Fetal Monitoring Flashcards
What is the purpose of monitoring?
- To detect and treat hypoxia asap to prevent acidosis
- See how fetus handles stress
What can decreases O2 to fetus be caused by?
- Contractions
- HTN
- Hypotension
- Hypovolemia
- Anemia
- Alteration in fetal circulation (pinched cord)
- Head compression of fetus
Auscultation
- Done with fetoscope/doppler
- immediately p ROM
- listen during and beyond contraction
- Increase/decrease of 30 bpm indicate distress
- Delay in return to baseline is sign of distress
What are some modes of monitoring?
- External (indirect)
- Internal (direct)
- Intrauterine Pressure Catheter (IUPC)
FM paper
-Each square=10 sec
- Paper speed set at 3 cm/min
- can be set lower for certain circumstances
Parts of EFM
Fetal-Ultrasound
- detects movement of heart not sound - use gel on transducer - Apply to baby’s back
Uterine-Tocotransducer (Toco)
- monitors via pressure button - no gel - apply to fundus (top) of uterus
Benefits of EFM
- continuous and complete
- noninvasive
- can show contraction before pt feels it
- shows fetal movement
- records FHR in relation to contraction
Limits of EFM
- slippage
- keeps pt in bed
- limited (maternal size, position, movement)
- may half or double heart tone
- artifact may show as variability
Types of IFM?
Fetal - spiral electrode
Uterine -IUPC
Spiral Electrode Benefits
- continuous recorded FHR in any position
- accurate STV
- 0 artifact
Spiral Electrode Limits
Can cause infection
-keep clean, s/s: baby tachy
Cord prolapse
IUPC Benefits
Accurate freq, duration, and intensity
Resting tone of uterus
Port for fluid withdrawal or infusion
TOLAC
Trial of labor after c section
VBAC
Vaginal birth after c section
IUPC Limits
invasive
Can cause infection
Catheter obstruction
Placental injury
Frequency
Beginning of contraction to beginning
Duration
Beginning of contraction to end
Hyperstimulation
Interval <60 sec
Peak intrauterine pressure
Peak of contraction
Intensity
Difference between peak and resting tone
Strength
Measure by touching
Mild, medium, or strong
Hypertonus
Resting tone >25 (can rupture uterus if too high)
Interval
End to beginning of contraction (60 sec)
Monte vedeo units (MVU)
Add up intensity of contractions within 10 min period
Tells you if its adequate labor (150-300)
> 300 too strong; potential to rupture
Dystocia
Difficult labor (slow, not doing anything)
NADIR
Peak of depression of FHR
Irritability
squiggly line
d/t dehydration, infection
*Variability
Are short term and long term
Can only be seen on monitor (Cant listen)
Indicates well-being
Long term variability
Absent: 1-3 bmp Minimal: 3-5 bmp Average:6-10 bpm Moderate: 11-25 bpm Marked: >25
Now called - decreased, average, increased
Absent or exaggerated variability
Find out why: acidosis, CNS depression (fentanyl given?), trauma, meds, infection?
If on EFM switch to IFM
d/c pitocin (don’t just turn down), bolus of fluids (makes contraction slower)
What are drugs that can slow contractions?
Terbutaline
Mag, sulfate
What can a early deceleration be due to?
Fetal head compression
What can a late deceleration be due to?
uteroplacental insufficiency
What can a variable deceleration be due to?
Cord compression
Decelerations
At least 15 bpm decrease from baseline lasting 15 sec
Late decelerations
Interventions: lay pt on L side, fluid bolus, O2 by mask (8-10 1/min), check BP, call provider
Risk factors: diabetes, vasoconstriction (ciggs)
Always document decels, interventions, and who you called and what they said
Orders: ephedrine 5-10 mg SLOW for bp; terbutaline 0.25 mg SLOW to slow contractions (can make pt nervous, have beta blocked handy in case of chest pain)
