Electronic Fetal Monitoring Standard of Care

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Electronic Fetal Monitoring
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Fetal Oxygenation
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Placental Physiology

• Maternal blood flows through the uterine arteries
  into the intervillous spaces then return
  through uterine veins to maternal circulation
• Fetal blood flows through the umbilical arteries
  into the villous capillaries and returns through
  the umbilical vein to fetal circulation.
• Exchange of blood gases depends on an
  unobstructed blood flow through the placenta.

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Uteroplacental exchange

• As the myometrium contracts, the flow of
  oxygenated blood through the uterine artery may
  be decreased.
• Therefore, the fetus may have less oxygen
  available.

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Regulation of Fetal Heart Rate

• Autonomic nervous system
• Baroreceptors
• Chemoreceptors
• Adrenal Gland
• Central Nervous System

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Methods of Electronic Monitoring
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Methods of Fetal Monitoring
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Auscultation by Doppler
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External Monitoring
The ultrasound device is placed over the area of
the fetal back. This device transmits information
about the FHR.
The tocodynamometer (toco) is placed over the
uterine fundus. The toco provides information
that can be used to monitor uterine contractions.
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Internal Monitoring

• Methods
• Scalp (spiral) electrode (SE)
• Intrauterine Pressure Catheter (IUPC)
• Criteria for Internal Monitoring
• Amniotic membranes must be ruptured
• Cervix dilated 2 cm.
• Presenting part down against the
• cervix

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Internal Monitoring
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Monitoring Patterns
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Baseline Fetal Heartrate Normal
Pattern

• Baseline FHR 120 160 bpm

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Patterns

• 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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Variability

• Normal/ increased variability or irregularity of
  a cardiac rhythm.
• Absence or decreased variability, or a smooth
  flat baseline, is a sign of fetal compromise.

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Causes of Decreased Variability
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Accelerations
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Periodic changes in the FHR

• Accelerations increase in the fetal heart rate
  with a return to baseline.
• Indication of fetal well-being is an acceleration
  of 15 bpm for 15 seconds.

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Reassuring Acceleration Pattern
Baseline fetal heart rate is 120-160 with
preserved beat-to-beat variability. Accelerations
last for 15 or more seconds above baseline, and
peak to 15 or more bpm.
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Decelerations
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Periodic changes in the FHR
Decelerations

• Early related to head compressions.
  Interventions not necessary
• Variable related to cord compression.
  Interventions vary, but focus on position
  changes.
• Late related to uteroplacental insufficiency.
  Most ominous and need immediate attention.

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Early Deceleration
The onset and return of the deceleration coincide
with the start and end of the contraction.
Fetal Heart Rate
Contractions
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Early Decelerations

• Related to Head Compression
• Intervention
• No intervention necessary. Just continue to watch
  for any changes.

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Variable Deceleration

• Variable decelerations are variable in duration,
  intensity, and timing

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Variable Decelerations

• Related to cord compression
• Intervention
• Reposition
• Amnioinfusion

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Late Deceleration

• The fetal heart tones return to the baseline
  AFTER end of contraction

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Late Decelerations

• Related to decreased uteroplacental perfusion

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Nursing Care for Late or Prolonged Decelerations

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

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Nursing Care

• Notify the primary care provider
• If condition does not improve, then prepare for
  immediate delivery

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Fetal Scalp Stimulation

• Gently stroke or massage fetal scalp for 15 sec.
  during a vaginal examination
• Assess fetal tracing for signs of accelerations
  of 15 bpm for 15 sec.
• This is a sign of fetal well-being

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Cord Blood Analysis

• Criteria
• Significant abnormal FHR
• Meconium stained amniotic fluid
• Infant is depressed at birth
• Small amount of blood obtained from the umbilical
  artery and vein
• Arterial samples are the best indicator of fetal
  oxygenation

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Review
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Monitoring Uterine Tone

• External monitoring (toco)
• Mild
• Moderate
• Firm
• Internal monitoring (IUPC)
• Pressure in mmHg

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Monitoring Uterine Activity

• Frequency
• Duration
• Intensity
• Resting tone

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Categorizing Fetal Monitor Strips
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• Category I
• Category II
• Category III
• See handout

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Review
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Review
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Review