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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

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 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.
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
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
  • Biophysical Profile (BPP) - U/S
  • Doppler Flow Studies - U/S
  • Fetal Movement Count-maternal sensation/palpation
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