Fetal Assessment in labor

1. Fetal Assessment in labor

2. Objectives • Compare fetal heart rate monitoring done by intermittent auscultation and external and internal electronic methods. • Explain baseline fetal heart rate. • Identify reassuring fetal heart rate patterns. • Describe preventative measures that can be used to maintain fetal heart rate patterns within normal limits. • Understand the concepts of timing, frequency, duration, terminology and physiology of uterine contractions. • Identify signs of non-reassuring fetal heart rate patterns, describe nursing interventions used for the management of specific fetal heart rate patterns, and discuss the etiology and rationale.

3. Why monitor?

4. Fetal Oxygenation • During labor the fetus can be deprived of oxygen. How the infant tolerates this must be monitored.

7. Electronic Fetal Monitoring (EFM) • External • Ultrasound transducer • Tocotransducer • Internal • Spiral electrode • Uterine catheter

10. Fetal Heart Rate Controlled by autonomic nervous system • Sympathetic increases FHR • Parasympathetic decreases FHR

11. Baseline fetal heart rate    Average rate during 10 minute segment 110 – 160 beats per minute 130 120

12. Tachycardia • >160 • Early sign of fetal hypoxia • Increased maternal temperature • PPROM • drugs 190 170 150

13. Bradycardia • <110 • Later sign of fetal hypoxia • Decreased maternal blood pressure • Prolonged umbilical cord compression • terminal 100 80 60

14. FHR Baseline Characteristic • Variability of FHR • Increased: early, mild sign of hypoxia and fetal stimulation • Decreased: sleep state, hypoxia, acidosis, CNS depressant medications (ominous if caused by hypoxia or associated with late decelerations) 130 120

15. Baseline fetal heart rate • Variability • Irregular fluctuations in FHR baseline • Rythmic wave cycles

16. Characteristics of reassuring fetal heart rate (FHR) pattern FHR between 110-160 Normal baseline variability Absence of non-reassuring changes (decelerations) • Accelerations of FHR with Fetal movement

17. Other Fetal Heart Rate Changes • Accelerations occur spontaneously and with fetal movement and indicate fetal well-being.

18. FHR Accelerations  15bpm 15bpm

19. Characteristics of Normal Uterine Activity • Contractions every 2 to 5 minutes •  Duration of contractions less than 90 seconds • Intensity of contractions less than 100 mm Hg pressure • 60 seconds or more from end of one contraction to beginning of another • intrauterine pressure of 15 mm Hg or less between contractions

21. Early Decelerations

22. Late decelerations

23. Variable Decelerations

24. Factors associated with reduction of fetal oxygen supply Reduction of blood flow through maternal vessels ctxs, BP, BP, hypovolemia • Reduction of oxygen content in maternal blood • Hemorrhage, severe anemia •  Alteration in fetal circulation • Cord compression – transient, prolonged • Placenta separation, head compression (ICP and vagal nerve stimulation  FHR • Reduction of blood flow to intervillous space in placenta • calcifications

25. Non-reassuring fetal heart rate patterns • §  Progressive  or  in baseline • §  Tachycardia • §  Decrease in baseline variability, loss of variability • §  Severe variable decelerations • §   Late decelerations • §   Prolonged deceleration • §   Severe bradycardia

26. Nursing actions when non-reassuring FHR pattern occurs • Change mom’s position • Increase perfusion • Correct maternal hypotension • Position, fluids, drugs • Elevate hips • Increase blood return • Increase rate of IV • Increase circulating volume • Discontinue oxytocin, if infusing • Possibly give tocolytics • Administer oxygen at 10 liters minute via face mask • Firm, tight fitting face mask

27. Non-reassuring FHR • Prepare for emergency delivery if pattern cannot be corrected

28. Assessment of Fetal Well-being • Scalp Stimulation • Vibroacoustic

29. http://utilis.net/fhm/2405.htm

30. The End