Chapter 6 Assessment of Fetal Health

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Chapter 6Assessment of Fetal Health
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Prenatal Fetal Assessment

• Why do antepartum testing?
• See fast focus 6-1

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Prenatal Fetal Assessment table 6-1

• Diagnostic techniques and nursing considerations
• Diagnostic (obstetric) ultrasound
• Doppler ultrasound blood flow
• Chorionic villi sampling
• Amniocentesis
• Percutaneous cord blood sampling
• Nonstress test (NST)
• Contraction stress test (CST)
• Biophysical profile (BPP)
• Vibroacoustic stimulation test
• Psychologic reactions to diagnostic testing may
  produce fear anxiety allow time for questions
  discussion

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Fetal Assessment During Labor

• Fetal monitoring during labor is used to identify
  the healthy fetus vs the fetus showing signs of
  compromise measures the response of the FHR to
  uterine contractions
• Intermittent FHR monitoring
• used for low risk pregnancies/labors see box
  6-2
• uses a doppler or fetal monitor
• advantages places fewer restrictions on
  maternal activity
• some health care providers feel legally
  vulnerable doing intermittent auscultation there
  is a tendency to monitor FHR continuously

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Fetal Assessment During Labor

• Continuous electronic fetal monitoring
• can detect changes problems immediately
  intervene there is a higher incidence of
  C-sections due to problems found
• data is transcribed on a continuous strip of
  graph paper or recorded in the computer-fig 6-5
• The nurses role
• reassuring heart rate pattern reflects adequate
  oxygenation
• nonreassuring heart rate pattern indicate
  presence of fetal distress, appropriate nursing
  measures should be taken fast focus 6-2
• documentation of interventions done on the
  strip as well as the medical record

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Fetal Assessment During Labor

• Types of electronic monitoring
• External skill 6-2, fast focus 6-3, fig 6-8
• Internal fig 6-9, fast focus 6-4
• Relation of FHR to uterine contractions during
  labor periodic changes fig 6-10
• accelerations
• decelerations ( early late)
• variable decelerations

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Reassuring and Nonreassuring FHR Patterns table
6-2

• Normal pattern /reassuring pattern heart rate of
  110-160 beats/min beat to beat variability is
  between 6 25 beats/min, no decelerations
• Accelerations brief, temporary increases in FHR
  of at least 15 beats/min above the baseline sign
  of fetal well being
• Decelerations transitory decreases in FHR from
  the baseline labeled in relation to uterine
  contractions
• Early
• Late
• Variable

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EARLY DECELERATIONS

• Fig 6-10, A
• Slowing of FHR when contraction begins returns
  to normal at the end of contraction
• Mirrors contraction
• Caused by head compression during contraction
  vaginal exam or fundal pressure
• No intervention required

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Late Deceleration

• Fig 6-10, C
• Slowing of FHR after the contraction begins, when
  uterine blood flow is at a minimum recover to
  normal is delayed, until uterine blood flow has
  resumed
• Causes utero-placental insufficiency
  inadequate fetal oxygenation maternal HTN
• Interventions change to side lying position,
  start O2 10L/min by MASK correct hypotension if
  possible discontinue oxytocin infusion notify MD

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Variable Decelerations

• Fig 6-10, B
• An abrupt, transient drop in FHR before, during,
  or after uterine contraction related to brief
  compression of the umbilical cord
• Causes cord compression, short cord, prolapsed
  cord, cord around neck, oligohydramnios
• Intervention Change maternal position, apply 02
  if FHR does not respond, correct hypotension if
  possible, notify MD if measures do not work,
  amnioinfusioin

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FETAL PULSE OXIMETRY

• A transcervical catheter placed against the fetal
  cheek level should be between 40 70
• Anything less than 30 may indicate fetal
  acidosis require rapid delivery of fetus
• Amniotic membranes must be ruptured cervix
  dilated to at least 2 cm

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Amnioinfusion

• Intrauterine infusion of warm normal saline or
  Ringers lactate after ROM
• To decrease cord compression increase fluid if
  oligohydramnios present dilute intrauterine
  meconium lessen risk of meconium aspiration
• Contraindicated with prolapsed cord, vaginal
  bleeding, severe fetal distress
• Must use an infusion pump for accurate
  administration
• Underpads used to absorb extra drainage