Fetal Monitorign Flashcards
Fetal Assessment
- primarily focuses on FHR pattern.
- characteristics of amniotic fluid
- Fetal cord blood sampling
- fetal scalp stimulation
SROM
SPONTANEOUS RUPTURE OF MEMBRANES
AROM
ARTIFICIAL RUPTURE OF MEMBRANES
(amnihook)
done by HCP
Green fluid in amniotic fluid
Meconium staining
Normal if breeched
- cause of respiratory failure in Term & post-term infants
MAS
(meconium aspiration syndrome)
What causes MAS (meconium aspiration syndrome)?
- occurs when newborns inhale particulate MECONIUM mixd with amniotic fluid INTO THE LUNGS while still in utero or on the FIRST breath after birth.
- INTRAUTERINE DISTRESS CAUSES PASSAGE OF MECONIUM INTO AMNIOTIC FLUID
- CAUSES RESPIRATORY DISTRESS
how to prevent MAS (meconium aspiration syndrome)
- Suctioning AFTER head is born BEFORE baby takes first breath
- direct tracheal suctioning AFTER birth
When MODERATE-HEAVY meconium is present in placenta, what is done?
- Amnioinfusion: intro of warmed, sterile normal saline (NS) or RINGERS LACTATE solution in uterus
- Assists in preventing MAS
What is used to monitor FETAL HEART RATE (FHR)?
- electronic fetal monitor
- fetoscope modified stethoscope
- doppler US
- Fetal Scalp electrode
Intermittent FHR monitoring involves
- using doppler or fetoscope for periodic assessment of FHR.
- listen for short periods of time at REGULAR INTERVALS.
- does not provide a complete picture of fetal well being.
- 1 full min AFTER a contraction
- listen for 30 sec x 2
does Intermittent FHR monitoring limit mobility?
no. MOM IS. MOBILE
What type of pts are candidates for intermittent FHR monitoring?
- Acceptable option for LOW-RISK laboring women.
When is the BEST time to listen FHR monitoring during ‘Intermittent FHR monitoring’
listen at the end of a contraction (NOT AFTER one) so late decelerations could be detected
Where is FHR best heard?
fetals BACK
What is CEPHALIC
cephalic means head in anatomy
IF fetus is in cephalic position, FHR is in
mothers lower quadrants (R or L)
IF fetus is in BREECH position, FHR is in
above level of maternal umbilicus
To ensure that Maternal HR is not confused with Fetal HR
Palpate the maternal radial pulse simultaneously while auscultating FHR
Guidelines for assessing FHR
- Initial 10 to 20 min continously. FHR upon entry in L&D
- Completion of a prenatal & labor risk assessment
- Intermittent auscultation during active labor
Intermittent auscultation DURING LABOR for lOW-RISK moms is every
Q 30 min
Intermittent auscultation DURING LABOR for HIGH-RISK moms is every
Q 15 min
Intermittent auscultation DURING 2ND STAGE for lOW-RISK moms is every
Q 15 MIN
Intermittent auscultation DURING 2ND STAGE for HIGH-RISK moms is every
Q 5 MIN AND DURING PUSHING STAGE
- CONTINUOUS tracing of the FHR
sound is produced with each heartbeat - provides information about fetal oxygenation
- prevent fetal injury resulting from impaired fetal oxygenation during labor.
Continuous electronic fetal monitoring (EFM)
Disadvantages of EFM (continuous electronic fetal monitoring)
- limits mobility
- needs supine position
Continuous EFM is used on MOMS that are
- Oxytocin infusion
- Epidural analgesia
- Compromised health – mom & baby
- Moderate hypertension >150/100
- Confirmed delay in 1st or 2nd stage of labor
- Prolonged ROM
- ____________ is demonstrated in a heart rate pattern change and is by far the MOST common etiology of fetal injury & death
- can be prevented WITH optimal fetal surveillance during labor & early intervention.
FETAL HYPOXIA
(low levels of O2)
continuous External monitoring is used when
- ROM intact or not.
- no cervical dialation
- dialated cervix
- involves placement of a spiral electrode INTO fetal presenting part (usually parietal bone on head) to ASSESS FHR
- Pressure transducer placed internally within the uterus to record uterine contractions
CONTINUOUS INTERNAL MONITORING
Candidates for cont. internal monitoring
- high risk
- decreased fetal mvmnt
- abnormal FHR on auscultation
- High HR, DM
BAseline FHR is measured by
- occurs during 10-min segment
- done when no contractions
- fetus NOT experiencing episodic FHR changes.
Baseline HR should be
110-160 BPM
higher than an adult.
(adult is 60-100)
fetal bradycardia
- < 110
(lasting > 10 min)
fetal tachycardia
- > 160
(lasting > 10 min)
`
FHR falls into 3 categories.
- Category 1= normal (no intervention needed)
- CAtegory 2= indeterminate
- category 3 = abnormal INTERVENTION NEEDED
type of category for FHR:
- NOT predictive of abnormal fetal acid–base
CATEGORY II
TYPE OF CATEGORY:
- ABNORMAL FETAL ACID-BASE
- REQ. PROMPT EVAL AND Rx
- Requires action on mothers side
CATEGORY III
- EARLY RESPONSE TO ASPHYXIA (suffocation)
- Fetal infection
- maternal fever
CAUSES:
TACHYCHARDIA
HIGH HR.
- Prolonged maternal low BS
- Maternal or fetal low Temp.
- Fetal acidosis
- MOM LOW BP
CAUSES:
BRADYCARDIA
LOW HR
- IRREGULAR fluctuations in the baseline HR (110-160)
- measured amplitude of PEAK TO TROUGH in beats per min.
- push & play Nervous system
baseline variability
VARIABILITY is ONE OF THE MOST IMPORTANT characteristics for
FHR
Variability FHR has 4 categories.
Name them:
4
- absent: undetectable
- minimal: < 5 bpm
- moderate: 6-25 bpm
- marked: >25 bpm
Absent (0 fluctuation= undetectable)
to
Minimal <5 bpm
indicates:
- mom low bp
- fetal problems
poor outcome
interventions for Absent-minimal bpm
- improve MATERNAL blood flow & perfusion
- notify HCP
- prepare for CS if no improvements
Moderate category of 6-25 bpm indicates
- ANS & CNS developed and oxygenated
- fetal well-being
continue to monitor
Marked category of >25 bpm interventions
- not good sign
- determine cause
- increase iv fluid rate
- O2 admin
- notify HCP
Absent fluctuations is
0 fluctuations
(undetectable)
Minimal fluctuations is
fewer 5 bpm
Moderate fluctuations is
6-25 bpm
Marked fluctuations is
more thabn 25 bpm
- transitory abrupt increases in the FHR above the baseline
- associated with sympathetic nervous stimulation
- considered reassuring and require no interventions
FETAL ACCELERATIONS
What is fetal accelerations considered
reassuring
This is good if in the 15x15 rule
Associated with SYMPATHETIC nervous stimulation
(fight-or-flight response)
Fetal Accelerations
FETAL ACCELERATION last
Last < 30 sec from Onset to Peak
Acceleration 15 x 15 rule
What is this rule
Increase of 15 bpm every 15 seconds but less than 2 mins.
What does fetal acceleration mean?
Is this good or bad?
Fetal movement
Fetal well-being
requires no interventions
A transient fall in FHR caused by stimulation of Parasympathetic NS
Fetal Decelerations
Decelerations are described by
thier shape
association to uterine contraction
3 types of Fetal Decelerations
- early deceleration
- variable deceleration
- late deceleration
Mirror contractions
Rarely below 100 bpm
Early deceleration
- Nadir (lowest point) occurs AFTER contractions
- gradual & shallow drops
late deceleration
- Vary in shape, depth, & time
- Abrupt decrease in FHR= QUICK DROPS
- 15 bpm x 15 sec <2 Min.
- Accels. at onset & at end of cont. ( “shoulders”)
- U, V, W shapped - jagged lines
- Not 1 looks like the other
- No apparent association with contractions
Variable decelerations
causes for prolonged deceleration
- Prolonged cord compression
- Supine maternal position
- Fetal blood sampling
- Maternal seizures
- Regional anesthesia
- Abrupt FHR declines
- at least 15 bpm last >2 mins BUT <10 mins
- drops to <90 bpm
Prolonged deceleration
RX for prolonged deceleration
id underlying cause and correct it.
- Visually apparent
- Smooth, wavelike undulating pattern
- Severe hypoxia R/T fetal anemia & hypovolemia
Sinusoidal Pattern
Sinusoidal pattern is considered a category
always category III
RX for sinusoidal pattern
fetal intrauterine infusion
which categories require further analysis
Category II and Category III
What are Other Fetal Assessment Methods
- umbilical cord blood analysis (done at birth- evaluates newborns condition)
- Fetal scalp (vibroacoustic) stimulation (promotes fetal mvmnt to accelerate FHR)
