FHR

• Intrapartum Electronic Fetal Monitoring (EFM)


  A procedure in which instruments are used to record the heartbeat of the fetus and the contractions of the woman's uterus during labor (CTG), or record the heartbeat of the fetus and the fetal movement (NST)

  
• Non-stress test (NST)


  Monitors an unborn baby's heart rate for 20 to 30 minutes to see if it changes as the fetus moves and during contractions

  
• Indications for EFM


  • Previous history of stillbirth (dead fetus)
  • Complications of pregnancy
  • Induction of Labor
  • Preterm labor
  • Non-reassuring fetal status; fetal movement
  • Meconium staining of amniotic fluid

  
• Internal or direct fetal monitoring

  By applying a bipolar electrode to the skin of the fetal scalp, the cervix has to be dilated and membranes ruptured
• Auscultation


  Use of the Doppler or fetoscope (a listening device) to assess the FHR by listening. This method can detect the baseline, rhythm, increase, and decrease in the FHR

  
• Research evidence supports the use of intermittent auscultation (IA) as a method of fetal surveillance during labor for low-risk pregnant

  
• External fetal monitoring


  Uses an ultrasound device to detect FHR and a pressure device to assess uterine activity

  
• Cardiotocogram (CTG)


  Ultrasonic gel, abdominal belt, and monitor paper are used
• Normal fetal heart rate range

  120–160 b/m

  
• Bradycardia


  Less than 120 b/m
• Severe bradycardia


  Less than 100 b/m
• Tachycardia


  Greater than 160 b/m for two contraction cycles or longer than 5 minutes

  
• Causes of tachycardia


  • Fetal hypoxia
  • Maternal fever
  • Prematurity
  • Maternal or Fetal infection
  • Maternal dehydration
  • Maternal hyperthyroidism
  • Fetal anemia
  • Fetal arrhythmia (more common with fetal heart rates greater than 200 b/m)

  
• Baseline FHR fluctuations


  Rise & fall of two cycles per minute or greater, is a reassuring sign of fetal well-being

  
• Normal variability


  5 – 25 b/m
• Deceleration


  Transitory (temporary) decrease in the FHR from the baseline of at least 10–15 b/m
• Early deceleration


  Visually apparent gradual decrease in FHR below the baseline, with the nadir occurring at the same time as the peak of the uterine contraction. Caused by pressure on fetal head, vagal response. Interventions not necessary.

  
• Variable deceleration


  Sudden decrease in FHR below baseline, FHR is 15 b/m lasting 15 seconds and 2 minutes in duration. Caused by cord compression.
• Causes of variable deceleration

  • Oligohydramnios
  • Rupture of membranes
  • Short cord or true knot
  • Occult prolapse of cord
  • Maternal positioning
  • Second stage labor with descent

  
• Interventions for variable deceleration

  1. Vaginal Exam rule out prolapse

  2. Position change

  3. IV fluids

  4. Oxygen 10 l/mask

  5. Turn pit (Oxytocin) off or down

  6. Assess fetal response

  7. Call MD

  
• Late deceleration


  Gradual decrease of FHR below the baseline, with the nadir occurring after the peak of the contraction. Caused by uteroplacental insufficiency.
• Late deceleration often indicates metabolic acidosis and needs urgent response
• Interventions for late deceleration

  1. Lateral position, (usually left works best)

  2. Increase IV fluids

  3. Oxygen 10 l/mask

  4. Determine cause, and correct if possible

  5. Assess fetal response

  6. Prepare for possible delivery

  
• Acceleration


  Rapid increase in FHR above baseline with onset to peak of the acceleration less than < 30 seconds and less than 2 minutes in duration
• Types of accelerations


  • Associated with fetal movements
  • Associated with uterine contractions
  • Prolonged: Increase in heart rate lasts for 2 to 10 minutes
  • Early: Occurring within 20 seconds after a fetal movement, indicating a healthy response to stimulation
  • Late: Occurring more than 20 seconds after a fetal movement, suggesting a possible hypoxic stress response
  • Variable: Irregular in shape and timing, not associated with movement, and may require further evaluation

  
• The absence of accelerations for more than 80 minutes correlates with increased neonatal morbidity (illness). Fetal scalp stimulation can be used to induce accelerations.
• Reactive NST


  When the fetus' heart rate accelerates (increases) when it moves or during contraction, indicating that fetal heart rate reacts to movement

  
• Nonreactive NST


  When the fetus' heart rate doesn't increase with movement or it doesn't move at all. Additional tests can help determine why the fetus wasn't active during the non-stress test.

  
• Some Medications can also cause nonreactive NST results.
• The midwife is responsible for the care of women during pregnancy, childbirth, postpartum period, and newborn.
• Midwives are trained to assess normal physiological changes that occur throughout pregnancy, labor, birth, and postpartum periods.