Electronic Fetal Monitoring Flashcards
What is the purpose of fetal monitoring
To assess the status and well being of the fetus while in the uterus.
External monitors
Fetal transducer belt for FHR
Toco transducer belt for pressure reading but not accurate
Internal monitors
Fetal scalp electrode for FHR
IUPC for activity and contractions and more accurate
Fetal transducer
What does it measure?
What to apply before using?
What should you identify first before placing it?
Fetal transducer measures FHR externally
Apply gel to improve conductivity
Identify fetal back location with Leopold maneuver
- they will confirm w sonogram just in general for PG tho to make sure baby is in cephalic positioning
Toco Transducer
What does this measure?
How accurate is it?
Toco transducer is an external way to help measure the onset, duration, frequency and ending of a contraction.
It will not pick up uterine intensity though, so you will have to feel yourself.
Fetal scalp electrode
What does this measure? And what has to happen before you can use it?
Where is it inserted?
Fetal scalp electrode measures FHR internally.
You must be ruptured and dilated 2cm first .
Inserted internally and on the occipital area of fetus
IUPC
What does this measure? What has to happen before you can use this?
Where is it inserted?
What is resting tonus?
What is resting phase?
IUPC is an internal monitor that measures contractions. It is way more accurate than the external toco.
But bc it is internal, you need to be ruptured and dilated to 2 cm as well (just like with the electrode).
IUPC inserted internally and lies between the uterus wall and fetus
Resting tonus is a relaxed uterus. 10-15 mmhg
Resting phase is the end of the contraction which ends when the next contraction starts. “recovery” for uterus and oxygenation of fetus
Baseline heart rate is what?
Avg FHR?
When trying to figure out the baseline, what should you exclude from your average?
The fetal baseline heart rate is the average FHR recorded in a 10 minute window
Avg is 110-160 at rest
Episodic and periodic changes
(episodic: not caused by contractions)
(periodic: caused by contractions)
Tachycardia
Marked Tachycardia
Causes
FHR greater than 160 for 10 minutes (since theirs is higher)
Marked - FHR greater than 180
Fetal anemia
Infections
Amnionitis
Drugs
Bradycardia
Causes?
FHR lower than 110 for 10 minutes
Maternal hypotension or supine
umbilical cord compression
late fetal hypoxia
What does Variability mean?
Types of variability?
A common cause of decreased variability?
Just a fluctuation in HR. Not a bad thing!!!
- it means the baby is getting enough oxygen
Absent
Minimal - 1-5 bpm
Moderate - 6-25 bpm
Marked - greater than 25
Sleep may be a reason the baby isn’t having variability
What are Accels?
How do you know it’s an accel?
Good things - it’s just the FHR going above the set baseline.
An accel is when the FHR rises by 15 or more and lasts at least 15 seconds. (15 sec rule)
What are decelerations?
List the different types
When the FHR goes below the baseline
Early, Late, Variable, Shoulders, Prolonged
Early decels
How fast is this and what do they mirror?
What is the main cause?
What should the nurse do?
Early decels are gradual and they occur as the same time the contraction is building.
Early’s are from HEAD compression & often occur during labor when you push.
Document them and just monitor. They really aren’t concerning.
Late Decels
How fast and when do the late’s occur?
What causes the late decels?
How does this affect the fetus?
Late decels are gradual decrease in FHR that doesn’t exactly mirror the contractions anymore. The FHR going down occurs after the contraction has already started which means the going back up will be a little late too.
Late decels are usually caused by placental insufficiency so maybe from DB, HTN, or being past the due date since the placenta isn’t meant to go past 40 weeks
So this means there is a slight decrease in blood flow to the fetus
