Electronic Fetal Monitoring Standard of Care • “Nurses who care for women during the childbirth process are legally responsible for correctly interpreting FHR patterns, initiating appropriate nursing interventions based on the pattern seen, and documenting the outcome of those interventions.”
Placental Physiology • Maternal blood flow • Fetal blood flow • Gas/substance Exchange • Contraction’s affect
Regulation of FHR • Autonomic nervous system • Baroreceptors • Chemoreceptors • Adrenal gland • Central nervous system
Fetal Heart Rate Monitoring Devices • Fetoscope • Hand held dopple
Methods of Fetal Monitoring • Intermittent auscultation • Continuous external • Continuous internal
Methods of Fetal Monitoring • External • Ultrasound transducer • Tocotransducer • Internal • Fetal scalp electrode (FSE) • Intrauterine pressure catheter (IUPC)
Internal Monitoring • Criteria for Internal Monitoring: • Amniotic membranes must be ruptured • Cervix dilated 2 cm. • Presenting part down against the • cervix Spiral Electrode is placed on the fetal occiput which allows for more accurate continuous data then external monitoring. Also is not affected by mom or fetal movement as with external monitoring.
Internal Monitoring The spiral electrode is attached to the fetal scalp Internal uterine pressure catheter (IUPC) is placed between fetus and the uterine wall.
Nursing Responsibilities Electronic Fetal Monitoring Placement of equipment Teaching the woman about use Notation of events on the strip Evaluation of data Intervention as indicated by data
Fetal Heart Rate • Baseline FHR = 110 – 160 bpm • Average rate over 10 minutes • Tachycardia– baseline above 160 BPM RT= maternal fever, fetal hypoxia, intrauterine infection, drugs • Bradycardia– baseline below 110 BPM RT = profound hypoxia, anesthesia, beta-adrenergic blocking drugs
Fetal Heart Rate Variability • Normal irregularity of the cardiac rhythm. • Absence of variability, or a smooth flat baseline is a sign of fetal compromise. • A determinant of fetal wellbeing.
Periodic Changes of FHR • Acceleration • Deceleration
Acceleration • Increase in the fetal heart rate from baseline by 15 bpm lasting 15 seconds or more. • A determinant of fetal wellbeing
Deceleration • Decreases in the fetal heart rate from the normal baseline. • Variable • Early • Late • Prolong
Deceleration • Variable – related to cord compression. Interventions vary. • Late – related to utero-placental insufficiency. Immediate intervention. • Early – related to head compressions. Interventions not necessary. • Prolong – lasts > 2 minutes. Interventions necessary.
Early Decelerations • Related to Head Compression • Intervention • No intervention necessary. Just continue to watch for any changes.
Variable Decelerations • Related to cord compression • Intervention • Reposition • Amnioinfusion
Late Decelerations Related to decreased uteroplacental perfusion
Nursing Care for FHR Decelerations Stop the Pitocin Reposition - Turn woman to a side-lying or knee-chest position. Avoid supine position Increase rate of the mainline IV Administer oxygen by mask at 10 L/min. Give Terbutaline sub-q. Notify the primary care provider If late decelerations do not improve, prepare for immediate delivery
Variable Early Acceleration Late Cord Head Okay Placenta VEALCHOP
Prolong Deceleration • Fetal heart rate deceleration that lasts greater than 2 minutes. Sinusoidal Pattern (Undulating) • Fetal heart rate repeating cycle of upward increase in the heart rate followed by a decrease in the rate.
Prolonged Deceleration Sinusoidal Pattern
Interpreting FHR as….. • Reassuring (Category I) • Accelerations • Moderate variability • Non-reassuring (Category II or III) • Tachycardia • Bradycardia • Decreased or absent variability • Late decelerations • Variable decelerations (persistent)
Non-reassuring FHR Tracing • Interventions • Reposition • Oxygen therapy • IV fluid bolus • (Discontinue oxytocin infusion) • Other
Fetal Scalp Stimulation • Used to assess fetal well being. • Procedure: examiner gently sweeps fingers in a circular motion on the fetal scalp • FHR acceleration = well oxygenated fetus and normal acid base balance.
Cord Blood Gases & pH • Analysis used to assess the infant’s acid-base balance immediately after birth.
Montevideo Units Montevideo units is a measure of uterine contraction intensity during labor. Units are calculated via internal pressure monitor, measuring uterine contraction peak pressure and subtracting the baseline resting tone. This is done over a 10 minute interval. Generally, above 200 MVUs is considered necessary for adequate labor to bring about dilation and effacement during the active phase.