Fetal Monitoring Flashcards
Monitor Strip Paper
o Each dark line = 1 minute of time
o Each small red box or unbolded line represents 10 seconds (bpm)
o Each line going up and down horizontally represents a 5-mmHg change
ultrasound transducer
Detects FHR baseline, variability, accelerations, and decelerations
Picks up ultrasound wave that is bounced back off the fetal heart and counts the FHR by the change in ultrasound wave frequency that occurs when the waveform is reflected of the moving heart
tocodynamometer
Measures the frequency and duration of the uterine contractions (UC)
Palpation of contractions = measure the pressure and intensity of UC
placement of ultrasound transducer
Use Leopold’s maneuver to determine the placement
Placed on the woman’s abdomen at the location of the fetus’s back and move the transducer until clear signal and FHR is heard. Secure it with monitor belt
placement of tocodynamometer
Place the TOCO on the fundus of the uterus where the contraction feels the strongest to palpate. Secure with monitor belt
Internal Electronic Fetal Monitoring
o Intrauterine Pressure Catheter
o Fetal scalp electrode (FSE) or internal scalp electrode (ISE)
o Applied to the presenting part of the fetus to directly monitor FHR
o Accurately measures the frequency, duration, intensity, resting tone, and Montevideo units
Documentation of Uterine Activity
Frequency
Duration
Intensity
Resting tone
Uterine Contraction Frequency
Measurement of the onset of one contraction to the onset of the next contraction
Uterine Contraction Duration
Length of a contraction from onset to then end
Uterine Contraction Intensity - external
Strength of contraction measured by palpation
Should be able to document the strength and when they change
Mild - feel tip of the nose
Moderate - feel the chin
Strong - feel the forehead
Uterine Contraction Intensity -internal
Strength of the contraction measured in the amniotic fluid
• Exact quantitative measurement
mmHg – can be reported in the chart
Montevideo units (MVU)
Resting Tone
Uterus muscle should be completely relaxed b/w contractions
Important for the blood flow to be restored to the fetus
o Normal range: 20 – 25 mmHg; relaxed or not by palpation
Tachysystole
Contraction frequency of more than 5 contractions in 10 minutes which may or may not include signs of nonreassuring FHR measurements averaged over 30 minutes
Documentation of FHR Data
Baseline
Variability
Periodic or Episodic Changes
Reoccurrence of patterns
FHR Baseline
o Mean FHR rounded to increments of 5 bpm during a 10-minute segment
Excluding periodic or episodic changes and periods of marked variability
o Baseline duration must be for a minimum of 2 minutes otherwise baseline is indeterminate
o Normal FHR range: 110 – 160 bpm
Tachycardia
> 160 bpm ≥ 10 minutes
causes: fetal anemia, hypoxemia, prematurity, maternal infection
Tachycardia Nursing Interventions
- If maternal fever exists; administer prescribe antipyretics
- Administer oxygen (8 – 10 L/min via nonrebreather mask)
- Monitor the administration of bolus IV fluids
Bradycardia
< 110 bpm ≥ 10 minutes
causes: hypoxemia, hypothermia, vagal stimulation, uterine rupture, prolasped cord, cardiac anomalies, placental abruption