Chapter 14: Fetal Monitoring

Question 1

What do the invervals between the dark lines respresent on a FHR tracing?

Answer 1

1 minute

Question 2

what is displaying on the tracing paper?

Answer 2

• upper: FHR in response to contractions
• lower: uterine activity

Question 3

what are 2 ways we can assess FHR?

Answer 3

• 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

Question 4

What is external fetal monitoring?

Answer 4

• 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)

Question 5

what types of thing affect the tocotransducer?

Answer 5

• fetal size
• abdominal fat thickness
• maternal position
• fetal position
• location of transducer

Question 6

how often and how long to chart external contraction monitoring?

Answer 6

depends on whether the mom is low risk or high risk and what stage of labor they are in

Question 7

Where do you place the tocotransducer and ultrasonic transducer?

Answer 7

• tocotransducer: over the fundus
• ultrasonic transducer: over the fetal back

Question 8

how do we determine where to put the transducers for EFM?

Answer 8

• 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

Question 9

what is involved with internal fetal monitoring?

what does it require?

Answer 9

• 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

Question 10

What does the intrauterine pressure catheter (IUPC) look at?

Answer 10

• uterine activity:
  
  • contraction intensity
  • resting tone of the uterus

Question 11

Internal Contraction Monitoring

Answer 11

• 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

Question 12

how to count contraction frequency?

duration?

Answer 12

• frequency: start of one contraction to another
• duration: length of one contraction from increment to decrement

Question 13

what to evaluate on an EFM strip?

Answer 13

• FHR baseline
• variability
• periodic changes (decels)
• clinical context
• maternal contractions:
  
  • frequency and duration (if external monitor)
  • intensity and resting tone (if internal monitor)

Question 14

what is baseline FHR?

Answer 14

• should be between 110-160
• evaluate on a 10 min strip
• round to nearest 10 bpm
• assess between contractions

Question 15

what is variability in FHR?

Answer 15

• change in baseline FHR
• it is the difference b/w the lowest and highest beat to beat over 1 minute

Question 16

how to interpret variability?

Answer 16

• absent: 0-2 bpm
• minimal: 3-5 bpm
• moderate: 6-25 bpm
• marked: >25 bpm

Question 17

what are the causes of decreased variability?

Answer 17

• fetal sleep wake states
• medication: narcs, sedatives
• hypoxia/acidosis
• fetal anomalies

Question 18

why is variability so important?

Answer 18

• Adequate oxygenation promotes normal function of ANS and helps fetus adapt to labor
• Variability evaluates the fetal ANS, esp the parasympathetic branch

Question 19

what is fetal bradycardia?

why does it occur?

Answer 19

• <110 bpm
• why?
  
  • late fetal asphixia
  • maternal hypoTN
  • prolonged cord compression/prolapse

Question 20

fetal bradycardia: interventions

Answer 20

• 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

Question 21

what is fetal tachycardia?

why does it occur?

Answer 21

• >160 bpm
• why?
  
  • maternal fever
  • fetal infection
  • dehydration
  • fetal anemia
  • congenital heart condition
  • medications: terbutaline (tocolytic)

Question 22

fetal tachycardia: interventions

Answer 22

• change maternal position
• O2 at 8-10 L/min
• notify physician
• evaluate whole monitoring strip, because could be prolonged accelerations

Question 23

what is acceleration?

Answer 23

• 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

Question 24

what is deceleration?

Answer 24

• transient dec in FHR
• occurrence is r/t pathophysiology

Question 25

What are early decels?

Answer 25

* gradual decrease in FHR * mirrors uterine contraction * starts and ends with contraction

Question 26

what is the interpretation of early decels?

Answer 26

* can be benign * may indicate head compression

Question 27

nursing care w/ early decels

Answer 27

* continue to monitor * vaginal exam

Question 28

mechanism of early decel

Answer 28

* pressure on fetal head--\> * inc intracranial pressure--\> * alteration in cerebral blood flow--\> * vagal N stimulation--\> * FHR deceleration

Question 29

what is a variable decel?

Answer 29

* 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

Question 30

why does variable decels occur?

Answer 30

* 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)

Question 31

mechanism of variable decels

Answer 31

* umbilical cord compression--\>drop in fetal systemic BP and HR

Question 32

nursing care for variable decels

Answer 32

* change position * d/c oxytocin * administer O2 * inc fluids * vaginal exam * notify healthcare provider * amnioinfusion

Question 33

what are late decels?

Answer 33

* gradual decrease * decrease after acme (peak) and recovers after contraction ends * shifted to the right: often begin after peak in contraction * nonreassuring

Question 34

why do late decels occur?

Answer 34

* uteroplacental insufficiency * maternal hypoTN * chronic HTN and GDM

Question 35

nursing care for late decels

Answer 35

* change position * d/c oxytocin * administer O2 * inc fluids * notify health care provider

Question 36

VEAL CHOP

Answer 36

* **V**ariable Decels--\>**C**ord Compression * **E**arly Decels--\>**H**ead compression * **A**ccelerations--\>**O**xygenation * **L**ate Decels--\>**P**lacental Insufficiency

Question 37

FHR Indicators: Reassuring

Answer 37

* indicates adequate fetal oxygenation * accelerations in FHR * moderate variability

Question 38

FHR Indicators: Non-Reassuring

Answer 38

* indicates deficient fetal oxygenation * repetitive decels in FHR * minimal variability w/ no accelerations * bradycardia