OB Basic Electronic Fetal Heart Monitoring

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aclift
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249984
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OB Basic Electronic Fetal Heart Monitoring
Updated:
2013-12-01 13:31:01
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OB Block MCC
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OB block 3
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  1. 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
  2. What are the consequences of Inutero Hypoxia/Asphyxia?
    • Cerebral Palsy
    • Mental Retardation
    • Epilepsy
    • RDS
    • Renal Damage --> lack of perfusion to kidney
    • NEC (Necrotizing Enterocolitis)
    • Chronic Brain Impairment
  3. Describe the device placement for External monitoring
    Top device --> Toco tranducer (senses uterine activity      NO GEL

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

  4. What are the 2 devices used for monitoring fetal heart rate?
    External: Ultrasound

    Internal: Fetal scalp electrode (FSE)
  5. What are the 2 devices used to monitor contractions?
    External: Toco

    • Internal: Interuterine pressure catheter (IUPC)
    •        only one that can measure intensity!
  6. What are two things that must happen before an IUPC can be placed?
    BOW must be ruptured

    Cervix must be dilated to 3 cm
  7. What is the only way to measure the intensity contractions objectively?
    IUPC
  8. How can a nurse measure the strength of a contraction subjectively?
    Palpate the fundus

    • Tip of nose --> mild
    • Chin --> Moderate
    • Forehear --> strong
  9. On a FHR strip...

    what is the top tracing?

    What is the bottom tracing?
    Top --> FHR

    Bottom --> contractions
  10. How do you count contractions?
  11. What happens to uterine perfusion during contractions?
  12. 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

    RUPTURE!!


  13. What are the 3 important components of the fetal heart rate strip
    Baseline heart rate

    Variability

    Periodic changes
  14. 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
  15. 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
  16. What are accelerations?
    Transient increases above the FHR baseline

    • Fetal movement
    • Contractions

    Always positive/reassuring!!!
  17. What are early decels?
    • 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
  18. What are variable decels?
    • U, V, or W in shape; varied shape
    • Variable in duratio, timing, depth, not uniform

    Cord Compression

  19. What are the interventions for Variable Decels?
    • Position change
    • Vag exam to rule out prolapsed cord
    • Stop oxytocin
    • Anticipate amnioinfusion
    • Notify MD
  20. 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
  21. What is an amnioinfusion used for?
    Replacing diminished amniotic fluid levels (helps prevent cord compression)

    Helps to dilute/flush meconium-stained amniotic fluid
  22. What are Late decels?
    • Decent of FHR begins after contraction
    • Delayed onset. Also delayed return to baseline. Late recovery

    Utero-placental insufficiency

    Ominous
  23. What are the interventions for late decels?
    • Lateral Positioning  (Left side)
    • Stop oxytocin
    • oxygen
    • IV fluid bolus  --> volume for baby
    • notify MD
    • anticipate rapid delivery
  24. What is a placental abruption?
    Placenta rips from uterine wall
  25. What is the #1 cause of tachycardia in a fetus?
    Infection!!

    Fight or flight response
  26. What is variability?
    • 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
  27. Variability is _______________
    the best indicator of fetal well-being!!!
  28. What type of periodic change would you expect to see:

    True knot in the cord
    Variable decels
  29. What are the 3 categories of Intrapartum fetal heart rate patterns?
    • Category 1: Normal
    • Category 2: Indeterminate
    • Category 3: Abnormal
  30. 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
  31. 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
  32. 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
  33. 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.

  34. Decelerations

    A review!!!
  35. V          C
    E          H
    A          O
    L          P
    • V  variable                C  cord
    • E  early                    H  head
    • A  acceleration          O  ok
    • L   late                     P  placental insufficiency

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