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Fetal Monitoring

Fetal Monitoring. Ann Hearn RNC, MSN 2010. Electronic Fetal Monitoring Standard of Care.

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Fetal Monitoring

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  1. FetalMonitoring Ann Hearn RNC, MSN 2010

  2. 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.”

  3. Placental Physiology • Maternal blood flow • Fetal blood flow • Gas/substance Exchange • Contraction’s affect

  4. Placental Physiology

  5. Regulation of FHR • Autonomic nervous system • Baroreceptors • Chemoreceptors • Adrenal gland • Central nervous system

  6. Fetal Heart Rate Monitoring Devices • Fetoscope • Hand held dopple

  7. Electronic Fetal Monitor

  8. Methods of Fetal Monitoring • Intermittent auscultation • Continuous external • Continuous internal

  9. Methods of Fetal Monitoring • External • Ultrasound transducer • Tocotransducer • Internal • Fetal scalp electrode (FSE) • Intrauterine pressure catheter (IUPC)

  10. Internal Fetal Monitoring

  11. Patterns of Fetal Heart Rate Monitoring

  12. 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

  13. Electronic Fetal Monitor Paper

  14. 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.

  15. Fetal Heart Rate Variability

  16. Periodic Changes of FHR • Acceleration • Deceleration

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

  18. Reassuring Fetal Heart Rate Pattern

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

  20. 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 > 2 minutes. Interventions necessary.

  21. Early Deceleration

  22. Variable Deceleration

  23. Late Deceleration

  24. Variable Early Acceleration Late Cord Head Okay Placenta VEALCHOP

  25. 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.

  26. Prolonged Deceleration Sinusoidal Pattern

  27. Interpreting FHR as….. • Reassuring • Accelerations • Moderate variability • Non-reassuring • Tachycardia • Bradycardia • Decreased or absent variability • Late decelerations • Variable decelerations (persistent)

  28. Non-reassuring FHR Tracing • Interventions • Reposition • Oxygen therapy • IV fluid bolus • (Discontinue oxytocin infusion) • Other

  29. Fetal Scalp Stimulation • Used to assess fetal well being. • Procedure: examiner gently sweeps fingers in a circular motion on the fetal scalp • FHR acceleration = well oxygenated fetus and normal acid base balance.

  30. Cord Blood Gases & pH • Analysis used to assess the infant’s acid-base balance immediately after birth.

  31. Review

  32. Review

  33. Review

  34. Review

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  40. The End

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