OB Basic Electronic Fetal Heart Monitoring

• Fetal oxygenation
• Acid-base status of the fetus
• Ability of the CNS to regulate FHR

Why monitor --> prevention of hypoxi/asphyxia

• Cerebral Palsy
• Mental Retardation
• Epilepsy
• RDS
• Renal Damage --> lack of perfusion to kidney
• NEC (Necrotizing Enterocolitis)
• Chronic Brain Impairment

Top device --> Toco tranducer (senses uterine activity      NO GEL

Bottom device --> Ultrasound (senses fetal heart beat)   GEL

External: Ultrasound

Internal: Fetal scalp electrode (FSE)

External: Toco

• Internal: Interuterine pressure catheter (IUPC)
•        only one that can measure intensity!

BOW must be ruptured

Cervix must be dilated to 3 cm

IUPC

Palpate the fundus

• Tip of nose --> mild
• Chin --> Moderate
• Forehear --> strong

Top --> FHR

Bottom --> contractions

Tetany --> uterus is almost vibrating from contractions!!

Decrease perfusion to the baby

RUPTURE!!

Baseline heart rate

Variability

Periodic changes

Tachycardia means there is still some fight left in him, bradycardia means he is giving up

110-160 for 10 min

Brady = <110 for > 10 min

Tachy = >160 for > 10 min

Transient increases above the FHR baseline

• Fetal movement
• Contractions

Always positive/reassuring!!!

• Gradual onset before peak of contraction
• Return to baseline before end of contraction
• Uniform in shape, similar to one another

Mirror!!

Head compression --> inc ICP, vagal nerve resp

May indicate CPD (head get stuck!)

Not associated with hypoxia or acidosis

• U, V, or W in shape; varied shape
• Variable in duratio, timing, depth, not uniform

Cord Compression

• Position change
• Vag exam to rule out prolapsed cord
• Stop oxytocin
• Anticipate amnioinfusion
• Notify MD

• Get 1000 cc NS from the warmer
• Use IUPC to administer
• Start with 500mL bolus
• ROA --> 125 cc/hr

Replacing diminished amniotic fluid levels (helps prevent cord compression)

Helps to dilute/flush meconium-stained amniotic fluid

• Decent of FHR begins after contraction
• Delayed onset. Also delayed return to baseline. Late recovery

Utero-placental insufficiency

Ominous

• Lateral Positioning  (Left side)
• Stop oxytocin
• oxygen
• IV fluid bolus  --> volume for baby
• notify MD
• anticipate rapid delivery

Placenta rips from uterine wall

Infection!!

Fight or flight response

• Squiggliness of the FHR tracing
• Baseline variability is a measure of the interplay (push-pull effect) between the sympathetic and the parasympathetic nervous systems)

Lack of Variability is ominous

the best indicator of fetal well-being!!!

Variable decels

• Category 1: Normal
• Category 2: Indeterminate
• Category 3: Abnormal

• 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

• 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

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

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