Fetal Monitoring Flashcards by Betty Tapia

Goals of FHR Monitoring

Assess fetal well-being/oxygenation

Assess fetal tolerance of labor

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Intermittent Auscultation

Using fetal doppler or fetoscope

Listen before, during, and for 30 sec after a contraction, to determine how the baby responds to the contraction

Palpate contractions w/ fingertips

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Electronic Fetal Monitoring (EFM)

Continuous tracing of fetal heart rate as well as contraction frequency and duration

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EFM Indications

Complications of pregnancy

Induction of labor (IOL)

Preterm labor

Decreased fetal movement

Meconium (fetal BM in utero)

Concerns about fetal status

Trail of labor after cesarean section (TOLAC/VBAC)

Maternal fever (>100.4)

Placental problems

Category II or III

Previous hx of stillbirth at > or = 38 weeks gestational age

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EFM: External

2 transducer placed on abd.

FHR (US) usually lower belt over fetal back

Contraction (TOCO) monitor placed at top of uterus (fungus)

Monitors FHR & contraction frequency and duration, but NOT contraction intensity

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EFM: Internal

Requires membranes to be ruptured

Fetal Spiral Electrode (FSE) - monitors FHR and attaches to fetal presenting part

Intra-uterine pressure catheter (IUPC) - measures intensity of cix in addition to frequency and duration

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FHR Baseline

Normal range 110-160 bpm

Rounded to 5 bpm, observed in a 10-minute period

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FHR Variability

Refers to the visually apparent fluctuations in the FHR over time (only in baseline)

Considered the most important predictor of adequate fetal oxygenation during labor

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Moderate Variability

Highly predictive of normal fetal acid-base status and intact nervous system, at the time it is observed

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FHR Variability Measurements

Absent = undetectable

Minimal = >0 but ≤ 5 bpm

Moderate = 6-25 bpm

Marked = ≥ 25 bpm

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When are decelerations considered repetitive?

If they occur with ≥ 50% of ctx

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FHR Accelerations

Abrupt increase in FHR in response to:

Fetal movement (exercise)
OR
Ctx

Indicates mature ANS and absence of acidosis

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What is counted as an acceleration?

FHR must increase by ≥ 15 bpm and must last ≥ 15 sec from onset to return to baseline

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What counts as an acceleration if <32 wks gestation?

10 bpm / 10 sec duration

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Types of FHR Decelerations

Early

Late

Variable

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Early Deceleration

Gradual onset

Timing generally coincides w/ ctx - starts when ctx starts and ends when ctx ends

Vagal response to fetal head compression = baby descending into the pelvis

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Late Deceleration

Gradual onset

Delayed timing so that deceleration reaches its lowest point after the peak of the ctx - starts after ctx already started and ends after ctx ends

Fetal response to chronic or transient uteroplacental insufficiency/placenta problem

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Variable Deceleration

Abrupt onset of at least 15 bpm below baseline and at least 15 bpm duration

With or without relationship to ctx; vary in shape, depth, duration, and timing

Fetal response to interrupted umbilical blood flow from cord compression

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FHR Sinusoidal

EMERGENCY!!!

Associated w/ fetal anemia and severe fetal acidemia

Baby needs to be delivered right away - C/S (cesarean)

Contraction Frequency

Measured from the beginning of 1 ctx to beginning of next ctx

Minutes

Contraction Duration

Measured from the beginning to end of one ctx

Seconds

Should not exceed 5 ctx in 10 min, averaged over 30 min

Contraction Intensity

External monitoring

Internal monitoring

ALWAYS use your hands to verify the information provided by the EFM!

External Monitoring

Palpation of indentability of uterus at the funds

Nose = mild ctx

Chin = moderate ctx

Forehead = strong ctx

Categories of FHR Tracings

Category I

Category II

Category III

Category I

Baseline 110-160 bpm Variability: moderate Accelerations: present or absent Early decelerations: present or absent Late or variable decelerations: absent

Category II

All tracings not categorized as I or III Moderate variability w/ recurrent late or variable decelerations Minimal variability w/ recurrent variable decelerations Absent variability WITHOUT recurrent decelerations Bradycardia w/ moderate variability Prolonged decelerations

Category III

Either: Absent variability WITH: - recurrent late declarations OR - recurrent variable declarations OR - bradycardia OR Sinusoidal pattern

Category I Nursing Actions

Routine measures to support labor progress Laboring pt's coping Fetal oxygenation

Category II Nursing Actions

Heightened surveillance Interventions to promote fetal oxygenation Reevaluation POISONS

Category III Nursing Actions

Prompt evaluation and preparation for expeditious birth, with attempts to resolve the abnormal findings POISONS

POISONS

P = Position change - improve BP move baby from compressing something O = Oxygen (nonrebreather mask/ 8-10 L) I = IV fluids bolus - increase volume = increase bp = fetus gets oxygenated S = Stop ctx (terbutaline) O = Off pitocin N = Notify provider S = Sterile vaginal exam (SVE)

Assessment of Fetal Well-Being

Non-stress test (NST) Biophysical profile (BPP)

Non-Stress Test (NST)

Evaluate fetal well-being May be used alone or part of more comprehensive test, BPP

Non-Stress Test Process

20-40 minute duration Pt marks fetal movement Pt placed on fetal monitor

Non-Stress Test Results

Reactive Non-Reactive Unsatisfactory/Equivocal

NST: Reactive

Presence of at least 2 accelerations of 15 bpm above the baseline and lasting at least 15 sec in a 20-minute window

NST: Non-Reactive

Accelerations are not present or do not meet the criteria Fetus is either at risk or asleep

NST: Unsatisfactory/Equivocal

Data cannot be interpreted or there was inadequate fetal activity

A well-oxygenated fetus w/ intact NS will have what?

FHR accelerations with fetal movement

Biophysical Profile (BPP)

Comprehensive assessment of 5 biophysical variables that reflect placental functioning 4 components evaluated by US + NST = 5 variables

What are the 5 variables in a biophysical profile?

Fetal movements - 3 body or limb movements Fetal tone - one episode of active extension and flexion of limbs Fetal breathing movement - episode of ≥ 30 sec in 30 min; hiccups are considered breathing activity Amniotic fluid volume - single 2 cm x 2 cm pocket Non-Stress Test - 2 accelerations > 15 bpm of at least 15 sec

Biophysical Profile Interpretation

Score of 8-10 is considered normal when amniotic fluid is normal 6 = equivocal (unsure & repeat) 4 or less = abnormal

Amniotic Fluid

Production = fetus swallows and then urinates amniotic fluid Polyhydramnios - too much fluid Oligohydramnios - too little fluid

Causes of Polyhydramnios

No apparent cause Swallowing malformations Neurological disorders (anencephaly) Diabetes Rh sensitization

Causes of Oligohydramnios

Placental insufficiency (associated w/ Han, post maturity) Fetal renal malformations Preterm pre labor rupture of membranes

Polyhydramnios Implications

Preterm birth d/t distended uterus Cord prolapse Malpresentation Postpartum hemorrhage Edema and SOB when severe

Oligohydramnios Implications

Fetal skin and skeletal abnormalities d/t impaired fetal movement Fetal pulmonary hypoplasia d/t minimal fluid for practice breathing Cord compression