fetal auscultation

Question 1

why do we auscultate the fetal heart

Answer 1

• Environments
  
  • Lungs
  • Heart
  • Vasculature
  • Uterus
  • Cord
    Placenta

Question 2

how do we auscultate the fetal heart

Answer 2

• Pinnard stethoscope
  
  • Doppler
    Fetal cardiotocograph

Question 3

antenatal

Answer 3

• For at least one full minute
  
  • Recorded as a single rate
  • Palpate maternal pulse to differentiate
    Record accelerations and decelerations if heard

Question 4

intrapartum

Answer 4

• At first contact and each further assessment
  
  • For at least for a full min immediately after contraction
  • Recorded as a single rate
  • Palpate maternal pulse to differentiate
  • Every 15 minutes in first stage of labour
    Every 5 mins second stage of labour

Question 5

what does the foetus rely on

Answer 5

• Fetus relies on gaseous exchange within the placenta
  
  • Contraction affects gaseous exchange
  • High fetal HB contraction supports adaptations to changes
    Well grown , term fetus , compensates readily

Question 6

what are acceleration and deceleration’s

Answer 6

Acceleration - abrupt increase in baseline rate greater then 15bpm for 15 seconds
Deceleration - abrupt decrease in baseline rate then 15bpm for 15 seconds

Question 7

benefits of a doppler

Answer 7

• Widely available
  
  • Easy to use
  • Less invasive
  • Suitable in pool
  • Inexpensive
  • Comfortable for women
    Freedom for movemen

Question 8

disadvantages of a doppler

Answer 8

• Consumables
  
  • Challenging in some situations
  • Does not provide visual
  • No document recorded
  • Signal quality
  • Transducer placement
    May require servicing

Question 9

Why do we need a guided approach to auscultation

Answer 9

• Lack of simple system of documentation
  
  • Inconsistency between midwives
  • Unexpected poor outcomes and cord gases
    Notes not reflecting Fetal heart

Question 10

Four principles of IIA

Answer 10

• Assess level of care on admission
  
  • Ongoing assessment of fh
  • Confidence to identify hypoxia in low risk labours
    Clear documentation and evidencing

Question 11

Care in established labour

Answer 11

Once in established labour the fh auscultation should occur immediately after a contraction
Be vigilant for signs of hypoxia (lack of oxygen)
Every 15 min in first stage
Every 5 min in second

Question 12

what should you do if their are rising baselines

Answer 12

• Carry out auscultation more frequently
  
  • Consider full clinical picture
  • Maternal position
  • Hydration
  • Vital signs
    Frequency of contractions

Question 13

Rising baseline or decelerations confirmed

Answer 13

• Help and escalate
  
  • Transfer women to obstetric led care
  • Carry out CTG - explain to women
    If trace is reassuring remove CTG