fetal monitoring

• non-invasive assessment, measures approximate duration and frequency of contractions
• may restrict mothers movements
• provides record of fetal heart rate
• cannot detect short term variability
• Internal monitoring: indicated for women considered high risk
• Internal monitoring: involves placement of an electrode on the fetal presenting part to assess fetal heart rate
• Internal monitoring: 4 criteria

  1. ruptured membranes
  2. cervical dilation of at least 2 cm
  3. presenting fetal part low enough to identify correctly and allow placement
  4. skilled practitioner
• Internal monitoring: short term and long term variability, unaffected by maternal movements
• FRH observed between contractions over a 10 minute period, rounded to increments of 5bpm
• tachycardia: FHR over 160 for longer than 10 minutes
• Bradycardia: FHR under 110 for longer than 10 minutes
• Interpreting FHR tracing

  • uterine activity
  • labour process
  • Baseline FHR
  • baseline variablity
  • periodic changes in FHR
• Marked: more than 25 bpm variability
• Moderate: 6-25 bpm variability, where you want to be
• Minimal: 5 and under bpm variation
• absent: no detectable variations
• acceleration: increase in FHR of 15 bpm about the FHR baseline that lasts for at least 15-30 sec
• acceleration: sign of fetal well-being when they accompany fetal movement
• acceleration: may occur before, during, or after a contration
• acceleration: are good things
• Decelerations: decrease in FHR below the baseline FHR
• Decelerations: further defined according to onset and duration

  • early
  • variable
  • late
  • prolonged
• acceleration: caused by increased maternal activity, spontaneous fetal movement
• accelerations: monitor but no nursing interventions required
• Early deceleration: good, vasalvagal response, baby is starting to descent, should mirror contraction
• Wha type of deceleration is this?

  early

  
• Late deceleration: placental insufficiency
• What type of deceleration is this?

  late

  
• Variable decelerations: umbilical cord compression, rapid, sudden drop
• what type of deceleration is this?

  variable

  
• Prolonged deceleration: less than 15 bpm and lasts 2 minutes but less than 10 minutes from onset to baseline
• What type of deceleration in this?

  prolonged decelerations

  
• Prolonged deceleration: caused by placental insufficiency, uterine rupture, cord compression, entanglement, or prolapse, maternal hypotension, cervical exam
• Decelerations: nursing intervention: if continued distress: intrauterine resuscitation is required, if not improvement, facilitate delivery of baby
• intrauterine resuscitation: change maternal position, notify primary healthcare provider, if receiving oxytocin stop it or decrease amount, administer IV fluid bolus if ordered, preform vaginal exam, administer oxygen, modify breathing, reduce maternal anxiety
• Reassuring patterns:

  • normal baseline FHR, presence of short-term and long-term variability
  • presence of accelerations with fetal movements or contractions
  • early decelerations may be noted in active labor
• Non-reassuring patterns:

  • abnormal baseline FHR
  • severe bradycardia or tachycardia
  • absence of variability late deceleration
  • severe variable decelerations
  • prolonged decelerations