Assessment of Fetal Wellbeing

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Assessment of Fetal Well-being

• Monitoring techniques
• Intermittent auscultation How to document
• Electronic Fetal Monitoring (EFM)
• External Monitoring
• Internal Monitoring

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Instrumental Methods of FHR Assessment

• Fetoscope
• Doppler
• Ultrasound
• Spiral Electrode

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Fetal Factors Influencing FHR

• Parasympathetic Nervous System
• Sympathetic Nervous System
• Baroreceptors
• Chemoreceptors
• CNS states

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FHR Patterns

• Baseline Fetal Heart Rate Average rate during a
  10 minute segment. (110-160)
• Tachycardia
• Bradycardia
• Variability (usually viewed together)
• Short term(beat to beat)
• Long term(cycles from baseline)

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Examples of Variability
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Display of Fetal Heart rate and Uterine Activity
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Periodic and Episodic Changes in FHR

• Accelerations Change above the baseline rate
  (abrupt) note the specific indicators for an
  acceleration.
• Causes sympathetic nervous response or breech
  presentation Episodic caused by fetal movement
• Deceleration Early, late or variable
• Early deceleration usually compression of fetal
  head

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Examples of Fetal Heart Accelerations
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Examples of Decelerations
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Clinical Diagnoses - Bradycardia

• Fetus at high risk of impaired gas exchange
• Maternal anxiety
• Alteration in Maternal comfort

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Variability

• Long Term Variability (LTV) appears as rhythmic
  fluctuations or waves
• 6-25 beats is normal
• Marked is greater than 25 beats
• Minimal is change of 0-5 beats
• Absent is less than 2bpm from baseline
• Decreased LTV indicates hypoxia, nerogenic
  problems or fetal sleep state

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Short Term Variability

• Described as present or absent
• Usually pattern is audible

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Obstetrics Diagnoses

• Fetal High Risk for impaired uteroplacental gas
  exchange and hypoxia
• Fetal Risk for inadequate perfusion
• Maternal anxiety

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Periodic FHR Patterns

• Variable Decelerations
• History
• Physical findings
• Pattern characteristics
• Indicative of fetal well-being
• Indicative of fetal compromise

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Variable Decelerations

• Fetus at High Risk for impaired gas exchange
• Interventions
• Maternal Position
• Administer O2
• Alter moms breathing/pushing technique
• Amnioinfusion
• Document Events

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Variable Decelerations

• Maternal Anxiety r/t fetal status
• Interventions
• Calm manner
• Explain
• Reassure
• Evaluate

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Late Decelerations

• History etiology
• Uteroplacental insufficiency
• Impeded maternal blood flow to placenta
• Physical findings
• Shape
• Pattern
• Deceleration onset
• Variability

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Obstetrics Diagnosis

• Fetus at high risk for impaired gas exchange
• Interventions
• Position of the client
• IV fluid
• Oxygen
• Decrease uterine activity
• Communicate
• Document

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Early Decelerations

• History probably etiology
• Physical findings
• Shape
• Pattern
• Deceleration onset
• Variability and timing

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Early Decelerations

• Maternal Anxiety r/t fetal status
• Interventions
• Vaginal Exam
• Reassure
• Continue to observe
• Document

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Accelerations

• History probable etiology
• Physical findings
• Pattern characteristics
• Clinical findings
• Things to consider

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Health Education

• Maternal Support and education
• Standards of care
• Evaluate clients previous experiences with fetal
  assessment
• Explain techniques
• Answer questions and explain the data obtianed