fetal heart rate interpretation adaptation to labor

8/9/2019 Fetal Heart Rate Interpretation Adaptation to Labor

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+

Fetal Adaptation toLabor


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+Basis for Monitoring

Physiologic stress to the fetus

Fetal oxygen supply must bemaintained during labor


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+Monitoring Techniques

Intermittent auscultation

• Pinard stethoscope

• Doppler ultrasound

• ltrasound stethoscope

• DeLee! "illis fetoscope


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+Monitoring Techniques

#lectronic Fetal Monitoring

#xternal !! ltrasound transducer$ Tocotransducer

Internal !! %calp electrode$ IP&

cer'ix must be dilatedmembranes must be ruptured

fetal descent at !( station


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+#lectronic Fetal

Monitoring


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+Assessment of terine

&ontractionsPalpation

#xternal tocotransducer

IP&


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+%ystematic #'aluation of

Fetal "eart )ate Tracing

Fetal %tatus• Baseline Fetal "eart )ate• *ariability

• Accelerations

• Decelerations

• #arly

• Late

• *ariable


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+Baseline F")

Bet+een &ontractions

,!(- minute segment

Document as range

.ormal is ((-!(/-


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+ *A)IABILIT0

The most reliable indicator of Fetal Well-being


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+*ariability

undetectable -!, bpm

/!1, bpm 21, bpm


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+Periodic and #pisodic

&hangesPeriodic

In response to contractions

#pisodic

.o relationship to uterine contractions


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+Acceleration


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+#tiology of Accelerations

Fetal mo'ement

terine contractions

*aginal exam

I%# application

Fetal scalp stimulation

Partial cord compression

Breech presentation

ALWAYS

REASSURRIN!


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+Accelerations


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+#tiology of Decelerations

• "ead &ompression#arly

• teroplacentalInsu3ciencyLate

•&ord &ompression*ariable


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+Periodic F") &hanges


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+#arly deceleration


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+Late deceleration


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+*ariable deceleration


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+ 4!Tier Fetal "eart )ateInterpretation %ystem

&ategory I

&ategory II

&ategory III

.ormal

.ot predicti'e ofabnormal fetal acid basestatus but can5tcategori6e I or III

Abnormal fetal acid!basestatus

N" A#TI"N RE$UIRE%

A#TI"N RE$UIRE%

Re-e&al'ation( intra-'tero t) and contin'eds'r&eillance


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+&ategory I

N" A#TI"N RE$UIRE%

.ormal

Must include ALL7

Baseline ((-!(/-Moderate 'ariability

.o late decelerations#arly decelerations 89!Accelerations 89!


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+&ategory II

.otpredicti'e

ofabnormalfetal acidbasestatus but

can5tcategori6eI or III

Re-e&al'ation( intra-'tero t) and contin'eds'r&eillance

#'erything that notcategori6ed as either&ategory I or III

#xamples 7 Tachycardia$bradycardia +ithnormal 'ariability

Absent 'ariability$mar:ed 'ariability

Lates 8 'ariability$unusual 'ariables


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+&ategory III

Abnormalfetal acid!base status

A#TI"N RE$UIRE%

Absent 'ariability$ pluseither;


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+Management for AbnormalFetal "eart )ate Patterns

)eposition=>pposite lateral$ ?nee!chest$ Trendelenberg

)elax

)emo'e Pitocin

)ehydrate

)eoxygenate =@!(- Liters 'ia face mas:

)eport to MD


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+.ursing &are for Acti'e Labor

*ital signs =temperature$ pulse$ respirations and bloodpressure

"ydration =>ral inta:e and Intra'enous inta:e

#limination =#ncourage 'oiding q 1hr$ pt may recei'eenema

Ambulation and positioning=#ncourage ambulation if

possible$ if not$ position change q 4-!/- mins$ +ith sidelying position preferred

eneral hygiene!>Cer +arm sho+er or bath possible<

#ncourage +omen to +ash hands after 'oiding andperform self hygiene< &hange linen as needed for soiledpads and sheets


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+.ursing &are for Acti'e Labor

Leopold5s Maneu'ers

Amniotic membrane status=Document time$ type$ color$amount$ and odor< Temp q 1hr

*aginal exam=dilation$ eCacement$ station$ position$and presenting part

.eurological exam=L>&$ DT)$ clonus

Laboratory data=rine specimen$ &B&$ type and screen


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+%econd %tage of Labor

Maternal positioning! =%upine$ semirecumbent$ or lithotomy

>pen!glottis pushing= #ncourage+omen to push as they feel li:e

pushing +hich is instincti'e$spontaneous pushing


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+Amnioinfusion

Treatment of 'ariable decels during labor

Dilute meconium!stained uid


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+>perati'e *aginal Birth

Forceps

*acuum assisted


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+&esarean Birth

Planned$ unplanned$ or electi'e

%urgical technique

&omplications

Anesthesia


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+*BA&

Approximately E-!@- success rate

*aginal deli'ery after cesarean criteria• >ne pre'ious lo+!trans'erse cesarean birth

•

&linically adequate pel'is• .o hx of uterine rupture or uterine scars

• MD immediately a'ailable

• Anesthesia a'ailable


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+>bstetric #mergencies

Meconium!stained amniotic uid

%houlder dystocia

Prolapsed umbilical cord

terine )upture

Amniotic uid embolism

fetal heart rate interpretation adaptation to labor

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