Fetal MonitoringAnn Hearn RNC, MSN

2010

Electronic Fetal Monitoring Standard of Care “Nurses who care for women

during the childbirth process are legally responsible for correctly interpreting FHR patterns, initiating appropriate nursing interventions based on the pattern seen, and documenting the outcome of those interventions.”

Placental Physiology

Maternal blood flow Fetal blood flow Gas/substance Exchange

– Contraction’s affect

Placental Physiology

Regulation of FHR

Autonomic nervous system Baroreceptors Chemoreceptors Adrenal gland Central nervous system

Fetal Heart Rate Monitoring Devices

Fetoscope Hand held dopple

Electronic Fetal Monitor

Methods of Fetal Monitoring

Intermittent auscultation Continuous external Continuous internal

Methods of Fetal Monitoring

External– Ultrasound transducer– Tocotransducer

Internal– Fetal scalp electrode (FSE)– Intrauterine pressure catheter

(IUPC)

Internal Fetal Monitoring

Patterns of Fetal Heart Rate Monitoring

Fetal Heart Rate Baseline FHR = 110 – 160 bpm

– Average rate over 10 minutes

Tachycardia – baseline above 160 BPM– RT= maternal fever, fetal hypoxia,

intrauterine infection, drugs

Bradycardia – baseline below 110 BPM– RT = profound hypoxia, anesthesia, beta-

adrenergic blocking drugs

Electronic Fetal Monitor Paper

Fetal Heart Rate Variability

Normal irregularity of the cardiac rhythm.

Absence of variability, or a smooth flat baseline is a sign of fetal compromise.

A determinant of fetal wellbeing.

Fetal Heart Rate Variability

Periodic Changes of FHR

Acceleration

Deceleration

Acceleration

Increase in the fetal heart rate from baseline by 15 bpm lasting 15 seconds or more.

A determinant of fetal wellbeing

Reassuring Fetal Heart Rate Pattern

Deceleration

Decreases in the fetal heart rate from the normal baseline.– Variable– Early– Late– Prolong

Deceleration

Variable – related to cord compression. Interventions vary.

Late – related to utero-placental insufficiency. Immediate intervention.

Early – related to head compressions. Interventions not necessary.

Prolong – lasts > 2 minutes. Interventions necessary.

Early Deceleration

Variable Deceleration

Late Deceleration

VEAL CHOP

Variable

Early

Acceleration

Late

Cord

Head

Okay

Placenta

Prolong Deceleration

Fetal heart rate deceleration that lasts greater than 2 minutes.

Sinusoidal Pattern (Undulating) Fetal heart rate repeating cycle of

upward increase in the heart rate followed by a decrease in the rate.

Prolonged Deceleration

Sinusoidal Pattern

Interpreting FHR as…..

Reassuring– Accelerations– Moderate variability

Non-reassuring– Tachycardia– Bradycardia– Decreased or absent variability– Late decelerations– Variable decelerations (persistent)

Non-reassuring FHR Tracing

Interventions– Reposition– Oxygen therapy – IV fluid bolus– (Discontinue oxytocin infusion)– Other

Fetal Scalp Stimulation Used to assess fetal well

being.– Procedure: examiner gently

sweeps fingers in a circular motion on the fetal scalp

– FHR acceleration = well oxygenated fetus and normal acid base balance.

Cord Blood Gases & pH

Analysis used to assess the infant’s acid-base balance immediately after birth.

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The End