Can fetal position mimic squatting on cardiac auscultation?

From the Guidelines

The fetal position can indeed mimic squatting on cardiac auscultation, as it produces similar hemodynamic effects, including increased venous return to the heart, increased left ventricular filling, and raised systemic vascular resistance. When a patient assumes the fetal position, it can be a useful alternative for patients who cannot physically squat due to mobility issues, arthritis, or other limitations. During cardiac auscultation, these positional changes can help differentiate certain murmurs, particularly in hypertrophic cardiomyopathy (where the murmur decreases in intensity) and mitral valve prolapse (where the click occurs later and the murmur shortens) 1. Some key points to consider when using the fetal position for cardiac auscultation include:

• The patient should lie on their left side with knees drawn up to the chest
• This position can help increase venous return to the heart and raise systemic vascular resistance
• The fetal position is especially valuable in elderly or physically limited patients who need dynamic auscultation but cannot perform traditional maneuvers like squatting
• To implement this technique, simply have the patient lie on their left side and draw their knees toward their chest while you listen with your stethoscope. It is essential to note that the provided evidence from the American Family Physician 1 focuses on intrapartum fetal monitoring, but the concept of fetal positioning can be applied to cardiac auscultation in a different context. In real-life clinical medicine, using the fetal position as an alternative to squatting can be a practical solution for patients with mobility issues, and it is supported by the underlying physiological principles. The technique of using the fetal position for cardiac auscultation is not directly addressed in the provided evidence, but it can be inferred from the general principles of physiology and the effects of positioning on hemodynamics 1.

From the Research

Fetal Position and Cardiac Auscultation

• The available evidence does not directly address whether fetal position can mimic squatting on cardiac auscultation 2, 3, 4, 5, 6.
• Studies have discussed various methods of fetal heart rate monitoring, including intermittent auscultation and electronic fetal monitoring, but none have specifically explored the relationship between fetal position and cardiac auscultation in the context of squatting 2, 4, 6.
• One study discussed the importance of correctly positioning the ultrasound transducer to obtain accurate fetal heart rate measurements, but it did not address the specific issue of fetal position mimicking squatting 3.
• Another study provided guidelines for fetal surveillance in labor, including the use of intermittent auscultation and electronic fetal monitoring, but it did not discuss the relationship between fetal position and cardiac auscultation in the context of squatting 5.
• A systematic review of intermittent auscultation for fetal monitoring in labor found that there is no robust evidence to guide clinical practice on the most effective method, but it did not address the specific issue of fetal position mimicking squatting 6.

Limitations of Current Evidence

• The available evidence does not provide a clear answer to the question of whether fetal position can mimic squatting on cardiac auscultation.
• Further research is needed to explore this topic and provide guidance for clinical practice.
• The current evidence is limited to studies on fetal heart rate monitoring and surveillance in labor, and does not address the specific issue of fetal position and cardiac auscultation in the context of squatting 2, 3, 4, 5, 6.