Fetal monitoring basics
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Fetal Monitoring Basics. NUR 134 M. Johnston, RN-BC, M.Ed. Types of Monitoring. Auscultation- listen to fetal heart rate (FHR) Electronic Fetal Monitoring – use of instruments to record FHR and uterine contractions(U/Cs). Auscultation.

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Fetal Monitoring Basics

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Fetal monitoring basics

Fetal Monitoring Basics

NUR 134

M. Johnston, RN-BC, M.Ed.


Types of monitoring

Types of Monitoring

Auscultation- listen to fetal heart rate (FHR)

Electronic Fetal Monitoring – use of instruments to record FHR and uterine contractions(U/Cs)


Auscultation

Auscultation

  • Doppler - ultrasound converts sounds waves to signals of fetal heart

  • Fetoscope- Like stethoscope, open end pressed on abdomen, used less frequently


Electronic fetal monitoring

Electronic Fetal Monitoring

  • Measures response of FHR to uterine contractions (U/Cs)

  • Intermittent or Continuous

  • External

    • Ultrasound transducer

    • Tocotransducer

  • Internal

    • Fetal Scalp Electrode

    • Intrauterine Pressure Catheter


Fetal monitoring setup

Fetal Monitoring Setup

http://www.youtube.com/watch?v=DvcDXvlCXAE&feature=player_embedded


Fetal heart rate characteristics

Fetal Heart Rate Characteristics

  • Evaluate to determine fetal status

  • NICHD terminology

    • Baseline Rate

    • BaselineVariability

    • Accelerations (present or absent)

    • Decelerations (present or absent)

    • Changes or trends over time


Baseline bl

Baseline (BL)

  • Normal range 110-160 bpm

  • Measure between U/Cs for 10 min. period

  • Tachycardia - >160 bpm for >10 minutes

  • Bradycardia - <110 bpm for >10 minutes


Classifications of fhr variability

Classifications of FHR Variability

  • Fluctuations in FHR, irregular in frequency and amplitude

    • Absent 0-2 bpm

    • Minimal >2 <6 bpm

    • Moderate 6 -25 bpm

    • Marked >25 bpm


Accelerations

Accelerations

  • Abrupt increase in FHR above BL

  • Present or Absent

  • < 32 wks gestation

    • Peak ≥ 10 bpm above BL for at least 10 sec.

  • >32 wks gestation

    • Peak ≥ 15 bpm above BL for at least 15 sec.

  • Accel ≥ 10 min. is defined as BL change


Accelerations1

Accelerations

  • Abrupt increase in FHR above BL

  • Peak ≥ 15 bpm above BL for at least 15 sec.


Types of decelerations

Types of Decelerations

  • Early – Gradual decrease and return to BL,mirrors the U/C

  • Variable – Abrupt (<30 sec) decrease (≥15 sec down, lasting ≥ 15 sec and <2 min from onset to return to BL)

  • Late – Gradual decrease (≥30 sec) and gradual return to BL; delayed timing nadir occurs after peak of U/C

  • Prolonged – Decrease in FHR below BL ≥15 sec, lasting ≥ 2 min. but <10 min.


Early deceleration

Early Deceleration

  • Gradual decrease and return to BL

  • Mirrors the U/C


Variable deceleration

Variable Deceleration

  • Abrupt (<30 sec) decrease (≥ 15 sec down, lasting ≥ 15 sec and < 2 min. from onset to return to BL)


Late deceleration

Late Deceleration

  • Gradual decrease (≥ 30 sec) and gradual return to BL

  • Delayed timing, nadir occurs after peak of U/C


Prolonged deceleration

Prolonged Deceleration

  • Decrease in FHR below BL ≥ 15 sec, lasting ≥ 2 min. but < 10 min.


Fetal heart rate interpretation system

Fetal Heart Rate Interpretation System

Normal

Indeterminate

Abnormal


Fhr interpretation

FHR Interpretation

  • Information about fetal oxygenation/placental function

  • Somewhat subjective

  • Abnormal patterns may need further testing


Monitoring uterine contractions

Monitoring Uterine Contractions

  • Assess U/C pattern while assessing FHTs

  • External

    • Palpation

    • EFM Toco measures frequency, duration

    • Noninvasive

  • Internal

    • Intrauterine pressure catheter (IUPC)

    • Measures exact intrauterine pressure

    • Invasive


Why monitor

Why Monitor?

  • FHR changes in response to oxygenation, gestation, and certain stimuli

  • EFM provides more objective data than auscultation

  • Infers information about current and ongoing fetal oxygenation


Interventions

Interventions

  • Abnormal FHR pattern:

    • Change maternal position

    • Give oxygen via mask

    • Increase IV fluids

    • Consider medication to relax uterus


Other fetal surveillance

Other Fetal Surveillance

  • Non-Stress Test (NST) - EFM

  • Contraction Stress Test (CST) - EFM

  • Biophysical Profile (BPP) - U/S

  • Doppler Flow Studies/Growth - U/S

  • Fetal Movement Count-maternal sensation/palpation


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