Fetal Well-being and Electronic Fetal Monitoring

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Fetal Well-being and Electronic Fetal Monitoring

• Fetal Tests
• Fetal Heart Rate
• Decelerations
• Variability
• Fetal Movement Counts

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Ultrasound

• Confirmation of pregnancy and fetal presentation
• Evaluation of fetal heartbeat and fetal
  respiration
• Identification of more than one embryo/fetus
• For examination of anatomical fetal structures
• To estimate gestational age, fetal weight, and
  growth
• Location of the placenta and amniotic fluid
  volume
• Accompanying invasive procedures

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Fetal Activity

• Vigorous fetal activity - provides reassurance of
  fetal well-being
• Marked decrease or cessation in activity
• May indicate possible fetal compromise
• May require immediate follow-up
• Assessment of fetal activity (from week 28 to
  week 38) - noninvasive method of monitoring the
  fetus

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Fetal Movement Counts

• Daily record beginning at 27 weeks gestation
• Count at same time each day 1 hour after meals
• Lie in side-lying position
• Contact health care provider when
• lt10 movements in 3 hours using Cardiff card
• lt 3 movements in 8 hours using daily movement
  record
• No fetal movement in AM
• Fetal movements becoming slower

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Electronic Fetal Monitoring

• Provides continuous data and is routine for
  high-risk clients
• Also used for women experiencing an induction of
  labor
• May be done externally or with an internal
  monitor

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Electronic Fetal Monitoring

• - Indications for
• Previous history of stillborn
• Presence of complication
• Induction of labor, preterm labor
• Decreased fetal movement
• Non-reassuring fetal status
• Meconium staining of amniotic fluid
• Trial of labor following a C-section

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Electronic Fetal Monitoring

• Fetal Heart Rate 110 160 bpm
• Fetal Tachycardia
• Sustained rate of 161 bpm or above
• If rate is 180 bpm or above, is marked
  tachycardia
• Causes
• Early fetal hypoxia
• Maternal fever
• Maternal dehydration
• Chorioamnionitis
• Maternal hyperthyroidism
• Beta-sympathomimetic drugs
• Fetal anemia

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Fetal Tachycardia

• Ominous sign if tachycardia is accompanied by
• Late decelerations
• Severe variable decelerations
• Decreased variability

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Fetal Bradycardia

• Fetal Bradycardia
• less than 110 bpm during a 10-minute period or
  longer
• Causes
• Profound hypoxia in fetus
• Maternal hypotension
• Prolonged umbilical cord compression
• Fetal arrhythmias
• Uterine hyperstimulation
• Abruptio placentae
• Uterine rupture
• Vaginal stimulation in second stage of labor

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Evaluate Fetal Monitoring

• Is baseline within normal limits?
• Is there tachycardia or bradycardia?
• Is variability present or absent?
• If present, is variability Minimal ( 5 bpm)?
  Moderate (6-25 bpm)? Marked (gt 25 bpm)?
• Are there accelerations or decelerations (early,
  late, variable, prolonged) (prolonged decrease
  15 bpm for 2 min but lt 10 min)?

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EFM Categories

• Category 1 - Normal
• FHR 110 160
• No late or variable decelerations
• May see early decelerations
• Category 3 Abnormal
• Absent variability and any of following
• Recurrent and variable decelerations
• Bradycardia
• Sinusoidal pattern (cycle frequency 3 5 minutes
  for gt 20 minutes)

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EFM Categories

• Category 2 Indeterminate
• Any fetal heart rate pattern not in Category 1 or
  Category 2

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Nursing Interventions for Nonreassuring FHR

• Optimize maternal positioning side-lying
• Discontinue oxytocin if indicated
• Give supplemental oxygen if indicated
• Notify physician or midwife
• Administer IV fluids as needed
• Monitor maternal v/s for hypotension and treat
• Elevate HOB 30 degrees
• Initiate continuous monitoring

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Nursing Interventions for Nonreassuring FHR

• Assist with internal monitors as appropriate
• Perform vaginal exam to assess for prolapsed cord
  or labor progress
• Assist physician with fetal blood sampling
• Prepare for expeditious birth
• Provide client and family with explanation
• Administer tocolytic as ordered

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Biophysical Profile
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Non-Stress Test

• Used to assess fetal status using an electronic
  fetal monitor
• Based on the knowledge
• Well-oxygenated fetus has adequate oxygenation
• Intact central nervous system
• Increase in fetal heart rate (FHR) with fetal
  movement
• Reactive NST Two accelerations of FHR over 20
  minutes
• Nonreactive Less than 2 accelerations over 40
  minutes
• Unsatisfactory Cannot be interpreted

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Non-Stress Test
Example of a reactive nonstress test (NST).
Accelerations of 15 beats per minute lasting 15
seconds with each fetal movement (FM).
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Non-Stress Test
Example of a nonreactive NST. There are no
accelerations of FHR with FM.
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Contraction Stress Test
Example of a positive contraction stress test
(CST). Repetitive late decelerations occur with
each contraction. Note that there are no
accelerations of FHR with three fetal movements
(FM).
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Amniocentesis

• Nursing care Assist the physician during
  amniocentesis
• Support the woman undergoing the procedure
• Obtain informed consent
• Clarify the physicians instructions or
  explanations
• Obtain baseline vital signs
• Obtain baseline fetal heart rate
• After procedure, review reportable side effects
• Assess vital signs and fetal heart rate

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L/S Ratio
166 Lecithin / Sphingomyelin (L/S) Ratio
and Phophatidylglycerol (PG)
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NCLEX Question

• A biophysical profile result of 4 is reported to
  the physician. Which intervention should the
  nurse plan to do?
• Schedule a repeat BPP for later today.
• Schedule a contraction stress test.
• Instruct in fetal movement counts.
• Prepare for delivery of fetus.

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