Frequently Asked Questions

FAQ's

Please find below some of the more frequently asked questions regarding the use of the Monica AN24.

For easy reading the FAQ's are split into the following categories:

Monica AN24 and Monica VR

What if I search for the Device and the right AN24 is not detected? Repeat the search, it can take up to 3 times. If this does not work contact the Monica Distributor in your country.
When the recording has started and I cannot see the fetal heart rate, what should I do? This is quite normal and unlike a Doppler fetal monitor you should not expect an immediate result. Look at the signal to noise icon on the VR display, if the red bar is high then even though you think mum is relaxed she may not be, so ask her to reposition herself, perhaps on her side and leave the room while she relaxes.
What does the grey and black TOCO trace represent? When the mother moves she could be using her abdominal muscles which can confound the TOCO signal. The Monica Device can see the womans movement and will change the TOCO waveform from black to grey when movement occurs. You should be very cautious in interpreting the TOCO waveform when it is grey.
I cannot get the red bar to go down. The women is not relaxing her abdominal muscles. If this persists monitor overnight while she is sleeping.
Will the Monica AN24 still work with a breach presentation i.e. if the fetal ECG is inverted? The orientation of the fECG complex is not important. The algorithm used by the Monica AN24 is designed to track the 'R' wave indpendant of its orientation.
How does the more sensitive FHR from the AN24 effect the STV comparison with Doppler CTG? The Monica AN24 uses the same 3.75 second period as used by System 8000/8002 to average the FHR before calculating the STV. A soon to be published paper on a direct comparison of STV using the AN24 and VR software versus System 8000/8002 has shown excellent results. For more information please contact Monica Healthcare here.
I am trying to monitor a patient between 26- 34 weeks and get a low success rate? What can I do? This can occur during this gestation period as there can be vernix caseosa around the fetus, it usually appears at about 28 to 32 weeks but can be earlier or later and the amount is variable. Just as Doppler CTG finds fatty tissue hard to penetrate the size of the fECG is substantially reduced by the vernix caseosa (waxy substance which covers the fetus in utero).  This acts as an insulator preventing the conduction of the fECG to the abdomen. When the size of the fECG is compromised, noise from abdominal muscle tension and other artifacts make it difficult for the Monica AN24 to extract the FHR. Please consider the following so as to minimize the noise and maximize the fECG:
  • Ensure your white electrode is in the correct position.
  • Check the signal to noise ratio indicator.  If the red noise indicator is above 25% of the scale the mother is not relaxed and the noise is too high.  Try a different posture or offer additional back support and reduce the activity around the women.  This can all help to relax the mother and improve the conduction path.  The lower the red noise indicator the better
  • Undertake a longer recording to obtain a satisfactory trace. This is best done during an overnight recording (feedback from mothers show that the AN24 does not interrupt their sleep), when the women is sleeping.  This ensures that noise and other artifacts are at the lowest level and a recumbent posture with the women lying on her left or right side improves the conduction path.

 

Electrode positioning and skin preparation

If the women has hair on her abdomen, should I place the electrode on top? Doing this would mean that when you remove the electrode it would be very uncomfortable for women, please ask her permission to gently shave the area, and explain the reason why - you will not need to exfoliate if you do this.
The electrode skin impedance was too high. I followed the protocol and defoliated the skin under the electrode after using the skin preparation tape and an alcohol wipe, what shall I do? Check the electrode, if the use by date on the packet has passed, or the packet is not sealed properly: Check the moisture on the back of the electrode. Sometimes it will help to simply leave the electrodes on the skin for 30mins which allows the electrolyte in the electrode sponge to penetrate the skin and provide good skin contact. If mum does apply creams it is worth asking her not to use them if you know in advance that you are going to use the AN24.
If I have an obese women, where should I place the yellow electrode? You may need to use a larger lead set, available from your Monica re-seller in your country, which are longer in order for the leads not to pull.
The yellow electrode should be placed over the overlap of fat.
What do I do if a mother has been using creams? Wash the skin with a soapy sponge, rinse well and dry

 

Multiple recordings using the Monica AN24

If the woman needs a CTG three times a day how long can I leave the electrodes on for? You can leave the electrodes on for 2 days; she can remove the AN24 leads and have a shower with the electrodes on. After drying the electrodes the leads can be reconnected. There is no need to switch off the AN24 or restart it as long as the leads are reconnected within 60 minutes. Discuss with the woman what she would like to do.

 

Washing, bathing and taking a shower

Can the woman have a soak in the bath with the electrodes on? The AN24 leads must be removed from the electrodes. The electrodes maybe ok. After a soak in the bath check that the electrodes are still attached and dry them. The AN24 leads can then be re-attached. There is no need to switch off the AN24 or restart it as long as the leads are reconnected within 60 minutes.
Can the AN24 be used in the shower? The AN24 itself cannot be used in the shower, however if the AN24 leads are removed from the electrodes it may be possible to re-connect the AN24 after the shower without re-applying the electrodes. After a shower check that the electrodes are still attached and dry them. The AN24 leads can then be re-attached. There is no need to switch off the AN24 or restart it as long as the leads are reconnected within 60 minutes.

 

Safety

During a real time recording does the use of Bluetooth harm the fetus in any way? No. The Bluetooth is set at a very low level almost 1000 times less than when using a mobile phone.
Can the woman use a TENS machine whilst being monitored with the Monica AN24?

Since the Monica AN24 detects the electrical signals generated from the fetal heart, if other equipment which introduces electrical energy in to the mother is used (e.g. TENS machine, diathermy, impedance meter), then the AN24 will not be able to detect the fetal heart rate.

 

Let Us Know What You Think

If you have any questions regarding the use of the Monica AN24 or would like any further information to be included above, please e-mail: comments@monicahealthcare.com