1 / 52

INTRAPARTAL FETAL ASSESSMENT

INTRAPARTAL FETAL ASSESSMENT. Developed by D. Ann Currie, R.N., M.S.N. FETAL MONITORING. ANTEPARTUM ASSESSMENT-FETAL SURVEILLANCE AND DIAGNOSTICS. INTRAPARTUM ASSESSMENT-FETAL SURVEILLANCE AND DIAGNOSTICS. ANTEPARTUM ASSESSMENT OF FETAL HEART RATE. AUSCULTATION-WITH FETOSCOPE OR DOPPLER.

christopher-monroe
Download Presentation

INTRAPARTAL FETAL ASSESSMENT

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. INTRAPARTAL FETAL ASSESSMENT Developed by D. Ann Currie, R.N., M.S.N.

  2. FETAL MONITORING • ANTEPARTUM ASSESSMENT-FETAL SURVEILLANCE AND DIAGNOSTICS. • INTRAPARTUM ASSESSMENT-FETAL SURVEILLANCE AND DIAGNOSTICS.

  3. ANTEPARTUM ASSESSMENT OF FETAL HEART RATE • AUSCULTATION-WITH FETOSCOPE OR DOPPLER. • ELECTRONICAL(EFM)- • NST(NONSTRESS TEST) • CST(CONTRACTION STRESS TEST) • FAST(FETAL ACOUSTIC STIMULATION TEST)

  4. Auscultation of FHR with Doppler

  5. Fetal Acoustic Stimulation Test-FAST

  6. AUSCULTATION OF FHR • FETOSCOPE- • ADVANTAGES-CHEAP • CAN BE DONE ANYWHERE • NO ELECTRICITY

  7. DISADVANTAGES • NOT CONTINOUS • NO HARD COPY OR PERMENANT RECORD • REQUIRES SKILL TO USE FETOSCOPE • UNABLE TO DETERMINE PATTERNS OF FHR • UNABLE TO DETERMINE VARIABILITY.

  8. ELECTRONICALFETALMONITORING(EFM)

  9. EXTERNAL EFM • NONINVASIVE METHOD OF ASSESSING FHR • PERMENANT RECORD OF FHR • CAN BE USED IN THE OUTPATIENT AREAS AND IN THE HOSPITALS. • MOST EQUIPMENT(EFM) IN EL PASO ARE ULTRASOUND TRANSDUCERS.

  10. DISADVANTAGES OF EXTERNAL EFM • NOT AS ACCURRATE AS INTERNAL EFM • CAN ONLY DETERMINE LTV(LONG • TERM VARIABILITY) • IF FETUS OR MOTHER MOVES IT MAY INTERUPT EFM STRIP…READJUST FREQ. • RESTRICTION OF CLIENT’S MOVEMENT

  11. Placement of External Monitor

  12. INTERNAL FETAL MONITORING • FETAL SCALP ELECTRODE • ADVANTAGES- DIRECT FHR • MORE ACCURATE FHR-CLEAR BASELINE,VARIABLITY-STV&LTV • MATERNAL COMFORT • DISADVANTAGES-MUST HAVE ROM. • INCREASE RISK OF INFECTIONS

  13. INTERNAL EFM • CONT. • CAN ONLY BE PLACED IF PRESENTATION IS KNOWN • NO FACE PRESENTATIONS,NO EYES,NOT OVER FONTANELLES,OR ON GENITALS. • CAN NOT BE PLACED WITH MATERNAL HX OF STI’S OR INFECTIONS

  14. INTERNAL EFM • CONT. • CAN NOT BE USED IF PLACENTA LOCATION IS NOT KNOWN OR WITH PLACENTA PREVIA. • PERSONNEL NEEDS TO BE TRAINED TO PLACE INTERNAL SCALP ELECTRODE • STERILE PROCEDURE

  15. FHR BASELINE • FHR BASELINE IS DETERMINED WHEN THERE IS NO CHANGES IN THE FHR- NO ACCELERATIONS OR DECELERATIONS. • FHR BASELINE RATE IS THE RANGE OF FHR-NORMAL IS 110-160. • FHR BASELINE VARIABILITY IS THE VARIABILITY ON BASELINE

  16. Fetal Heart Rate Baseline

  17. FHR BASELINE • NORMAL -110-160 • BRADYCARDIA-UNDER 110 FOR TEN MINUTES • TACHYCARDIA-OVER 160 FOR TEN MINUTES

  18. FHR BASELINE VARIABILITY • SHORT TERM VARIABILITY(STV)-ALSO CALLED BEAT TO BEAT. • ONLY DETERMINED BY INTERNAL EFM • IT IS PRESENT OR NOT. • DOCUMENTING STV-PRESENT OR ABSENT.

  19. FHR BASELINE VARIABILITY • LONG TERM VARIABILITY(LTV)- • RHYTHMIC CYCLES -3-5 CYCLES LONG TERM VARIABILITY(LTV)- • RHYTHMIC CYCLES -3-5 CYCLES PER MINUTE • DESCRIBED AS ABSENT 0-2 BPM ,MINIMAL 3-5BPM, AVE. 6-25 BPM,INCREASED/MARKED OVER 25BPM. • .

  20. Absent Variability

  21. Minimal Variability

  22. Average Variability

  23. PERIODIC FHR CHANGES • ACCELERATIONS- NOTE IN THIS COURSE JUST NOTE THAT THEY ARE PRESENT OR ABSENT. • ACCELERATIONS OF FHR SHOULD GO UP 15-20 BEAT ABOVE BASELINE FOR 15-20 SECONDS. • ACCCELERATIONS INDICATE FETAL WELL-BEING.

  24. ACCELERATIONS • TYPES- SHOULDERS-SEEN WITH VARIABLE DECELERATIONS AND INDICATE WELLBEING • OVERSHOOTS- SEEN AFTER VARIABLE DECELERATIONS INDICATE DISTRESS. • ACCELERATIONS ARE UNDER TEN MINUTES.

  25. Accelerations

  26. Acelerations

  27. EARLY DECELERATIONS • REASSURING • MECHANISM-FETAL HEAD COMPRESSION.,VAGAL REFLEX. • DOCUMENT THEIR PRESENTS • TX: NONE.

  28. Early Deceleration

  29. LATE DECELERATIONS • NONREASSURING • MECHANISM: UTERINE PLACENTA INSUFFICIENCY-FETAL HYPOXIA. • CAUSES: UTERINE HYPERACTIVITY,SUPINE HYPOTENSION, COMPLICATIONS-SLE,DM ETC. • TX:TURN TO SIDE FIRST LEFT IS BEST.

  30. Late Decelerations

  31. LATE DECELERATIONS • TX: TURN TO SIDE, INCREASE FLUID IF OK WITH CLIENT’S CONDITION, OXYGEN,IF PITOCIN RUNNING STOP, NOTIFY DR. IF LATE CONT. BE PREPARED FOR DELIVERY OR C/SECTION, NOTIFY ICN. • DOCUMENT

  32. VARIABLE DECELERATIOS • ABURPT DROP IN FHR AND RETURNS TO BASELINE ABURPTLY • MOST COMMON OR FREQUENT SEEN TYPE OF DECELERATION • MECHANISM: UMBILICAL COMPRESSION. • TX: TURN CLIENT OFF CORD-EITHER TO SIDE OR OTHER POSITIONS

  33. Variable Decelerations

  34. REASSURING FHR PATTERN • BASELINE RATE-110-160 • BASELINE VARIABILITY-AVERAGE • ACCELERATIONS WITH FM OR UC OR STIMULATION. • EARLY DECELERATIONS • NO LATE DECELERATIONS • NO MODERATE OR SEVERE VARIABLE DECELERATIONS

  35. NONREASSURING FHR PATTERN • BASELINE RATE BELOW 110 OR ABOVE160 FOR 10 MINUTES. • BASELINE VARIABILITY-MINIMAL,ABSENT,OR INCREASED. • DECELERATIONS-LATES, MOD-SEVERE VARIABLES,PROLONGED. • NO ACCELERATIONS WITH UC, FM • OVERSHOOTS. • SINUSIODAL PATTERN

  36. Sinusiodal FHR Pattern

  37. Evaluate this EFM strip/What do you think is happening?

  38. What do you think of this EFM Strip?

  39. MONITORING UTERINE ACTIVITY METHODS • EXTERNAL UTERINE MONITORING • INTERNAL UTERINE MONITORING

  40. UTERINE CONTRACTIONS • DEFINIONS OF TERMS • FREQUENCY • DURATION • INTENSITY-1.BY PALPATION 2. IUPC-mmHg.3.MONTEVIDEOUNITS(MVU) • RESTING PERIOD • RESTING TONE(TONUS) -

  41. Uterine Contractions

More Related