Fetal Monitoring

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Fetal Monitoring

• Ann Hearn RNC, MSN
• 2010

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Electronic Fetal Monitoring
Standard of Care

• Nurses who care for women during the childbirth
  process are legally responsible for correctly
  interpreting FHR patterns, initiating appropriate
  nursing interventions based on the pattern seen,
  and documenting the outcome of those
  interventions.

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Placental Physiology

• Maternal blood flow
• Fetal blood flow
• Gas/substance Exchange
• Contractions affect

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Placental Physiology
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Fetal Heart Rate Monitoring Devices

• Fetoscope

• Hand held dopple

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Electronic Fetal Monitor
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Methods of Fetal Monitoring

• Intermittent auscultation
• Continuous external
• Continuous internal

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Patterns of Fetal Heart Rate Monitoring
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Fetal Heart Rate

• Baseline FHR 110 160 bpm
• Average rate over 10 minutes
• Tachycardia baseline above 160 BPM
• RT maternal fever, fetal hypoxia, intrauterine
  infection, drugs
• Bradycardia baseline below 110 BPM
• RT profound hypoxia, anesthesia,
  beta-adrenergic blocking drugs

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Electronic Fetal Monitor Paper
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Fetal Heart Rate Variability

• Normal irregularity of the cardiac rhythm.
• Absence of variability, or a smooth flat baseline
  is a sign of fetal compromise.
• A determinant of fetal wellbeing.

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Fetal Heart Rate Variability
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Periodic Changes of FHR

• Acceleration
• Deceleration

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Acceleration

• Increase in the fetal heart rate from baseline by
  15 bpm lasting 15 seconds or more.
• A determinant of fetal wellbeing

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Reassuring Fetal Heart Rate Pattern
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Deceleration

• Decreases in the fetal heart rate from the normal
  baseline.
• Variable
• Early
• Late
• Prolong

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Deceleration

• Variable related to cord compression.
  Interventions vary.
• Late related to utero-placental insufficiency.
  Immediate intervention.
• Early related to head compressions.
  Interventions not necessary.
• Prolong lasts gt 2 minutes. Interventions
  necessary.

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Early Deceleration
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Variable Deceleration
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Late Deceleration
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Prolong Deceleration

• Fetal heart rate deceleration that lasts greater
  than 2 minutes.
• Sinusoidal Pattern (Undulating)
• Fetal heart rate repeating cycle of upward
  increase in the heart rate followed by a decrease
  in the rate.

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Prolonged Deceleration

• Sinusoidal Pattern

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Nursing Care for FHR
Decelerations

• Reposition Turn woman to a side-lying position,
  or knee- chest position. Avoid supine position
• Hydrate Increase rate of mainline IV
• Decrease uterine activity
• Stop Pitocin infusion
• Give Terbutaline sub-q.
• Oxygenate Provide oxygen by mask at 10 L/min.

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VEAL CHOP

• Variable
• Early
• Acceleration
• Late

• Cord
• Head
• Okay
• Placenta

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Review
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Review
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Review
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Review
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Review
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Review
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Review
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Review
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Review
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• The End