranty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183

Manufacturer’s Responsibility. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183

Warranty. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183

23. Training Evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .187

M1350 XM, XMO Fetal Monitoring Lab Evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . 187

Competency Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187

Performance Objectives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187

Maternal Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188

Fetal SpO2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188

Fetal Telemetry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188

Resources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188

Fetal Monitor Lab Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189

Maternal Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192

Fetal SpO2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193

Fetal Telemetry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194

Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194

Maternal Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198

Fetal SpO2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199

Fetal Telemetry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199

xii Contents

General Safety Information

1

Safety

This symbol indicates that you should consult the
Instructions For Use (this guide), and particularly any
warning messages.

Equipotential Terminal

This symbol identifies terminals which are
connected together, bringing various equipment or
parts of a system to the same potential. This is not
necessarily earth potential. The value of potentials
of earth may be indicated adjacent to the symbol.

Protective Earth Terminal

This symbol identifies the terminal for connection
to an external protective earth system.

2 x 1.5 V

The monitor is de signed to fulfil safety requirements according to IEC
60601-1/EN 60601-1 (Class I), UL 2601-1, CSA-C22.2 No 601.1­M90.

It complies with the essential requirements of the Medical Device
Directive 93/42/EEC. The monitor is classed:

Chapter 1 - Safety 1

Battery

This symbol identifies the battery holder conta ining
two 1.5 V batteries.

2 x 1.5V

Electrical Safety

The Series 50 XMO and the Series 50 XM are not “ECG-Monitors”, are
not defibrillator-protected, and are not designed for direct cardiac
application.

Electrical Safety

Equipment Equipment Type Information

ORDINARY EQUIPMEN T - Enclosed equipment protected
against ingress of water.

CONTINUOUS OPERATION - Can be operated continuously.

External Toco transduce r (M135 5A)
and
IUP quartz transducer (1290C) and
IUP transducer (CPJ840J5)

Ultrasound transducer (M1356A)

DECG transducer (M1357A) and
MECG transducer (M1359A)

US/MECG combi transducer
(M1358A)

SpO

transducer (M1191A)

2

Adapter cable (M1940A)
NIPB cuffs (M1574A and M1575 A)

Interco nn ect tubing (M1599A)

FSpO

/ECG patient module

2

(M1365A)
ECG only patient module
(M1364A)

B

B

CF

B (Ultrasound)
CF (MECG)

CF

CF

CF

Patient Connector is electrically isolated.
Connecting the transducer to the Toco
channel results in CF condition.

Connecting the trans ducer to a Cardio
channel results in a B condit i on .

Connecting the transducers to a Cardio
channel results in a CF condition.

Connecting the combi transducer to the
Cardio 1 channel results in a CF condition
for MECG and a B condition for US
application.

Connecting the SpO2 transducer results in
a CF condition.

Connecting the NIBP tubing results in a
CF condition.

Connecting a patient module results in a
CF condition.

2 Chapter 1 - Safety

Maximum Input/Ou tp ut Volt a ges

The following diagram shows the sockets for peripheral devices.

Maximum Input/Output Volta ge s

Chapter 1 - Safety

3

Maximum Input/Output Voltages

1. Mains Socket.

2. Equipotential Grounding P oint.
To use the monitor with other equipment in an operating room
environment, connect the equipotential grounding point (2) to
earth potential. Use the grounding cable supplied with the
monitor.

3. +5V input socket for the HBSW8200 Barcode Reader.

4. Socket for the Philips M1310A Series 50 T Fetal Telemetry
System. +5V input except for:
Pins 1, 14, 15 and 16: ± 12V input
Pin 2 -12V output
Pin 3 +5V output
Pin 4 ±12V output

5. RS232 Digital System Interface:
Pin2 ±12V input
Pin 3 ±12V output

6. Socket for one of the following:

• 80225A or 80235A/B Obstetrical Information Management
System ( OBMS)

• M1370A Obstetrical Display Information System (ODIS)

• ±12V except for Pins 17, 18 and 22 which are +5V input.

7. Socket (9-pin) for an external device:
Pin 3 ±12V

8. Socket (25-pin) for an external device:
Pin 2 ±12V
Pins 9 and 10 +5 Volt

4 Chapter 1 - Safety

Service Socket for Upgrade Key

The Service En gineer can conne ct a compatible PC to this socket (1) to
carry out extended configuration and service functions.

Maximum voltage of ±12V.

Service Socket for Upgrade Key

Protective Ea rth

To prote ct hospital personnel and the patien t, the monitor’s casing must
be ground ed. Accordingly, the monitor has a 3-wire power cable that
grounds it to the power line ground when plugged into an appropriate 3­wire receptacle. Do not use a 3-wire to 2-wire adapter with the monitor.
Any interruption of the protective earth grounding will cause a potential
shock hazard that could result in serious personal injury.

Whenever it is likely that the protection has been impaired, the monitor
must be made inoperative and be secured against any unintended
operation.

Chapter 1 - Safety

5

Environment

Warning
Check each time before use that the monitor is in perfect working

order and properly grounded.

Position the patient cable so that it does not come into contact with any
other electrical equipment. The cable connecting the patient to the
monitor must be free of electrolyte.

Make sure that during operation, the monitor is free from condensation.
This can form when equipment is moved from one building to another,
and is exposed to moisture and differences in temperature.

Warning
Possible explosion hazard if used in the presence of flammable

anaesthetics.

Environment

Use the monitor in a n environment that is r easonably fr ee from vibration,
dust, corrosive or explosive gases, flammable agents, extremes of
temperature, humidity and so forth. It operates within specifications at

ambient temperatures between 0 and 55
exceed these limits can affect the accuracy of the monitor and cause
damage to the components and circuits. Only products that fulfil the
necessary safety and electrical standards should be used in conjunction
with the monitor (contact your local response center for details).

Allow at least 5cm (2in) clearance around the monitor for proper air
circulation. If the monitor is mounted in a cabinet, allow sufficient space
at the front for operation and at the rear for servicing with the cabinet
door open.

6 Chapter 1 - Safety

o

C. Ambient temperatures that

Spillage

When the maternal display is in a tilted position, take additional care to
prevent spillage of liquid. If liquid accidentally enters the monitor
through the maternal display recess, you must cease using the monitor
immediately. Contact an authorized engineer for a safety inspection.

Electromagnetic Compatibility (EMC)

The electromagnetic compatibility (EMC) validation includes testing
performed according to the international standard for EMC with medical
devices. See the Manufacturer’s Declaration for details.

EMC Testing

Caution
If operating under conditions according to the EMC-st andard

60601-1- 2 (Radiated I mmunity 3 V /m), fi eld st rength s a bove 1 V/m
may cause erroneous measurements at various frquencies. Therefore
it is recommended to avoid the use of electr ical ly r adiating
equipment in close proximity to these measurem en ts.

Spillage

Chapter 1 - Safety

During the test prog ram the monitor was sub j e cted to international
standard and Philips proprietary EMC tests. During most of the testing
no anomalies were observed. Some reduced performance was observed
with the IEC 801-3 Radiated Immunity and IEC 801-4 Fast Transient/
Bursts Immunity tests.

IEC 801-3 specifies that the pro duct must be subjected to a field of 3 V/m
over a frequency range of 26 to 1000 MHz with no degradation of
performance. At many of the test frequencies over the specified range no
anomalies were ob served. However increase d jitter of SpO

values and

2

DECG derived fetal heartrate values was observed at a number of test
points. For these test points the radiated field was reduced to the level at
which the trace returned to normal. These reduced levels are shown in
the following table.

7

Electromagnetic Compatibility (EMC)

Parameter Sensor Frequency Range

SpO

2

IEC 801-4 specified that the pro duct is subjected to high speed p ulses up
to 1000 V applied to the powe r cord and al l I/O cables. D uring and af ter
most of the test pulses, no anomalies were observed. However in rare
cases the ultrasound channel had been triggered.

Parameter Sensor

Ultrasound M1356A

SpO

with adapter

2

cable M1940A

System Characteristics

M1191A
M1192A
M1194A

M1358A
M1191A

M1192A
M1194A

52 MHz to 70
MHz

Immunity

Level

2.3 V/m

Burst Immunity

Level

600 V

≤ 200V

The phenomena discussed above are not unique to the monitor but are
characteristic of pat ient monitors in use today. This performance is due
to very sensitive high gain front end amplifiers used to process the
physiological signals from the patien t. Among the many similarly
performing monitors already in use by customers, interference from
electromagnetic sources is rarely a problem.

8 Chapter 1 - Safety

Avoiding Interference

When electromagnetic interference (EMI) is encountered there are a
number of things that can be done to mitigate the problem.

1. Eliminate the source. Possible sources of EMI can be turned off or
moved away to reduce their strength.

2. Attenuate the coupling. If the coup ling path is through the patient
cables the interference may be reduced by moving and/or
rearranging th e cables to a diffe rent location of the monitor. If the
coupling path is throu gh the power cord, plugg ing the monitor
into a differen t mains circuit may help.

3. Connect the equipotential terminal of the moni tor to the
corresponding terminal of your mains installation.

4. Add external attenuators. If EMI becomes an unusually difficult
problem, external devices such as an isolation transformer or a
transient suppressor may help. An Philips customer engineer can
assist you in determining the need for external devices.

ESU, MRI and Defibrillation

ESU, MRI and Defibrillation

Warning
Remove all transducers, patient modules, sensors and accessor ies

before performing electrical surgery, defibrillation, and MRI. High
frequency current can flow through the equipment and burn the
skin.

The equipment has not been tested with defibrillators.

Chapter 1 - Safety

9

Leakage Current

Leakage Current

Leakage current can be hazardous to the patient.

Warning
If the monitor is connected directly to other equipment, such as an

additional patient monitor, or a second monitor is to be connected
directly to the mother, you must carry out all relevant safety tests in
accordance with safety standard IEC 60601-1-1.

10 Chapter 1 - Safety

About This Guide

This guide tells midwives, nurses and other healthcare professionals how
to use the Series 50 XMO fetal/maternal monitor and the Series 50 XM
fetal/maternal monitor . I t discusses and ill ustrates all possible featur es and
parameters of both mo nitors. Your monitor may not have every one o f
these features and may lo ok slightly different to the monito r shown in t he
illustrations in this guide. It can be upgraded to incorporate them.

About the Monitors

Both monitors let you observe and record:

2

Overview

• Fetal heart rate (inclu ding twins)

• Uterine activity

• Maternal heart rate (MHR) and ECG waveform

• Maternal pulse oximetry (SpO

• Fetal movement profile (FMP)

• Maternal blood pressure, non-invasively.

The Series 50 XMO also allows you to record fetal pulse oximetry
(FSpO

You can monitor fetal heart rate externally with u ltrasound from
approximately 20 weeks and with the other parameters internally during
labor and delivery.

Not all parame ters and features detai led in this manual are ava ilable on all
monitors.

Chapter 2 - Overview 11

).

2

)

2

Major Parts and Keys

Major Parts and Keys

.

The display panel can be viewed flat in the monitor, or tilted at an angle.

1. Monitor on/off switch

2. Monitor on/off light

3. Recorder keys

4. Recorder

5. Maternal parameters

6. Cardio 2 channel

7. Toco channel

9. Function key

10. Telemetry indicator

11. FSpO

parameter

2

12. Opening recess

13. Socket for remote event marker

14. Setting keys

15. Service socket

8. Cardio 1/ combi channel

12 Chapter 2 - Overview

Cardio, Toco and FSpO2 Channels

Major Parts and Keys

Chapter 2 - Overview

1. Toco Display shows uterine activity.

2. Fetal SpO

display shows fetal pulse indicator, signal quality,

2

alarm status, and cross channel verifi cation plus indicator.

3. Cardio Display shows the FHR.

4. Signal Quality Indicator shows the quality of heart rate signal
detected by the transducer:

– Green (good).
– Yellow (fair to potentially poor).
– Red (unacceptable).

5. Function Key: selects menus for:

– FMP, twins offset, logic, FHR alert and FSpO

.

2

– returns to the normal display.

6. MECG Indicator shows when MECG is being measured through
this channel. (Indicator location different for Series 50 XM.)

13

Major Parts and Keys

7. Fetal SpO2 display shows current value of FSpO2.

8. Speaker Lamp shows which heartbeat is heard from the
loudspeaker.

9. Volume Keys set the volume and select the channel to which you
are listening. Changes current setting of FMP, twins offset, logic,
FHR alert and FSpO

alarms.

2

10. Recess for use when tilting the display.

11. Remote Event Marker Socket for connecting remote event marker
(15249A).

12. Cardio 1/Combi Transducer Socket for connecting:

– FSpO

/ECG combined patient module (M1365A).

2

– ECG patient module (M1364A).
– Ultrasound transducer (M1356A).
– DECG transducer (M1357A).
– US/MECG Combi transducer (M1358A).
– MECG transducer (M1359A).

13. Transducer Socket for connecting:

– external Toco transducer (M1355A).
– IUP transducer (1290C, 13972A, or M1333A).

14. Toco Baseline Key zeroes the Toco display and trace to 20 units
(when monitoring uterine activity externally) or 0 units (when
monitoring uter ine activity internally).

15. Cardio 2 Transducer Socket for connecting:

– ECG patient module (M1364A).
– US transducer (M1356A).
– DECG transducer (M1357A).
– MECG transducer (M1359A).

14 Chapter 2 - Overview

Maternal Parameters

1. NBP Transducer Socket for connecting:

2. SpO

Major Parts and Keys

– NBP cuff interconnect tubing (M1599A) and blood pressure

cuff.

Transducer Socket for connecting:

2

–SpO2 transducer (M1940A adapter cable connected to M1191A

transducer).

Chapter 2 - Overview

3. Softkeys for setting maternal parameters.

– selects modes and alarm limits for NBP.
– selects modes and alarm limits for MHR.
– selects modes and alarm limits for SpO

.

2

4. Reset Key acknowledges al arms and re turns monitor from setting
mode to maternal parameter display.

5. SpO

Value indicates the current reading for patient’s SpO2 level.

2

15

Major Parts and Keys

6. Maternal heart/pulse rate icon indicates measurement source of
maternal heart/pulse rate.

indicates heart rate value comes from MECG.

indicates pulse rate value comes from SpO

.

2

indicates average pulse rate value comes from NIBP.

7. Maternal Heart Rate shows the current heart/pulse rate .

8. Systolic Value shows the value for the systolic parameter of th e
non-invasive blood pressure measurement.

9. Diastolic Value shows the value for the diastolic parameter of the
non-invasive blood pressure measurement.

16 Chapter 2 - Overview

Recorder Keys

Major Parts and Keys

1. Recorder On/Off Light lights when the recorder is working.
Flashes when monitor detects five or fewer pages remaining in the
pack, or if the paper runs out.

2. Recorder On/Off Key switches recorder on and off. Also starts
NST timer (switch off recorder and press for two seconds).

3. Event Marker Key records event on paper. Acknowledges all alerts
and alarms.

4. Paper Advance Key advances paper automatical ly to the next fold.
Tear paper at fold. Never pull paper to advance it.

5. Paper-Eject Key unlocks drawer when you press it once. Press a
second time and hold when removing paper.

Chapter 2 - Overview

17

Major Parts and Keys

Setting Keys

1. Time and Date Key for changing the time and date. Press to show
the current time in the Cardio 1/Combi and Toco di splays, to
cycle through the settings to be ch anged (hours, minutes, day,
month and year ) and to return to the normal display.

2. Paper Speed Key for changing the paper speed. Press to show the
current paper speed in the Cardio 1/Combi display, and to return
to the normal display.

3. Test Key for starting monito r’s self test.

18 Chapter 2 - Overview

Introduction

Features

3

General Information

This section contains information common to a number of parameters
and discusses the intended use of the monitor. Your monitor may not
have all these features.

The Philips Series 50 XMO fetal/maternal mo nitor and the Phili ps Series
50 XM fetal/matern al monitor combine advanced fetal monitoring with
integrated maternal non-invasive blood pressure, pulse oximetry and
ECG measurement. Easy to use, they offer:

• Fetal pulse oximetry (FSpO
assessment of fetal oxygenation during labor and delivery.

• Nellcor’s fetal oxygen sensors.

• Maternal ECG waveform display.

• Automatic printing of maternal and fetal parameters on the trace.

• Transmission of maternal and fetal parameters to an obstetrical

overview system.

• Audible and visual alarms.

• Gross fetal body mo vements (F etal M ovement P rofil e) and statistics

recording for advance information on fetal well being.

• Twin heart rate trace separation for easier interpretation.

• NST timer and paper-end alarm.

• Watertight transducers.

• Heart rate/pulse rate from maternal ECG, SpO

Chapter 3 - General Information 19

) measurement for direct, continuous

2

or NIBP.

2

Suspected Fetal Demise

The monitors give you flexible monitoring capability for bo th high-risk
patients and those with normal labo r and delivery. Both monitors can
measure traditional fetal parameters, including twins. Maternal vital signs

- blood pressure, pulse oximetry, and maternal ECG - are monitored
non-invasively. These are displayed on a tiltable LCD screen.When
monitoring maternal ECG, you can display and freeze the waveform on
the LCD screen to assist in interpretatio n . You can also print the
waveform on the FHR trace.

The Series 50 XMO also offers measurement of fetal pulse oximetry.
Based on proven technology from Nellcor, it monitors fetal oxygen
saturation during labour and delivery. Th is is non-invasive to the fetus
and non-traumatic to the mother. Fetal pulse oximetry gives status
information about fetal oxygenation to help you interpret non-reassuring
fetal heart rate traces.

Suspected Fetal Demise

Be very careful when interpreting a trace if you suspect fetal demise. The
maternal heartrate may be atypically high and therefore confused with
that of a live fetus. Apparent fetal movement may also be detected by the
monitor but this may be a result of maternal movement causing the fetus
to move within the amniotic fluid. Please refer to “Cross-Channel
Verification” on page 125.

20 Chapter 3 - General Information

Fastening a Belt

Arrange the belt a round the patient u ntil it is tight but still comfortable .
Fa sten it by pushing t he fixi ng butt on thr ough th e o verl apping se ction of
the belt, with the p oint facing away fro m the patient. Ensure that the
fixing button and the loose ends of the belt are at the patient’s side.

You can use more than one belt if, for example you are measuring fetal
heart rate using ultrasound and uterine pressure simultaneously.

Fastening a Belt

Chapter 3 - General Information

21

Clipping a Transducer to the Belt

Clipping a Tran s du ce r to th e Belt

When you have positioned a transducer satisfactorily, you can clip it to
the belt.

Alternatively, you can affix a button to the transducer and use this to
attach the transdu cer to the abdominal belt. See the Installation Note
that comes with the Transducer Knob Adapter for assembly instructions.

22 Chapter 3 - General Information

Attaching a Patient Module to the Belt

Attaching a Patient Module to the Belt

You can attach a patient module to the belt b y sli ding th e pati ent mod ule
under the belt and pushing the fixing knob (1) on the patient module
through one of the holes in the belt.

Connecting a Transducer o r Patient Module to the Monitor

When you connect a transducer or pa tient modu le to eit her the Car di o 1/
Combi socket, the Toco socket or the Cardio 2 socket, the three da shes in
the display go out. The signal quality light for the heart rate display turns
red (because the transducer is not yet receiving a good signal from the
patient). The monitoring mode is printed on the paper, and repeated
every three to four pages.

If you are measuring:

• Uterine activity, the display jumps to 20 (the Toco baseline).

• Intrauterine pressure, the display shows 0.

Warning
NEVER immerse a transducer in liquid when it is connected to the

fetal monitor.

Chapter 3 - General Information

23

Signal Quality

Signal Quality

During monitoring, if the signal quality indicator fluctuates between red,
yellow and green, it does not necessarily means that the transducer needs
repositioning. The fluctuation may be caused by fetal movement. Allow
time for the signal to stabilize before deci ding whether to repositi on the
transducer (ultrasound) or apply a new electrode (ECG). A trace is
possible when the indicator is yellow, but for the best trace it should be
continuously green.

Note—Disconnect NON-USED ultrasound transducer, as

continuous mechanical influence of the transducer may
result in an artificial trace.

24 Chapter 3 - General Information

Input Channels at a Glance

Input Channels at a Glance

This table indicates which combination of transducers and patient
modules you can use in the Cardio in put sockets .

Cardio1/Combi Cardio 2 Measurements

US
(M1356A)

FSpO2/ECG combined
patient module (M1365A):

with DECG adapter cable
(M1362A or M1362B)

with MECG adapte r ca ble
(M1363A)

ECG only patient module
(M1364A):

with MECG adapte r ca ble
(M1363A)

DECG adapter cable
(M1362A or M1362B)

DECG
(M1357A)

MECG
(M1359A)

US/MECG
(M1358A)

US (M1356A or M1358A) Dual ultrasound.
DECG (M1357A or M1364A) Single ultrasound and fetal ECG.
US (M1356A) Fetal S pO 2 with fe tal ECG and single ultrasound.
MECG

(M1364A or M1359A)

US (M1356A) Fetal SpO 2 with mate rnal ECG a n d single

US (M1356A ) Maternal ECG and single ult rasound.
DECG (M1357A or M 1364A)

with DECG adapter cable
(M1362A or M1362B)

US (M1356A) Fetal ECG and single ultrasound.
MECG (M1359A or M1364A)

with MECG adapter cable
(M1363A)

US (M1356A) Fetal ECG and single ultrasound.

US (M1356A ) Maternal ECG and single ult rasound.
DECG

(M1357A or M1364A or
M1365A)

DECG
(M1357A or M1364A)
with DECG adapter cable
(M1362A or M1362B)

US (M1356A) Single ultrasound with maternal ECG and second

Fetal SpO2 with feta l ECG and maternal ECG.

ultrasound.

Maternal ECG and fetal ECG.

Fetal ECG and maternal ECG.

Maternal ECG and fetal ECG.

Single ultrasound with maternal ECG and fetal
ECG.

ultrasound.

You can use the combined US/MECG transducer (M1358A) in the
Cardio 2 socket to measure ultrasound only. However if you want to use
the combination of US/MECG, you must connect it to the Cardio 1/
Combi socket.

Chapter 3 - General Information

25

Example Trace

Example Trace

1. Manufacturer’s logo.

2. Time, date and paper speed.

3. Barcode notes.

4. Fetal movement profile.

5. Fetal blood oxygen saturation level (FSpO

) trace.

2

6. Uterine activity trace.

7. Maternal heart rate (78 bpm) (either Sp0

or NBP pulse rate).

2

8. Maternal blood pressure:

– Systolic blood pressure is 128 mmHg.
– Diastolic blood pressure is 98 mmHg.
– Mean arterial pressure is 109 mmHg.

9. Maternal temperature (37.5

o

C). An asterisk * marks measurements

from external devices.

10. Maternal blood oxygen saturation level (97%).

11. Maternal heart rate trace (either MECG or Sp0

12. Fetal heart rate from Ultrasound or DECG.

pulse).

2

Your trace may not look exactly like this - the actual appearance de pe nds
on which options you have installed, and which features are in use.

26 Chapter 3 - General Information

Marking an Event

Use the event marker key or the remot e event marker to record signifi cant
events on the paper (for example, when pain medication is administered
or when the mother changes position). To mark an event on the paper:

• Press the event marker key on the monitor or

• Press the button on the remote event marker.

A small arrow (A) prints on the FHR Scale. The arrow starts with the
peak to show the exact time when the key or button is pressed. If the key
or button is not releas ed, a black bar is prin ted on the paper. The width
of the bar corresponds to the length of time the key or button is pressed.

Marking an Event

pap5bw.hpg

Chapter 3 - General Information

27

Marking an Event

28 Chapter 3 - General Information

Introduction

This chapter tells you how to prepare your monitor to begin monitoring
your first patient. You should:

• Ensure that your m onitor is set for the correct voltage fo r your
country

• Check the time, date, and paper speed

• Load paper in to the recorder.

Before Connecting Power

4

Getting Started

Operate the monitor from an ac (alternating current) power source of

• 100 V (± 10%)

• 120 V (± 10%)

• 220 V (± 10%)

• 240 V (± 10%)

and 50 to 60 Hz (± 5%). The maximum power consumption is 60 VA.
Before connecting power, ensure that the voltage selector (A) on the

monitor’s rear panel shows the correct setting for your country.

Chapter 4 - Getting Started 29

Switching On the Monitor

To use the monitor with other equipment in an operating room
environment, connect the equipotential grounding point (B) to earth
potential. Use the grounding cable supplied with the monitor.

Switching On the Monitor

Connect the power cord to the rear of the moni tor.
Press to switch on the monitor. When you switch on:

Line~

• The monitor on/off light and the displ ays come on.

• There are two clicks from the loudspeaker.

• The monitor carries out a self test. For details of the self test see

page 150. The error messages that may be displayed are given in
Chapter 19, “Troubleshooting”.

• The maternal display screen shows an egg-timer symbol for a few
seconds and then its alarm parameters screen.

• All parameter displays show two or three dashes, indicating there is
no transducer or patient module plugged in.

• The maternal display lights up, showing the default alarm
parameters.

30 Chapter 4 - Getting Started

Loading Paper

Loading Paper

To load a new pack of paper:

a. Switch off the recorder.

rep5_bw.hpg

b. Push the paper-eject key (1) to unlock the drawer. Make sure

that the drawer is fully open (2).

c. Push and hold the paper-eject key and lift out any remaining

paper.

d. Place the new paper i n the tray with the bottom side down.

The bottom side is indicated by the word STOP on the final
page of the new pack.

e. Unfold the top page of the pack.

Chapter 4 - Getting Started

31

Loading Paper

f. Position the uterine activity scale on the right.

rep6_bw.hpg

g. Slide the pack into the tray (3).

h. Push the drawer back until it “clicks” closed. Don’t push on

the paper when closing the drawer (4).

pega73_bw.hpg

i. Press the recorder on/off key(5) to switch on the recorder. If

the recorder on/off light flashes after the paper is loaded and
the recorder is switched on, the drawer is not closed properly.

j. Press and release the paper advance key (6) to advance the

paper automatically to the next fold. Check that the pa per
feeds straight.

32 Chapter 4 - Getting Started

Caution
Using recorder paper that is not ap proved by Philips c an damage

the monitor. This type of damage is not covered by warranty.

If you have difficulty removing the paper, ensure that you have pushed
the paper-eject key twice. The first push releases the paper drawer. The
second push engages the paper eject mechanism which pushes the
remaining paper up the drawer towards you, making it easy to remove.

Switching on the Recorder

Press the r ecor der on /off key to switch on th e r ecord er if necessary. When
you switch on:

• The recorder on/off light comes on.

• The paper advances quickly for 2 cm and then returns to the set

speed.

• The time, date and paper speed are printed.

• The current monitoring modes (if any t ransducers ar e connected to

the monitor) are printed.

The monitor prints the time, date, paper speed and monitoring modes
when first switched on, every ten minutes after, and if the monitoring
modes change.

Switching on the Recorder

The recorder on/off light flashes when the monitor detects that there are
five pages or fewer remai ning in the pack. I f you switch on the r ecord er or
press the paper advance key when there are fewer than five pages
remaining, it may take two pages before the recorder on/off light flashes.
Load a new pack as soon as possib le.

Chapter 4 - Getting Started

33

Displaying the Time and Date

Displaying the Time and Date

The date and time are printed on the trace. You can choose from a variety
of standard date and time formats, such as 12 hour format or 24 hour
format, US or European date format. If you have a barcode reader you
can change the time and date display format by scanning the desired
format from the barcode sheet. If you do not have a barcode reader, you
can set the desired format using a service setting. See the Installation and
Service Guide for this monitor for instructions.

Setting the Time and Date

Use the following keys to view and change the time and date:

1. Clock key displays the time.

2. Paper speed displays the paper speed.

3. Volume keys change the time, date and paper speed.

After you make changes and return to th e n ormal display, the new time
and date are set, and the time, date and paper speed are printed on the
paper immediately and then every 10 minutes. You return to the normal
display automatically if yo u don’t press any key for a few seconds.

34 Chapter 4 - Getting Started

Choosing Paper Speed

To set the time and date:

1. Press and release to display the current time. The Cardio 1/
Combi display flashes to show that the hour can be changed.

2. Press or to set the hour. Press and hold the keys to
change the setting more quickly.

3. Press and release and the Toco display flashes to show that
the minutes can be changed.

4. Press or to set the minutes.

5. Repeat the procedure:

a. To set the month (in North America) or the day (in other

countries).

b. To set the day (in North America) or the month (in other

countries).

c. To set the year.

6. Press and release to return to the normal display.

Choosing Pap er Sp eed

You can choose a paper spee d of 1, 2 or 3 centimeters per minute (cm/
min). The default for North America is 3 cm/min; the default for other
countries is 2 cm/min.

The ACOG technical bulletin on FHR monitoring states that “accurate

pattern recognition is difficult if not imp ossible at 1 cm/ min and that 1 cm/
min is only recommended for more economic screening. When FHR
abnormalities arise, the faster paper speeds will enhance FHR pattern
recognition”.

Additionally, because a change in paper speed results in a change in the
appearance of an FHR trace, you are advised to ensure ALL monitors in
your institution are set at the same speed.

Chapter 4 - Getting Started

35

Setting the Paper Speed

Setting the Paper Speed

Use the paper speed key to disp lay the current paper speed and to return
to the normal display. You also return to the normal display automatically
if you don’t press any key for a few seconds. Use the volume keys to
change the speed. When you return to the normal display, the new paper
speed is set, and the time, da te, speed and monitoring modes are printed
on the paper.

To set the paper speed:

1. Press and release to display the current speed.

2. Press or to set the speed.

3. Press and release to return to the normal display.

36 Chapter 4 - Getting Started

Switching Off After Mo nitoring

1. Switch off the recorder (1).

2. Press and release the paper advance key (2) to advance the paper
automatically to the next fold.

3. While you wait for the paper to advance to the next fold, remove
the transducers from the patient. Use a soft tissue to remove any
gel from the transducers.

4. Tear off the paper at the fold (3). Don’t pull on the paper to
advance it, and tear off th e paper at the fold only.

5. Switch off the monitor.

Switching Off After Monitoring

Chapter 4 - Getting Started

37

Switching Off After Monitoring

38 Chapter 4 - Getting Started

Monitoring FHR and FMP Using Ultrasound

Introduction

This chapter describes how to monitor a single fetal heart rate using
ultrasound. M onit orin g using ultras ound i s r ecomm ended f rom the 2 5th
week of gestation for non-stress or normal routine fetal monitoring. The
monitor can also detect fetal movements and display the resulting fetal
movement profile (FMP) on the trace.

Warning
NEVER immerse the ultrasound transducer in liquid when it is

connected to the monitor.

If you simultaneously monitor a single FHR using both ultrasound and
DECG, the ultrasound trace is delayed by approximately two to three
beats per m inute.

5

Performing ultrasound imaging or Doppler flow measurements together
with the ultrasound fetal monitoring may cause false FHR readings, and
the trace recording may deteriorate.

What You Need

• Ultrasound transducer

• Gel

• Transducer belt and button

Chapter 5 - Monitoring FHR and FMP Using Ultrasound 39

Getting Started

Getting Started

1. Fasten the belt around the patient.

2. Switch on the monitor and the recorder.

3. Connect the transducer to either the Cardio 1/Combi socket, or to
the Cardio 2 socket.

4. Find the fetal heart position by palpation, auscultation or
ultrasound imaging.

Caution
Using ultrasound gel that is not approved by Philips may reduce

signal quality and may dam age the transducer. This type of damage
is not covered by warranty.

40 Chapter 5 - Monitoring FHR and FMP Using Ultrasound

Getting Started

5. Apply a small amount of ultrasound gel in a thin layer to the
transducer.

6. Apply the transducer to the patient, working it in a circular motion
to ensure the gel layer makes good contact.

7. When you have a good signal, clip the transducer in position on
the belt.

Note—Disconnect NON-USED ultrasound transducers as the

continuous mechanical influence of the transducer will result
in an artificial trace .

Warning
Periodically compare the mother ’s pulse with the signal coming from

the monitor’s loudspeaker to ensure that you are monitoring fetal
heart rate. Do not mistake a doubled maternal heart rate for FHR.
When you monitor maternal heart rate simultaneously with FHR,
cross-channel verification alerting warns you if maternal and fetal
heart rates coincide.

Please refer to “Cross-Channel Verification” on page 125.

Chapter 5 - Monitoring FHR and FMP Using Ultrasound

41

Fetal Movement Profile

Fetal Movement Profile

The monitor can detect fetal movements via an ultrasound transducer
plugged into the Cardio 1/Combi socket. The resulting fetal movement
profile (FMP) appears as “activity blocks” (A) along the top of the Toco
Scale, the length of each block showing the duration of the activity.

FMP Statistics

FMP Statistics (B) are printed below the activity blocks every 10 minutes.

The first value shows the percentage of detected fetal movements in the
previous 10 minutes, and the value in parentheses shows the percentage
of detected fetal movements since the recorder was switched on. During
the first 10 minutes of monitoring, the values will be identical .

If you plug an ultrasound transducer into the Cardio 1/Combi socket,
FMP statistics start again from zero.

The FMP output activates after about half a minute of valid heart rate
signals (green or yellow signal quality indicator) to minimize transducer

positioning ar tifact. FMP is pr inted on the pa per to mark the starting
point of the FMP statistic.

42 Chapter 5 - Monitoring FHR and FMP Using Ultrasound

Note—The transducer detects gross fetal body movements. Eye

movements are not detected and movement of the feet and
hands may not be detected. Positioning or repositioning the
transducer i s recorded as fetal movement. Maternal
movement, excessive fetal breathin g or feta l hiccups may a lso
be recorded as fetal movement. You can mark this artifact on
the paper using either the remote event marker or the event
marker key. Ignore these movements when you interpret the
FMP.

When monitoring twins, remember that movements recorded for twin 1
may also be caused by movement of twin 2.

Switching FMP Off and On

Switching the monitor on also switches FMP on, unless M1310A fetal telemetry
is connected. You can use either the function key or the optional barcode reader
to switch FMP off and on.

Fetal Movement Profile

Chapter 5 - Monitoring FHR and FMP Using Ultrasound

43

Fetal Movement Profile

Using Keys

You must connect an ultrasound transducer to the Cardio 1/Combi socket before
you can change the FMP setting.

1. Press repeatedly until the monitor displays .

The Signal Quality Indicator shows:

RED if FMP is OFF.
GREEN if FMP is ON.

2. Press or to change the setting.

3. Press and release to return to the normal display.

4.

FMP is printed on the paper.

You return to the normal display automatically if you do n’t press any key
for a few seconds.

Using the Barcode Reader

Enter FMP Off or FMP On from the barcode sheet.

44 Chapter 5 - Monitoring FHR and FMP Using Ultrasound

Troubleshooting

Problem Possible Causes Solutions

Troubleshooting

Erratic trace.
Erratic display.

Signal quality
indicato r is r ed
continuously.

Questionable
FHR.

FHR not recorded. FHR is less than 50 bmp or over 300. None.
Light or no trace. Wrong paper or dirty printhead. Use recommended paper or clean printhead.
End of paper

noted when pack
not finished.

Fetal arrhythmia.
Obese patient.
Transducer wrongly positioned.

Belt loose.
Too much gel.
Very active fetus.
Maternal movement.
Insufficient gel.

Transducer wrongly positioned.
FHR less than 50 bpm.

Record ing MHR by mistake.
Recording periodic signals when the
transducer is not applied to the
patient.

FHR exceeds 300 bpm. F HR is half-counted (for example 320 bpm is

Bad paper feed or wrong paper. Check paper feed and use recommended paper.

None.
None.
Reposition transducer until signal quality
indicator is green.
Tighten belt.
Remove excess.
None.
Relax the patient.
Use recommende d amou n t.

Reposition transducer until signal quality
indicator is green.
None.

Reposition transducer.

recorded as 160 bpm).

Error message is displayed. See Chapter 19, “Troubleshooting” for a table of

error messages, their causes and their solutions.

If you suspect the transducer. Carry out the Parameter Test as described on page

152.

If you suspect the recorder or display. Carry out the Quick Test as described on page

151.

Chapter 5 - Monitoring FHR and FMP Using Ultrasound

45

Troubleshooting

46 Chapter 5 - Monitoring FHR and FMP Using Ultrasound

Introduction

6

Monitoring FHR Using DECG

This chapter describes how to monitor a single fetal heart rate using a
spiral Fetal Scalp Electrode.

Because the tip of the electrode penetrates the fetal epidermis, the
possibility of trauma, hemorrhage and infection exists. Use the electrode
only under aseptic conditions. Do not apply the electrode:

• To the fetal face, to the fontanels, or to the genitalia

• When placenta previa is present

• When you cannot identify the portion of the fetal body where

application is contemplated

• Before the membranes are ruptured

• If genital infection exists

• When the patient i s less than two centime te rs dilated

• When the fetal station is less than minus two.

Chapter 6 - Monitoring FHR Using DECG 47

What You Need

What You Need

• If you are measuring fetal DECG using the traditional open-wire
method with a legp late transducer:

– DECG legplate transducer (M1357A)
– Transducer leg belt and button
– Open-wire Fetal Scalp Electrode (M15133A/M15133C).

• If you are measuring fetal DECG using the traditional open-wire

method with a patient module:

– Either ECG only patient module (M1364A) or FSpO

combined patient module (M1365A)

1

/ECG

2

– Adapter cable (M1362A)
– Pre-gelled electrode (40493E)
– Open-wire Fetal Scalp Electrode (M15133A/M15133C).

• If you are measuring fetal DECG using the DECG Adapter Cable

M1362B with a legplate transducer:

– DECG legplate transducer (M1357A)
– DECG adapter (M1347A)
– DECG Adapter Cable (M1362B)
– Transducer leg belt and button
– Pre-gelled Pad Electrode (M1349A)
– Fetal Scalp Electrode (15133E/15133D).

• If you are measuring fetal DECG using the DECG Adapter Cable

M1362B with a patient module:

– Either ECG only patient module (M1364A) or FSpO

combined patient module (M1365A)

1

/ECG

2

– DECG Adapter Cable (M1362B)
– Pre-gelled Pad Electrode (M1349A)
– Fetal Scalp Electrode (15133E/15133D).

1. The FSpO2/ECG combined patient module (M1365A) can be used only with
the Series 50 XMO Fetal Monitor (M1350C).

48 Chapter 6 - Monitoring FHR Using DECG

Getting Started

Prepare as you would for a routine sterile vaginal examination. Ensure
that the fetus is in a p osition to be monitored by DE CG. Attach the
electrode to the fetus a s described in the instructions that come with the
Fetal Scalp Electrode.

Attaching the Fetal Scalp Electrode Fetal Scalp Electrode Attached

Getting Started

Warning
Do not insert the fetal scalp electrode wires into the AC mains

socket.

Chapter 6 - Monitoring FHR Using DECG

49

Using the Traditional Open-wire Method to Monitor DECG

Using the Traditional Open-wire Method to

Monitor DECG

(applicable to Fetal Scalp Electrode 15133A and 15133C)

With DECG legplate M1357A

To monitor fetal DECG u si n g the tradition al open-wire method a n d a
DECG legplate M1357A, follow these instructions.

1. Fasten the belt around the patient’s upper thigh. Ensure that the
belt is correctl y attached to preve nt tension in the cable from
pulling on the Fetal Scalp Elec trode and injur ing the fetus.

2. Slide the transducer under the belt, pointing the connectors
towards the abdomen. To get the best signal the transducer must
have good contact to th e mother’s skin. Do not apply Redux creme
or any other conductive gel to the silver plate on the bottom of the
DECG transducer.

50 Chapter 6 - Monitoring FHR Using DECG

Using the Traditional Open-wire Method to Monitor DECG

3. Connect the Fetal Scalp Electrode wires to the DECG transducer.

4. You are now ready to begin monitoring DECG: see the section
“Monitori n g DE CG” for your next step.

With Patient Module M1364A or M136 5A

To monitor fetal DECG u si n g the tradition al open-wire method a n d
either an ECG-only patient module (M1364A), or an FSpO

combined patient module (M1365A), follow these instructions.

1. Fix the DECG cable clip (2) to a pre-gelled electrode 40493E (1).

2. Connect the Fetal Scalp Electrode wires (3) to the DECG cable
clip as shown below:

1

/ECG

2

3. Peel the backing from the electrode (40493E) and affix it to the
mother’s thigh. A good contact between the electrode and the
mother’s skin will improve the FHR signal. To get the best signal,
ensure that the skin is clean and dry before attaching the electrode.

Chapter 6 - Monitoring FHR Using DECG

3

2

51

Using the Traditional Open-wire Method to Monitor DECG

A

Ensure that the elec trode is correctly p ositioned to prevent tension
in the cable from pulling on the Fetal Scalp Electrode and injuring
the fetus.

4. Attach the pink connector (1) on the DECG Cable (M1362A) to
the ECG pink connector (1) on the patient module (M1364A/
M1365A).

1

M1362

M1364A

M1365A

5. Position the patient module under the abdominal transducer belt
wherever it is comfortable for the mother, securing it to the belt
using the fixing knob (3).

6. You are now ready to begin monitoring DECG: see the section
“Monitori n g DE CG” below for your next step.

52 Chapter 6 - Monitoring FHR Using DECG

Using the DECG Adapter Cable M1362B to Monitor DECG

Using the DECG Adapter Cable M1362B to Monitor DECG

(Applicable to Fetal Scalp Electrode 15133D/15133E)

With DECG Legplate M1357A

To monitor fetal DECG using the DECG Adapter Cable (M1362B) and
a DECG legplate transducer (M1357A), follow these instructions.

1. Connect the DECG adapter (M1347A) to the DECG legplate
transducer (M1357A):

– With the finger and thumb of one hand, press in the spring clips

on the legplate.

M1357A

– Fit the DECG adapter (M1347A) onto the legplate and release the

spring clips to lock the adapter into place.

M1347A

Chapter 6 - Monitoring FHR Using DECG

M1357A

53

Using the DECG Adapter Cable M1362B to Monitor DECG

2. Secure the legplate transducer under the abdominal belt or under
the leg belt. To get the best signal the transducer must have good
contact to the mother’s skin. Do not apply Redux creme or any
other conductive g el to the silver plate on the bottom of the
DECG transducer.

3. Attach a pre-gelled electrode (M1349A) to the DECG Adapter
Cable (M1362B).

M1349A

M1362B

54 Chapter 6 - Monitoring FHR Using DECG

Using the DECG Adapter Cable M1362B to Monitor DECG

A

4. Connect the DECG Adapter Cable (M1362B) to the DECG
Adapter (M1347A).

M1362B

M1347A

M1357

5. Connect the Fetal Scalp Electrode (15133D/15133E) to the
DECG Adapter Cable (M1362B).

M1349A

15133D or

M1362B

15133E

6. Peel the backing from the electrode (M1349A) and affix it to the
mother’s thigh. Make sure that the skin is clean and dry before
attaching the electrode. Ensure that the electrode is correctly
positioned to preve nt tension in the cable from pulling on the
Fetal Scalp Electrode and injuring the fetus.

7. You are now ready to begin monitoring DECG: see the section
“Monitori n g DE CG” for your next step.

Chapter 6 - Monitoring FHR Using DECG

55

Using the DECG Adapter Cable M1362B to Monitor DECG

With Patient Module M1364A or M136 5A

To monitor fetal DECG u si n g the DECG Adapte r Cable M1362B a n d
either an ECG-only patient module (M1364A) or an FSpO

combined patient module (M1365A), follow these instructions.

1. Attach a pre-gelled electrode (M1349A) to the DECG Adapter
Cable (M1362B).

M1349A

M1362B

2. Connect the Fetal Scalp Electrode (15133E/15133D) to the
DECG Adapter Cable (M1362B).

3. Peel the backing from the electrode (M1349A) and affix it to the
mother’s thigh. A good contact between the electrode and the
mother’s skin will improve the FHR signal. To get the best signal,
ensure that the skin is clean and dry before attaching the electrode.
Ensure that the elec trode is correctly p ositioned to prevent tension
in the cable from pulling on the Fetal Scalp Electrode and injuring
the fetus.

15133E or
15133D

/ECG

2

56 Chapter 6 - Monitoring FHR Using DECG

Using the DECG Adapter Cable M1362B to Monitor DECG

4. Attach the pink connector (1) on the DECG Adapter Cable
(M1362B) to the ECG pink connector (1) on the p atient module
(M1364A/M1365A).

M1349A

1

M1362B

M1365AM1364A

5. Fix the patient mod ule to the patient’s belt using the fixing knob
(2).

6. You are now ready to begin monitoring DECG: see the section
“Monitori n g DE CG” for your next step.

Chapter 6 - Monitoring FHR Using DECG

57

Using the DECG Adapter Cable M1362B to Monitor DECG

Typical Configuration Showing Fetal Scalp Electrode 15133E/D, DECG Adapter
Cable M1362B, and Patient Modul e M1 364A

58 Chapter 6 - Monitoring FHR Using DECG

Monitoring DECG

1. Switch on the monitor and the recorder.

2. Connect the legplate, or patient module, to the monit or . To

Monitoring DECG

simultaneously measure fetal pulse oximetry and DECG you must
connect the patient module to the Ca rdio 1/Combi socket. If you
are measuring DECG only you may use either the Cardio 1/
Combi socket or the Cardio 2 socket.

3. Check the arrhythmia logic setting. A red Signal Quality Indicator
indicates logic is OFF. Gr een indicates logic is ON. You can

change the setting by pressing until the monitor displays
LOG. Use and to change the color of the signal quality

indicator. You must have a DECG transducer connected to either
Cardio 1/Combi socket or the Cardio 2 socket.

Chapter 6 - Monitoring FHR Using DECG

59

Why use Arrhythmia Logic?

Warning

Periodically compare the mother’s pulse with the signal coming
from the monitor’s loudspeaker to ensure tha t yo u are monitoring
fetal heart rate. Do not mistake a high maternal heart rate for FHR.
When you monitor maternal heart rate simultaneously with FHR,
cross-channel v erification alerting warns you if maternal an d fetal
heart rates coincide.

Why use Arrhythmia Logic?

When arrhythmia logic is on, instantaneo us heart rate change s of 28 bpm
or more are not recorded. Recording r esumes when successive beats again
fall within predetermi ne d limits. This avoids recording artifacts but does
not show genuine arrhythmia. When logic is off, all recorded fetal
heartbeats are shown. If you suspect fetal arrhythmia, switch logic OFF.
Unless you suspect fetal arrhythmia, we recommend that you use the
default setting, with lo gic on, as this makes the trace easier to read and
interpret.

After Monitoring

Turn the spiral electrode counter-clockwise to remove it, either with the
presenting part crowning and the a pplication sit e visible, or after delivery.
Never pull it off or reuse it.

60 Chapter 6 - Monitoring FHR Using DECG

Troubleshooting

Problem Possible Causes Solutions

Troubleshooting

Erratic trace.
Erratic displa y.

Signal quality indicator is red
continuously.

nop displayed.

An error message is displayed. See Chapter 19, “Troubleshooting.”
If you suspect the signal from the transducer. Carry out the Parameter Test as

If you suspect the recorder or display. Carry out the Quick Test as described

No ECG signal.
Poor contact between the
reference electrode and the
mother.
Patient module is no t
securely fixed.

Fetal arrhythmia. Be sure that logic is off.

Electrode leads not properly
connected to cable block.

No contact or poor cont act
between reference electrode
and mother.

Spiral electrode detached. Reattach the spiral electrode.

Use a new spiral electrode.

Attach the patient module to the
patient’s belt with the fixing button.

Check electrode lead connection.

Use a new spiral electrode.

described on page 152.

on page 151.

Chapter 6 - Monitoring FHR Using DECG

61

Heart Rate Out of Limits

Heart Rate Out of Limits

A questionable heart rate is rare but these are some of the possible causes.

Problem Possible Cause

Questionable
heart rate.

FHR less than 30 bpm

FHR is not recorded and the signal quality
indicator is red.

FHR between 30 and 50 bpm

50-210 bpm paper records a straight line at 50
bpm.
30-240 bpm paper records the FHR.

FHR is between 210 and 240 bpm

50-210 bpm paper records a straight line at 210
until 240 bpm is exceeded.
30-240 bpm paper records the FHR up to 240
bpm.

FHR exceeds 240 bpm

FHR is not recorded and the signal quality
indicator is red.

62 Chapter 6 - Monitoring FHR Using DECG

Introduction

7

Monitoring Twin FHRs

You can monitor twins throughout labor and delivery after rupture of the
membranes by monitoring one twin externally using ultrasound and the
other internally using DECG.

If you want to monitor twins externally, you can use two ultrasound
transducers, or one ultrasound transducer and a US/MECG transducer.
The external method is poss ible on ly if your mo nito r has dual ultras ound
capability.

Refer to the appropriate preceding chapters for contra-indications and
other information about the measurement methods you have chosen.

Things to Remember During Monitoring

When monitoring you should:

• Make sure that you are recording two different heart rates. The
cross-channel verification feature alerts you if the two heart rates
coincide (that is, if both transducers are recording the same FHR).
If this happens, reposition an ultrasound transducer until you
detect the second FHR.

• Note that the trace recorded for the Cardio 1/Combi channel is
thicker (darker) than that recorded for the Cardio 2 channel. This
ensures that the two heart rates are easily distinguishable.

• Remember that only one fetal heartbeat can be heard from the
loudspeaker at any time. To hear the other fetal heartbeat, press
either of the volume keys for the channel monitoring that fetus.

Chapter 7 - Monitoring Twin FHRs 63

Monitoring Internally

• Monitor maternal heart rate , especially during la ter stages of labor,
to avoid mistaking mate rnal heart rate for FHR. Cross-channel
verification then alerts you if this occurs.

Monitoring Internally

Monitor one twin using the procedures described in
Chapter 5, “Monitoring FHR and FMP Using Ultrasound”. Monitor the
second twin using the procedures described in Chapter 6, “Monitoring
FHR Using DECG”.

pop43fin.gif

Monitoring Exter nally

Monitor both twins using the procedures described in
Chapter 5, “Monitoring FHR and FMP Using Ultrasound”. You will
need either two ultrasoun d transducers , or one ultraso und transduce r and
a US/MECG combi transducer. If you are using two US transducers,
removing the white clips from both ends of one transducer will help you

64 Chapter 7 - Monitoring Twin FHRs

to distingu ish at a glance the Cardio 1 / Combi US t ransducer f rom the
Cardio 2 US transducer.

Separating Twin FHR Traces

To help interpretation of traces with similar baselines, you can separate
the baselines, so that one is displayed on the trace as if it is 20 bpm higher
than the other. Use either the Function Key or the optional Barcode
Reader to separate the traces. This feature is also known as “Twins
Offset”.

Usi ng Keys

You must connect transducers to the Cardio 1/Combi and Cardio 2
sockets. You may use either two ultrasound transducers or a combination
of one ultrasound and one DECG transducer. You cannot use two
DECG transducers.

Separating Twin FHR Traces

1. Press and release to display .
The Signal Quality Indicator shows:

– REDif the traces are NOT SEPARATED.
– GREENif the traces are SEPARATED.

2. Press or to change the setting.

3. Press several times to return to the normal display.

Chapter 7 - Monitoring Twin FHRs

65

Separating Twin FHR Traces

Using the Barcode Reader

Enter “Twins Offset” from the barcode sheet.

Twins Offset: On

To indicate that Twins Offset is switched on and the Cardio 1/Combi
trace is offset:

• A dotted line labeled ‘+20’ prints across the FHR scale.

• The Cardio 1/Combi trace is labeled ‘+20’ every 5cm. The

following trace shows Twins Offset switched on.

Only the trace from the Cardio 1/Combi transducer is offset. The
numerical FHR value displayed on the monitor r emains unchanged. The
Cardio 2 trace and di splay do no t change. Subtract 20 from the Cardio 1/
Combi recorded trace to calculate the true FHR. For example, if the
recorded trace shows 160 then the true FHR is 140.

If you disconnect the Cardio 2 transducer, the Cardio 1/Combi trace
returns to normal. But if you later reconnect the Cardio 2 transducer, the
Cardio 1/Combi tr ace is automatically offset again.

66 Chapter 7 - Monitoring Twin FHRs

Twins Offset: Off

Troubleshooting

To indicate that Twins Offset is switched off a dotted line labeled “+0”
prints across the FHR scale.

Switching off the monitor automatically switches off Twins Offset.

Troubleshooting

The following problem may occur when monitoring twins.

Problem Possible Cause Solution

is printed repeatedly.

Chapter 7 - Monitoring Twin FHRs

Both transducers are
recording the same FHR.

Reposition an ultrasound
transducer.

67

Troubleshooting

68 Chapter 7 - Monitoring Twin FHRs

Introduction

You can m easure uterine activity externally using a Toco transducer, or
internally using an intrauterine catheter. A To co transducer measures the
frequency and duration of c ontractions but not thei r intensity. Amplitude
and sensitivity depend on various factors such as the position of the
transducer, the belt tension and the si ze of the patient. To obtain an
absolute measurement, you must monitor intrauterine pressure .

External Toco Monitoring

1. Fasten the abdominal transducer belt around the patient.

2. Connect the Toco transducer to the Toco socket on the monitor.

8

Monitoring Uterine Activity

3. The Toco display shows 20. “Toco ext”, indicating external uterine
measurement, is printed on the trace intermittently.

Chapter 8 - Monitoring Uterine Activity 69

Internal Toco Monitoring (IUP Monitoring)

4. Place the transducer o n the patient’s fundus to ensure the
optimum recording of uterine activity.

5. When you have a good signal, clip the transducer in position on
the belt.

6. Between contractions, press the Toco Baseline Key . This
zeroes the display and trace to 20.

The following example trace shows two contractions.

Internal Toco Monitoring (IUP Monitoring)

You can monitor intrauterine pressure (IUP) using either a reusable or a
disposable intrauteri ne catheter. Each catheter comes with its own
detailed user instructions. Read the instructions that come with your
intrauterine catheter before you start monitoring. Ensure that you zero
the monitor when instructed.

Perform a complete clinical evaluation. Catheterize after membrane
rupture. Do not catheterize if placenta previa is diagnosed or if uterine
bleeding from an undetermined source is present.

1. Insert the catheter according to its accompanying instructions.

2. Connect the catheter to the monitor’s Toco socket. Some catheters
link to a cable that connects to the monitor. The Toco display

70 Chapter 8 - Monitoring Uterine Activity

3. Zero the monitor by pressing the Toco Baseline Key . This

4. Flush periodically during monitoring. A pressure spike appears on

Troubleshooting

External Toco

Problem Possible Causes Solutions

Troubleshooting

shows 0. “Toco int”, indicating internal measurement, is printed
intermittently on the trace.

zeroes the display and trace to 0. If you do not zero the monitor
properly, the pressure trace may exceed the paper scaling. To
correct this, ensure that the transducer is level with the maternal
xiphoid (lower end of the sternum), then zero the monitor.

the trace if you flush after connecting the transducer to the
monitor.

Quality of the
trace deteriorates
or the Toco
baseline varies.

Toco sensitivity is
too high (above
100 units).

An error message is displayed. See Chapter 19, “Troubleshooting.”
If you suspect the signal from the transducer. Carry out the Parameter Test as

If you suspect the recorder or display. Carry out the Quick Test as described

Chapter 8 - Monitoring Uterine Activity

The belt is incorrectly fastened and is
too slack or too tight or the belt has lost
its elasticity.

Maternal movement. Relax the patient.
Fetal movement. None.
Maternal respiration superimposed on

trace.
Physical transmission of pressure from

the uterus to the sensor is much higher
than the average value.

The belt must be tight enough to ensure
good contact between the patient’s skin
and the entire surface of the transducer
without causing discomfort. Ensure
your are using the correct Philips belt.
Adjust it as necessary.

Check belt is not too loose.

Ensure a good contact between the
patient’s skin and the entire surface of
the transducer. Reposition transducer if
necessary.

described on page 152.

on page 151.

71

Troubleshooting

Internal Toco

No trace. Catheter blocked. Flush with sterile solution.

Problem Possible Causes Solutions

No change in pressure during
contraction.

Only pressure peaks can be seen
(baseline not visible).

“-” indicator fl a s hes.
Trace is a straight line. Transducer is

Trace is superimposed with
noise.

An error message is displayed. See Chapter 19, “Troubleshooting.”
If you suspect the signal from the transducer. Carry out the Parameter Test as described

If you suspect the recorder or display. Carry out the Quick Test as described on

Dry environment or
possible extra-ovular
placement of sensor
tip.

Zero adjustment is
incorrect.

defective.

End of catheter is in
the uterine wall or dry
column.

Flush with sterile solution or reposition
sensor.

Zero the system.

Remove and touch the catheter. If the
trace does not show up and down
movements, use a new transducer.

Retract the catheter a little and flush.

on page 152.

page 151.

72 Chapter 8 - Monitoring Uterine Activity

Introduction

9

Fetal Pulse Oximetry

Fetal pulse oximetry (FSpO2) gives you a continuous real-time
measurement of the percentage of oxygen saturation in the fetal arterial

blood. Identifying adequately oxygenated fetuses and those at risk of
hypoxia may help clarify whether or not intervention in the case of a non­reassuring fetal heart rate trace is ne ce ssary.

The FSpO
maternal monitor. You can upgrad e the following monitors to

incorporate FSpO

• Series 50 XM (M1350B) fetal/maternal monitor.

• Series 50 IX (M1350A) fetal monitor.

This parameter is NOT available for monitors purchased in the USA.

Before You Start

Read the accompanying Sensor Placement Guide carefully. It contains
full details about how to place the sensor, and any contra-indications.
Only clinical professionals trained in the use of sensor placement may
place a fetal oxygen sensor. Use only Nellcor-approved FS14 fetal sensors.

Unlike other fetal meas urements, wher e yo u get an almost instant displ ay
on the monitor as soon as you apply a transducer correctly, the FSpO

measurement can take several minutes after the sensor is correctl y placed
before you see a value displayed on the monitor.

parameter is built into the Series 50 XMO (M1350C) fetal/

2

:

2

2

Chapter 9 - Fetal Pulse Oximetry 73

To Begin Monitoring

To Begin Monitoring

1. Plug the FSpO2/ECG combined patient
module into the Cardio 1/Combi socket.

The monitor displays the symbol:

2. Check, and if necessary change, the alarm settings.

3. Connect the sensor to the patient module, maintaining sterility by
exposing only the connector when you open the sensor package.
The connector is color coded blue to ensure that you connect to
the blue FSpO

4. Make sure that you can see red light
coming from the emitter on the sensor
body. If there is no light, use a new
sensor.
The monitor displays the sensor lifted
symbol:

connector, not the pink E CG input.

2

5. Apply the sensor to the side of the fetal
face closest to the maternal spine,
according to the ins tructions in the
sensor placement guide. Adjust the sensor
until you get skin contact. When you
have contact, the monitor displays the
pulse search symbol and the pulse bar
lights rhythmically as the monitor
searches for a signal of sufficient quality
to allow it to determine the saturation
value.

74 Chapter 9 - Fetal Pulse Oximetry

6. Wait until the four-step signal quality indicator shows that it is
receiving a medium or good signal (with three or four segments
lit). It may take up to a minute after this until the monitor
displays the fetal o xygen saturation value. Do not reposition the
sensor unless you are certain the monitor is not receiving a signal
of accepta ble quality.

Understanding the Display

The following diagram shows the elements of the FSpO2 display:

Understanding the Disp la y

1. Pulse indicator

The six segments pulse rhythmically in conjunction with the fetal
pulse rate when the pulsatile activity is of acceptable quality.

If the indicator pulses regularly but the monitor does not displa y a
fetal oxygen saturation val ue, wait before you repo sition the sen sor.

Chapter 9 - Fetal Pulse Oximetry

75

Understanding the Display

The monitor may not yet be able to calculate a saturation value
from the signal it is r eceiving.

If the pulse indicator becomes briefly irregular, and then returns to
a regular rhythm, do not reposition the sensor. The irregularity is
probably caused by fetal or maternal movement.

2. Signal quality indicator

Shortly after the pulse indicator moves rhythmically, the four­segment signal q uality indicator illuminates to show how good a
signal the monitor is receiving from the sensor. The more segments
that light, the better the quality of the signal. Typically, the
monitor needs a medium to good quality signal (with three or four
lit segments) f or up to a min ute to calculate and then disp lay the
saturation value.

3. Alarm status indicator

When the crossed bell symbol is lit, alarming is switched off.
When it is not lit, alarming is switched on.

4. Cross-Channel Verification Plus (CCV+) indicator

The fetal pulse ra te from FSpO

is determined i n ternally by the

2

monitor. It is not displayed, on either the trace or monitor.
To warn you if you accidentally record maternal SpO

fetal SpO

(because the sensor is facing the uterine wall instead of

2,

instead of

2

the fetus) the monitor compares the heartrate it d erives from
DECG on the Cardio 1/Combi channel, (or from US on the
Cardio 2 channel if DECG is not in use) with the pulse rate it
derives from FSpO

. The CCV+ indicator illuminates and is

2

printed on the trace if the monitor:

– records a pulse rate from FSpO

and a heart rate from DECG

2

or ultrasound that do not match for more than one minute.

– records more than 80% fetal saturation for more than one

minute.

76 Chapter 9 - Fetal Pulse Oximetry

Alarm

Alarm Limits

Alarm

You should check the fetus and adjust the sensor until you are sure
you are recording fetal oxyg en saturation.

5. Saturation value

This displays the level of oxygen saturation in the fetal blood.
Typical fetal values lie within the range 40% to 70%.

See Chapter 3, “General Information” on page 19 for a sample trace
including FSpO

.

2

The monitor makes a “beeping” noise and the saturation display flashes.

FSpO2 has two alarm criteria, whic h you ca n change o nly when a pa tien t
module is conne cted to the monit or. If you change an alarm limit, your

change is retained by the monitor, even if you switch the power off. The
alarm limits are:

• Saturation alarm level

The alarm triggers if the percentage of fetal oxygen saturation falls
below this point. The defau lt se tting is 30%.

• Time delay

This is the length of time for which fetal oxygen saturation must be
at or below the saturation limit before the alarm triggers. The
default setting is one minute.

When you change the monitor’s battery, the alarm sett ings return to the
factory settings.

Chapter 9 - Fetal Pulse Oximetry

77

Alarm

Triggering an Alarm

For an alarm to trigger:

• The FSpO

2

• The percentage sa tura tion must fall below the saturation alarm level
for the length of time specified b y the time delay.

Acknowledging an Alarm

Press the acknowledge key on the recorder or the yellow key on the
maternal display to acknowledge an FSpO

Turning the Alarm On and Off

1. Connect the ECG/FSpO2 patient module to the Cardio 1/Combi
socket.

2. Press until the FSpO

3. Press to toggle between alarming on and off. The signal
quality in dicator for th e Cardio1/Combi channel is red when
alarming is OFF and green when it is ON.

4. Press to return to normal monitor function. A crossed bell
symbol, near the FSpO

Changing Alarm Limits

alarm must be switched on and

alarm.

2

display shows .

2

display, illuminates when the alarm is off.

2

1. Connect the ECG/FSpO2 patient module to the Cardio 1/Combi
socket.

2. Press until the FSpO

display shows .

2

3. Press to access the saturation alarm limit setting. The Toco
display shows , indicating that you are changing the
saturation low alarm limit. The FSpO

display shows the current

2

low limit. There is no high limit.

4. Press or to increase or decrease the FSpO

saturation

2

alarm limit.

78 Chapter 9 - Fetal Pulse Oximetry

Inop Alarms

Alarm

5. Press to set the time delay. The Toco display shows ,
indicating that you are chang ing the time delay . The FSpO

2

display shows the current delay, in minutes.

6. Press or to increase or decrease the time delay in
increments of 0.5 minutes.

Press to return to normal monitor functi on.
If alarming is enabled, the alarm limits are printed on the trace. If it is

disabled, is printed.

If the signal quality has been good for a minute or longer, and then the
quality falls below an acceptable level for more than 30 seconds, the
monitor beeps. This feature can be enabled or disabled through the
service settings. See the Installation and Service Guide for details.

Chapter 9 - Fetal Pulse Oximetry

79

Troubleshooting

Troubleshooting

Display Problem Solution

Patient module not
plugged in.

Pati ent module plugged
in but sensor not
attached.

Patient module and
sensor are both
correctly connected but
no signal is obtained.

Pulse indicator bar
pulses rhythmically but
monitor does not
display a saturation
value.

Plug in patient module.

Check connection of
sensor to patient
module. Replace
patient module or
sensor if necessary.

The sensor has lost
contact with the
patient. Reposition the
sensor slightly.

Observe the quality
indicator lights. If you
do not obtain a
medium to good
quality signal (three or
four segments lit) after
waiting for at least one
minute, reposition
sensor.

80 Chapter 9 - Fetal Pulse Oximetry

Loss of Pulse Signal

Temporary loss of pulse signal is normal and the clinical professional
must judge whether the trace gives enough information for diagnosis.
Loss of pulse signal can occur:

• If there is excessive or prolonged fetal or maternal movement

• During uterine contractions

• If the fetus experiences shock, hypotension, severe vasoconstriction,

arterial occlusion proximal to the sensor, or cardiac arrest.

Inaccurate Measurements

Inaccurate measurements may be caused by:

• Incorrect placement of the sensor

• Significant levels of dysfunctional hemoglobin, such as

carboxyhemoglobin or methemoglobin

• Excessive fetal or maternal movement

• Uterine contractions

• Venous pulsation

• Side effects from some drugs.

Loss of Pulse Signal

Chapter 9 - Fetal Pulse Oximetry

81

Inaccurate Measurements

82 Chapter 9 - Fetal Pulse Oximetry

Introduction

10

Monitoring Using External Devices

This chapter describes how to record maternal non-invasive blood
pressure (NIBP), maternal blood oxygen saturati on level (SpO

maternal temperature and maternal heart rate (MHR) by connecting a
supported extern al device to your monitor. If you have a Series 50 XM
you can connect an Nellcor OxiFirst
compatible fetal pulse oximeter.

 Pulse Oximeter (N-400) or

),

2

Chapter 10 - Monitoring Using External Devices 83

Recording From an External Device

Recording From an External Device

If you connect an external device that replicates parameters already
installed in your monitor (such as MHR, maternal SpO

FSpO
You can connect:

), the external device is ignored.

2

Parameters

, NIBP and

2

Supported External Devices

Philips M1165A/1166A/1175A/

NIBP

2

Yes

Maternal Fetal

SpO

2

Yes

2

Temp

2

Yes

MHR

2

Yes

1

1176A/1167A/1177A CMS
Philips 78352C/78354C Compact

Yes

2

Yes

2

Yes

2

Yes

2

Configurable Monitor (CCM)
Dinamap 1846/8100 NIBP Monitor Yes No No Yes No
Press-Mate/Listmini

YesNoNoYesNo

Model BP-8800
Accutorr 3, 4 Yes No No Yes No
Accutorr 3SAT, 4SAT Yes Yes No Yes No
Nellcor N-200 SpO

Nellcor N-400 FSpO

1. An MHR measurement is provided in conjunction with maternal NIBP or SpO2 monitoring.

2. Only if this parameter is installed on the external device.

Monitor No Yes No Yes No

2

Monitor No No No No Yes

2

FSpO

No

No

2

84 Chapter 10 - Monitoring Using External Devices

What You Need

Recording From an External Devic e

To connect a supported external device you require:

Requirements

Model

1

Option J13

Additional Requirement

Press-Mate/Listmini
Model BP-8800

Dual Interface
Board

NIBP
Dinamap 8100 Dual Interface

Board

Others Dual Interface

Board

1. Includes one interface cable (M1350-61609)

Connecting the External Devices to the Monitor

Connect a supported external device via the dual serial interface at the
rear of the monitor.

Caution
Before connecting an external device to the monitor, connect the

equipotential grounding point (3) to earth potential. Use the
grounding cable supplied with the monitor.

COLIN Interface cable
(available from COLIN
Corporation)

Model 8801 interface adapter
(available from General Electric)

None

Chapter 10 - Monitoring Using External Devices

85

Recording From an External Device

The Dual Serial Interface has two sockets:

1. Use socket 1 (9 pin) for connecting:

• Philips M1165A/1166A/1175A/1176A/1167A/1177A

Dual Serial Interface

CMS.

• Philips 78352C/78354C Compact Configurable Monitor.

• Dinamap 1846/8100 NIBP Monitor.

• Press-Mate/Listmini Model BP-8800.

• Accutor 3, 4, 3SAT and 4SAT.

2. Use socket 2 (25 pin) for connecting:

• Nellcor N-200 Maternal SpO

• Nellcor N-400 Fetal SpO

If you use both sockets 1 and 2, and maternal SpO

Monitor

2

Monitor (M1350B only).

2

can be

2

recorded from the external device connected to socket 1, the
measurement from this external device has priority over the
measurement from the Nellcor Monitor N-200 in socket 2.

86 Chapter 10 - Monitoring Using External Devices

Recording From an External Devic e

3. Use the interface cable to connect the external device to the
appropriate socket.

4. Connect the other end of the interface cable to the external device.
(See the service documentation supplied with the external device
for the correct socket to use for the connection.)

If you are monitoring maternal SpO

or temperature and the monitor is

2

switched on before the appropriate sensor is applied, the first value
documented may be incorrect as it takes up to five minutes for the correct
value to be obtained.

To monitor maternal temperature on the M1165A/1166A/1175A/
1176A/1167A/1177A CMS, you must connect the te mperature sensor to
TEMP1.

Chapter 10 - Monitoring Using External Devices

87

Recording From an External Device

Example Trace

1. Maternal blood pressure:

– Systolic blood pressure is 128 mmHg.
– Diastolic blood pressure in 98 mmHg.
– Mean arterial pressure is 109 mmHg.

2. Maternal heart rate (78 bpm).

3. Maternal oxygen saturation level of blood (97%).

4. Maternal temperature (37.5
coming from external monitors ar e prefixed with an asterisk, “*”.

o

C). Note that trace annotations

What is printed on the trace?

External

Measurement

Maternal NIBP Value at each measurement, unless in automatic mode.
Maternal SpO

Maternal
temperature

Fetal SpO

88 Chapter 10 - Monitoring Using External Devices

Fetal SpO2 trace and annotation printed on Toco scale.

2

Value every 5 minutes.

2

Value every 5 minutes.

Print on Trace