Chapter 14: Fetal Monitoring Flashcards
What do the invervals between the dark lines respresent on a FHR tracing?
1 minute
what is displaying on the tracing paper?
- upper: FHR in response to contractions
- lower: uterine activity
what are 2 ways we can assess FHR?
- intermittent auscultation (IA)
- 1 min before contraction starts, during contraction, and 2 min after
- mobility, more natural, less costly
- only assessing a small % of labor, maternal obesity/large amniotic fluid V may make it difficult to use
- EFM
- has more data and can help a woman through a contraction
- reduced mobility, may require frequent adjustment
- best identifies a well oxygenated fetus but does not reliably identify a compromised fetus
What is external fetal monitoring?
- non invasive
- perform Leopold’s maneuvers to determine where to put transduccers
- apply the tocotransducer for contractions and ultrasonic transducer (for FHR)
- position client in comfortable position (but avoid supine)
what types of thing affect the tocotransducer?
- fetal size
- abdominal fat thickness
- maternal position
- fetal position
- location of transducer
how often and how long to chart external contraction monitoring?
depends on whether the mom is low risk or high risk and what stage of labor they are in
Where do you place the tocotransducer and ultrasonic transducer?
- tocotransducer: over the fundus
- ultrasonic transducer: over the fetal back
how do we determine where to put the transducers for EFM?
- Leopold’s Maneuvers:
- assesses fetal presentation, position, and lie
- Steps:
- face woman, palpate upper abdomen with both hands, and note shape, consistency, and mobility of part
- fetal head is firm, round, and moves independently of trunk
- fetal buttocks is softer and moves with trunk
- move hands on pelvis and palpate abdomen with deep pressure
- you should feel the fetal back (smooth) on one side and fetal extremities on the other (knobby)
- then, place one hand just above symphysis and note whether palpated part feels like fetal head or buttocks, and whether it is engaged
- face woman’s feet and place both hands on lower abdomen and move hands down the sides of the uterus toward pubis
- note cephalic prominence or brow
- face woman, palpate upper abdomen with both hands, and note shape, consistency, and mobility of part
what is involved with internal fetal monitoring?
what does it require?
- Invasive:
- fetal scalp electrode (FSE): placed on fetal scalp or buttocks (not face, genitals, or fontanels)
- intrauterine pressure catheter (IUPC)
- Requires:
- ROM
- 2-3 cm dilation
- engaged presenting part
What does the intrauterine pressure catheter (IUPC) look at?
- uterine activity:
- contraction intensity
- resting tone of the uterus
Internal Contraction Monitoring
- IUPC: will tell you intensity and resting tone
- more objective, but not perfect
- position in uterus matters
- meconium and vernix can disrupt reading
- chart depending on stage of labor and whether high or low risk
how to count contraction frequency?
duration?
- frequency: start of one contraction to another
- duration: length of one contraction from increment to decrement
what to evaluate on an EFM strip?
- FHR baseline
- variability
- periodic changes (decels)
- clinical context
- maternal contractions:
- frequency and duration (if external monitor)
- intensity and resting tone (if internal monitor)
what is baseline FHR?
- should be between 110-160
- evaluate on a 10 min strip
- round to nearest 10 bpm
- assess between contractions
what is variability in FHR?
- change in baseline FHR
- it is the difference b/w the lowest and highest beat to beat over 1 minute
how to interpret variability?
- absent: 0-2 bpm
- minimal: 3-5 bpm
- moderate: 6-25 bpm
- marked: >25 bpm
what are the causes of decreased variability?
- fetal sleep wake states
- medication: narcs, sedatives
- hypoxia/acidosis
- fetal anomalies
why is variability so important?
- Adequate oxygenation promotes normal function of ANS and helps fetus adapt to labor
- Variability evaluates the fetal ANS, esp the parasympathetic branch
what is fetal bradycardia?
why does it occur?
- <110 bpm
- why?
- late fetal asphixia
- maternal hypoTN
- prolonged cord compression/prolapse
fetal bradycardia: interventions
- notify physician
- perform vaginal exam (check for cord)
- initiate intrauterine resuscitation:
- change maternal position & palpate uterus
- oxygenate: 8-10 L/min
- hydrate w/ inc IV fluids
- assess maternal BP and medicate as needed
- turn Pitocin off (if infusing)
- prepare for possible C/S
what is fetal tachycardia?
why does it occur?
- >160 bpm
- why?
- maternal fever
- fetal infection
- dehydration
- fetal anemia
- congenital heart condition
- medications: terbutaline (tocolytic)
fetal tachycardia: interventions
- change maternal position
- O2 at 8-10 L/min
- notify physician
- evaluate whole monitoring strip, because could be prolonged accelerations
what is acceleration?
- visual, apparent, abrupt inc in FHR (15 beats and <15 seconds)
- occurs with fetal movement
- may or may not be related to uterine contractions
- interpretation: sign of fetal well-being
what is deceleration?
- transient dec in FHR
- occurrence is r/t pathophysiology
What are early decels?
- gradual decrease in FHR
- mirrors uterine contraction
- starts and ends with contraction
what is the interpretation of early decels?
- can be benign
- may indicate head compression
nursing care w/ early decels
- continue to monitor
- vaginal exam
mechanism of early decel
- pressure on fetal head–>
- inc intracranial pressure–>
- alteration in cerebral blood flow–>
- vagal N stimulation–>
- FHR deceleration
- vagal N stimulation–>
- alteration in cerebral blood flow–>
- inc intracranial pressure–>
what is a variable decel?
- abrupt decrease
- dec in FHR is at least 15 bpm and lasts 15 sec but less than 2 min
- vary in occurrence, waveform, and onset
- not uniform in appearance
- V, W, or U shaped
why does variable decels occur?
- cord compression: the HR rises and falls abruptly (w/in 20 sec) w/ the onset and relief of cord compression
- nuchal cord
- cord prolapse (rarely)
mechanism of variable decels
- umbilical cord compression–>drop in fetal systemic BP and HR
nursing care for variable decels
- change position
- d/c oxytocin
- administer O2
- inc fluids
- vaginal exam
- notify healthcare provider
- amnioinfusion
what are late decels?
- gradual decrease
- decrease after acme (peak) and recovers after contraction ends
- shifted to the right: often begin after peak in contraction
- nonreassuring
why do late decels occur?
- uteroplacental insufficiency
- maternal hypoTN
- chronic HTN and GDM
nursing care for late decels
- change position
- d/c oxytocin
- administer O2
- inc fluids
- notify health care provider
VEAL CHOP
- Variable Decels–>Cord Compression
- Early Decels–>Head compression
- Accelerations–>Oxygenation
- Late Decels–>Placental Insufficiency
FHR Indicators: Reassuring
- indicates adequate fetal oxygenation
- accelerations in FHR
- moderate variability
FHR Indicators: Non-Reassuring
- indicates deficient fetal oxygenation
- repetitive decels in FHR
- minimal variability w/ no accelerations
- bradycardia
