Chapter 14 pp350- 371 Intrapartum Fetal Surveillance Flashcards
Exam 2
What is the primary goal of intrapartum fetal surveillance?
to enable clinicians to assess adequacy of fetal oxygenation during labor
How has fetal monitoring transitioned over the years?
from “low” technology to “high” technology
What percentage of births in the US are electronically monitored?
89%
Information that is gathered at the bedside assists clinicians with their assessment by:
1.) Evaluation of fetal oxygenation
2.) Decision to implement corrective measures to improve fetal oxygenation.
3.) Provision of a mechanism to optimize communication between clinicians and patients.
4.) Support of clinical decision making which promotes as environment of patient safety and quality care.
Five Factors for adequate fetal oxygenation:
1.) Sufficient maternal blood flow and volume to the placenta.
2.) Normal maternal oxygen saturation.
3.) Adequate exchange of oxygen and carbon dioxide.
4.) An open circulatory path from placenta to fetus through umbilical cord vessels.
5.) Normal fetal circulatory and oxygen-carrying functions.
Uteroplacental circulation
The placenta is a unique vascular organ that receives blood from the circulatory systems of both the pregnant client and the fetus. In other words, there are two separate circulatory systems, maternal–placental (i.e., uteroplacental) blood circulation and fetal–placental blood circulation.
Fetal placental circulation
The umbilical cord links the fetal umbilicus to the placenta’s fetal surface. Protected by Wharton’s jelly, an umbilical cord has three vessels: two arteries and one vein. Oxygenated nutrient-rich blood is carried to a fetus by the umbilical vein and is distributed by the fetal heart throughout the body. Deoxygenated blood and waste products circulate back to a placenta via two umbilical arteries. Three anatomic shunts, ductus venosus, foramen ovale, and ductus arteriosus, allow fetal blood to bypass the fetal liver and lungs. The fetal heart circulates oxygenated blood throughout the fetal body.
What 3 systems influence the Fetal Heart Rate regulation?
*Autonomic nervous system
*Baroreceptors and Chemoreceptors
*Hormonal influences
A light abdominal touch with fingertips over the fundus as a contraction develops is called what?
palpation
Descriptive terms of palpation
soft, mild, moderate, strong
Palpation is what when assessing uterine activity?
subjective
a uterus that is not taut
soft
a uterine fundus that is tense but easily indented, like the tip if a soft nose
mild
feel firm and difficult to indent, comparable to touching a chin
moderate contractions
often feel rigid and challenging to indent like palpating a forehead
strong contractions
Example of Intermittent Fetal Heart Rate Auscultation devices
*fetoscope
*pinard stethoscope
*hard-held doppler ultrasound
FHR is heard best where?
fetal back
When the fetus is cephalic the FHR is heard best where?
lower quadrants below umbilicus
If fetus is breeched the FHR is best heard where?
in upper quadrants above the umbilicus
Benefits of Auscultation and Palpation
- widely available and easy to use with proper training
- less invasive than EFM
- outcomes comparable to EFM in low-risk women
- inexpensive
- atmostphere more natural than technologic
- comfortable for the woman
- oftters women freedom of momvement and ability to ambulate to promote normal labor
- 1:1 nursing care promotes “doula effect” benefits
- allows easy FHR and uterine activity assessment during use of hydrotherapy
EFM
electronic fetal monitoring
These maneuvers provide a systematic method for palpating the fetus through the abdominal wall during the latter part of pregnancy. These maneuvers provide valuable information about the location and presentation of the fetus.
Leopold’s Maneuvers
What are the 4 Leopold’s Maneuvers
1st maneuver: fundal palpation
2nd maneuver: lateral palpation
3rd maneuver: Pallach’s maneuver/ grip
4th maneuver: pelvic palpation
Limitations of Auscultation and Palpation
- difficult to perform in some situations, such as hydraminos and maternal obesity
- client may be intolerant of clincian’s touch during contraction
- doesd not provide a permanent, documented visual record of the FHR or Uterine Activity
- Counting of FHR is intermittent
- Cannot assess visual patterns of FHR variablility or periodic and non-periodic changes
- unable to detemine UA intensity objectively
- significant events, such as prolonged decelerations, may occur during periods when the FHR is not auscultated
- may not allow early detection of FHR changes reflective of hypoxemia
- not recommended for high-risk pregnancies
What is EFM (Electronic Fetal Monitoring) used for?
used to recognize, analyze and display FHR, UA, and maternal vital signs
Types of EFM
external, internal, or combination of both
What does an External EFM do?
collects data via transducers applied to the abdomen
Where is an Internal EFM placed and why?
placed on a fetal presenting part to monitor FHR or within the uterine cavity to measure intrauterine pressure
EFM instrumentation
- Non-electronic intermittent auscultation and palpation
- Electronic bedside fetal monitor and transducers
Non-electronic intermittent auscultation and palpation should be performed how?
in a consistent manner and in accordance with professional guidelines