Title: Fetal Well-being and Electronic Fetal Monitoring
1Fetal Well-being and Electronic Fetal Monitoring
- Fetal Tests
- Fetal Heart Rate
- Decelerations
- Variability
- Fetal Movement Counts
2Ultrasound
- 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
3Fetal 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
4Fetal 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
5Electronic 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
6Electronic 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
7Electronic 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
8Fetal Tachycardia
- Ominous sign if tachycardia is accompanied by
- Late decelerations
- Severe variable decelerations
- Decreased variability
9Fetal 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
10Evaluate 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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13EFM 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)
14EFM Categories
- Category 2 Indeterminate
- Any fetal heart rate pattern not in Category 1 or
Category 2
15Nursing 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
16Nursing 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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18Biophysical Profile
19Non-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
20Non-Stress Test
Example of a reactive nonstress test (NST).
Accelerations of 15 beats per minute lasting 15
seconds with each fetal movement (FM).
21Non-Stress Test
Example of a nonreactive NST. There are no
accelerations of FHR with FM.
22Contraction 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).
23Amniocentesis
- 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
24L/S Ratio
166 Lecithin / Sphingomyelin (L/S) Ratio
and Phophatidylglycerol (PG)
25NCLEX 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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