Fetal Monitoring Orientation Day-1
Fetal Monitoring Orientation Day-1
Fetal Monitoring Orientation Day-1
Labor is a physiologic stress to fetuses Fetal monitoring allows the health-care team to evaluate fetal response to labor Monitoring is predictive of infants post-delivery status
FHR Baseline
Normal FHR 110-160 Rounded to increments of 5 bpm The FHR baseline excludes periodic or episodic changes (accelerations & decelerations) periods of marked variability segments of baseline that differs by >25bpm
Fetal Bradycardia
baseline of <110 bpm for at least 10 minutes
Fetal Tachycardia
baseline of >160 bpm for at least 10 minutes
Variability
Fluctuations in the baseline Variability represents a mature, intact nervous system pathway through the brain, vagus nerve, and cardiac conduction system *The most significant indicator of fetal wellbeing Reflects the fetal oxygen reserve
Variability
Absent Amplitude range undetectable Minimal Amplitude range < 5 bpm Moderate Amplitude range 6-25 bpm Marked Amplitude range >25 bpm
Absent Variability
Non-reassuring fetal heart status Notify the provider immediately Prepare for c-section
Minimal Variability
Fetal sleep (cycles usually < 30 minutes) Maternal drugs: Nubain or Stadol for pain, tranquilizers, barbiturates, ETOH Hypoxia: evaluate for potential causes Prematurity
Moderate Variability
Reassuring Fetus has good oxygen reserve.
Moderate Variability
Marked Variability
Hypoxia/acidosis reduced oxygen to the fetus Second stage of labor/pushing phase
Accelerations
Increase of FHR 15 bpm above baseline for at least 15 seconds (15x15). This is reassuring. The fetal heart rate accelerates when the fetus moves.
Decelerations
Variable Early Late Prolonged
Variable Decelerations
Variable Decelerations
An abrupt decrease in FHR of > 15 bpm The onset of the deceleration to the nadir of the contraction is < 30 seconds *Caused by cord compression May occur with or without the contraction
Variable Decelerations
Variable Decelerations
*Reposition Notify physician Amnioinfusion Discontinue oxytocin Oxygen per face mask Consider vaginal exam
Early Decelerations
Early Decelerations
Gradual decrease in FHR with onset of deceleration to nadir >30 seconds. The nadir occurs with the peak of a contraction. Benign, often indicative of fetal descent *Caused by head compression No nursing interventions indicated, but consider getting prepared for delivery of infant
Early Decelerations
Late Decelerations
Late Decelerations
Gradual onset of a deceleration (> 30 seconds from onset to nadir); the nadir of the deceleration occurs after the peak of the contraction Non-reassuring if the late decelerations are recurrent *Cause: uteroplacental insufficiency
Late Decelerations
Late Decelerations
Prolonged Decelerations
More than 2 minutes in duration
Prolonged Deceleration
Contractions
Frequency of contractions is timed by counting the minutes from the beginning of one contraction to the beginning of the next Duration of contractions is measured by counting the seconds between the onset and ending of a contraction Strength of the contractions is measured by palpation when you have an external monitor. Internal monitors measure the strength in mmHg.
Contractions
Contractions
ALWAYS remember that external tocotransducers are used only as a rough tool to time contractions and MUST be combined with palpation of abdomen.
Contractions
Contractions
Summary
FHR Baseline 110-160 Tachycardia >160 for 10 minutes Bradycardia <110 for 10 minutes Variability
Absent Amplitude range undetectable Minimal Amplitude range < 5 bpm Moderate Amplitude range 6-25 bpm Marked Amplitude range >25 bpm
Decelerations
Variable cord compression Early head compression Late uteroplacental insufficiency Prolonged-- > 2 minutes
Contractions
Frequency time from the beginning of one contraction to the beginning of the next Duration time from the start of a contraction to the end of the contraction Intensity
External palpation Internal mmHg
Remember
Look at the big picture: Always think about prenatal history and physical assessment data when evaluating strip There are several basic cook-book interventions you will see used with a non-reassuring FHR. Be prepared to help with repositioning, O2 administration, etc. Experienced RNs often consult one another when evaluating strips. Dont be afraid to ask questions.
Questions?