fetal monitoring orientation day-1

8/4/2019 Fetal Monitoring Orientation Day-1

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Why Monitor?

Labor is a physiologic

stress to fetuses

Fetal monitoring allows

the health-care team to

evaluate fetal response

to labor

Monitoring ispredictive of infants

post-delivery status


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Methods of Fetal Monitoring

Auscultation with fetoscope and palpation ofcontractions

External electronic fetal monitoring (EFM)

Tocotransducer to monitor uterine activity

Ultrasound transducer to monitor FHR

Internal EFM (most accurate, most invasive)

Intrauterine pressure catheter (IUPC) to monitor

uterine activity

Fetal scalp electrode (FSE) to monitor FHR


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External Fetal Monitoring


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Internal Fetal Monitoring


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Internal Fetal Monitoring: FSE


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Internal Fetal Monitoring: IUPC


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Fetal Monitor Paper

The top half of the strip is the fetal heart rate.

The bottom half of the strip are the contractions.


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Fetal Monitor Paper Horizontal Calibration:

One large box= 1 minute = 3cm

One small box= 10 seconds


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FHR Baseline

Normal FHR 110-160

Rounded to increments of 5 bpm

The FHR baseline excludes

periodic or episodic changes(accelerations & decelerations)

periods of marked variabilitysegments of baseline that differs by

>25bpm


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Fetal Bradycardia

baseline of


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Fetal Tachycardia

baseline of >160 bpm for at least 10 minutes


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Variability

Fluctuations in the baseline

Variability represents a mature, intact nervous

system pathway through the brain, vagus

nerve, and cardiac conduction system

*The most significant indicator of fetal well-

being

Reflects the fetal oxygen reserve


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Variability

Absent Amplitude range undetectable

Minimal Amplitude range < 5 bpm

Moderate Amplitude range 6-25 bpm

Marked Amplitude range >25 bpm


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Absent Variability

Non-reassuring

fetal heart

status

Notify the

provider

immediately

Prepare for

c-section


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Minimal Variability Fetal sleep (cycles usually < 30 minutes)

Maternal drugs: Nubain or Stadol for pain,

tranquilizers, barbiturates, ETOH

Hypoxia: evaluate for potential causes

Prematurity


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Moderate Variability

ReassuringFetus has good oxygen reserve.


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Moderate Variability


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Marked Variability

Hypoxia/acidosis reduced oxygen to the fetus Second stage of labor/pushing phase


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Accelerations

Increase of FHR 15 bpm above baseline for at

least 15 seconds (15x15). This is reassuring.

The fetal heart rate accelerates when the fetus

moves.


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Decelerations

Variable

Early

Late

Prolonged


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Variable Decelerations

An abruptdecrease in FHR

of > 15 bpm

The onset of thedeceleration to the nadir of

the contraction is < 30

seconds

*Caused by cordcompression

May occur with or without

the contraction


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Interventions for Variable Decels(Will depend on the severity)

*Reposition

Notify physician

Amnioinfusion Discontinue oxytocin

Oxygen per face mask

Consider vaginal exam


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Early Decelerations


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Early Decelerations

Gradualdecrease in FHRwith onset of decelerationto nadir >30 seconds. Thenadir occurs with the peak

of a contraction. Benign, often indicative of

fetal descent

*Caused by head

compression No nursing interventions

indicated, but considergetting prepared for

delivery of infant


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http://utilis.net/fhm/fhm/media/Strips.009.jpg


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Early Decelerations


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Late Decelerations


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Late Decelerations Gradual onset of a

deceleration (> 30seconds from onset tonadir); the nadir ofthe deceleration

occurs after the peakof the contraction

Non-reassuring if thelate decelerations are

recurrent *Cause:

uteroplacentalinsufficiency


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Late Decelerations


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Late Decelerations


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Interventions for Late Decelerations

Reposition

Oxygen

Discontinue pitocin

Administer fluid bolus

Notify the physician

Check the blood pressure

Administer terbutaline

Possibly prepare for c-section


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Prolonged Decelerations

More than 2 minutes in duration


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Prolonged Deceleration


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C, Variable decelerations causedby cord compression.

B, Late decelerations caused byuteroplacental insufficiency.

A,Early decelerations causedby head compression.

Review of the Decelerations


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Contractions

Frequency of contractions is timed by countingthe minutes from the beginning of one

contraction to the beginning of the next

Duration of contractions is measured by counting

the seconds between the onset and ending of a

contraction

Strength of the contractions is measured by

palpation when you have an external monitor.Internal monitors measure the strength in mmHg.


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Contractions


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Contractions

ALWAYS remember that external tocotransducers

are used only as a rough tool to time contractions

and MUST be combined with palpation of

abdomen.


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Contractions


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Contractions


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Summary

FHR Baseline 110-160 Tachycardia >160 for 10 minutes

Bradycardia 25 bpm


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Decelerations

Variable cord compression

Early head compression

Late uteroplacental insufficiency

Prolonged-- > 2 minutes


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Contractions

Frequency time from the beginning of one

contraction to the beginning of the next

Duration time from the start of a contraction

to the end of the contraction

Intensity

External palpation

Internal mmHg


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Remember

Look at the big picture: Always think about prenatal

history and physical assessment data when

evaluating strip

There are several basic cook-book interventionsyou will see used with a non-reassuring FHR. Be

prepared to help with repositioning, O2

administration, etc.

Experienced RNs often consult one another whenevaluating strips. Dont be afraid to ask questions.


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Questions?

fetal monitoring orientation day-1

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