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What does fetal monitoring tell us?
- Fetal oxygenation
- Acid-base status of the fetus
- Ability of the CNS to regulate FHR
Why monitor --> prevention of hypoxi/asphyxia
What are the consequences of Inutero Hypoxia/Asphyxia?
- Cerebral Palsy
- Mental Retardation
- Renal Damage --> lack of perfusion to kidney
- NEC (Necrotizing Enterocolitis)
- Chronic Brain Impairment
Describe the device placement for External monitoring
Top device --> Toco tranducer (senses uterine activity NO GEL
Bottom device --> Ultrasound (senses fetal heart beat) GEL
What are the 2 devices used for monitoring fetal heart rate?
Internal: Fetal scalp electrode (FSE)
What are the 2 devices used to monitor contractions?
- Internal: Interuterine pressure catheter (IUPC)
- only one that can measure intensity!
What are two things that must happen before an IUPC can be placed?
BOW must be ruptured
Cervix must be dilated to 3 cm
What is the only way to measure the intensity contractions objectively?
How can a nurse measure the strength of a contraction subjectively?
Palpate the fundus
- Tip of nose --> mild
- Chin --> Moderate
- Forehear --> strong
On a FHR strip...
what is the top tracing?
What is the bottom tracing?
Top --> FHR
Bottom --> contractions
How do you count contractions?
What happens to uterine perfusion during contractions?
What can happen if a mother is given too much petocin during labor?
Tetany --> uterus is almost vibrating from contractions!!
Decrease perfusion to the baby
What are the 3 important components of the fetal heart rate strip
Baseline heart rate
Why is tachycardia better than bradycardia in a fetus?
Tachycardia means there is still some fight left in him, bradycardia means he is giving up
What is a normal heart rate for a fetus?
What constitutes bradycardia?
What constitutes tachycardia?
110-160 for 10 min
Brady = <110 for > 10 min
Tachy = >160 for > 10 min
What are accelerations?
Transient increases above the FHR baseline
- Fetal movement
What are early decels?
- Gradual onset before peak of contraction
- Return to baseline before end of contraction
- Uniform in shape, similar to one another
Head compression --> inc ICP, vagal nerve resp
May indicate CPD
(head get stuck!)
Not associated with hypoxia or acidosis
What are variable decels?
- U, V, or W in shape; varied shape
- Variable in duratio, timing, depth, not uniform
What are the interventions for Variable Decels?
- Position change
- Vag exam to rule out prolapsed cord
- Stop oxytocin
- Anticipate amnioinfusion
- Notify MD
Describe how you would set up an amnioinfusion?
- Get 1000 cc NS from the warmer
- Use IUPC to administer
- Start with 500mL bolus
- ROA --> 125 cc/hr
What is an amnioinfusion used for?
Replacing diminished amniotic fluid levels (helps prevent cord compression)
Helps to dilute/flush meconium-stained amniotic fluid
What are Late decels?
- Decent of FHR begins after contraction
- Delayed onset. Also delayed return to baseline. Late recovery
What are the interventions for late decels?
- Lateral Positioning (Left side)
- Stop oxytocin
- IV fluid bolus --> volume for baby
- notify MD
- anticipate rapid delivery
What is a placental abruption?
Placenta rips from uterine wall
What is the #1 cause of tachycardia in a fetus?
Fight or flight response
What is variability?
Lack of Variability is ominous
- Squiggliness of the FHR tracing
- Baseline variability is a measure of the interplay (push-pull effect) between the sympathetic and the parasympathetic nervous systems)
Variability is _______________
the best indicator of fetal well-being!!!
What type of periodic change would you expect to see:
True knot in the cord
What are the 3 categories of Intrapartum fetal heart rate patterns?
- Category 1: Normal
- Category 2: Indeterminate
- Category 3: Abnormal
Describe Category 1 (Normal) FHR pattern
- Tracing shows ALL of the following:
- Baseline FHR 110-160 BPM, moderate FHR variability, accelerations may be present or
- absent, no late or variable decelerations, may have early decelerations
Strongly predictive of normal acid-base status at the time of observation. Routine care
Describe Category 2 (Indeterminate) FHR pattern
- The fetal heart rate tracing shows ANY of the following:
- Tachycardia, bradycardia without absent variability, minimal variability, absent variability
- without recurrent decelerations, marked variability, absence of accelerations after stimulation, recurrent variable decelerations with minimal or moderate variability, prolonged deceleration > 2minute but less than 10 minutes, recurrent late decelerations with moderate variability, variable decelerations with other characteristics such as slow return to baseline
- Not predictive of abnormal fetal acid-base status, but requires continued surveillance
- and re-evaluation
Describe Category 3 (Abnormal) FHR tracing
The fetal heart rate tracing shows EITHER of the following:
Sinusoidal pattern OR absent variability with recurrent late decelerations, recurrent variable decelerations, or bradycardia
Predictive of abnormal fetal-acid base status at the time of observation. Depending on the clinical situation, efforts to expeditiously resolve the underlying cause of the abnormal fetal heart rate pattern should be made
Describe a Sinusoidal Fetal Heart Pattern
A sinusoidal fetal FHR pattern is defined as a pattern of fixed, uniform fluxuations of the FHR that creates a pattern resembling successive geometric sine waves. Characterized by the absence of variability. Associated with increased perinatal morbidity and mortality and poor perinatal outcome.
- V variable C cord
- E early H head
- A acceleration O ok
- L late P placental insufficiency