NURS 2410 UNIT 2

1. NURS 2410 UNIT 2 Nancy Pares, RN, MSN Metro Community College

2. External Electronic Uterine Monitoring: Advantages • Noninvasive • Easy to place • May be used before and following rupture of membranes • Can be used intermittently • Provides a permanent, continuous recording

3. External Electronic Uterine Monitoring: Disadvantages • The nurse must compare subjective findings with monitor • The belt may become uncomfortable • The belt may require frequent readjustment • The mother may feel inhibited to move

4. Internal Electronic Uterine Monitoring: Advantages • Provides pressure measurements for contraction intensity and uterine resting tone • Allows for very accurate timing of UCs • Provides a permanent record of the uterine activity

5. Internal Electronic Uterine Monitoring: Disadvantages • Membranes must be ruptured and adequate cervical dilation must be achieved • Invasive • Increases the risk of uterine infection or perforation • Contraindicated in cases with active infections • Use with a low-lying placenta can result in placenta puncture

6. Figure 23–3 INTRAN Plus intrauterine pressure catheter. There is a micropressure transducer (electronic sensor) located at the tip of the catheter and a port for amnioinfusion at the distal end of the catheter. SOURCE: Photographer: Elena Dorfman.

7. Auscultation: Advantages • Uses minimum instrumentation • Is portable • Allows for maximum maternal movement • Convenient and economical

8. Auscultation: Disadvantages • Can only provide the baseline fetal heart rate, rhythms, and obvious increases and decreases • Does not provide a permanent record

9. External Electronic Fetal Heart Monitoring: Advantages • Produces a continuous graphic recording • Can show the baseline, baseline variability, and changes in the FHR • Noninvasive • Does not require rupture of membranes

10. External Electronic Fetal Heart Monitoring: Disadvantages • Is susceptible to interference from maternal and fetal movement • May produce a weak signal • Tracing may become sketchy and difficult to interpret

11. Internal Electronic Fetal Heart Monitoring: Advantages • Clearer tracings • Provides information about short term variability

12. Internal Electronic Fetal Heart Monitoring: Disadvantages • Infection • Injury • Requires ruptured membranes and sufficient cervical dilatation

13. Leopold’s Maneuvers • Is the fetal lie longitudinal or transverse? • What is in the fundus? Am I feeling buttocks or head? • Where is the fetal back? • Where are the small parts or extremities? • What is in the inlet? Does it confirm what I found in the fundus? • Is the presenting part engaged, floating, or dipping into the inlet?

14. Figure 23–7 Leopold’s maneuvers for determining fetal head position, presentation, and lie. NOTE: Many nurses do the fourth maneuver first to identify the part of the fetus in the pelvic inlet.

15. Figure 23–7 (continued) Leopold’s maneuvers for determining fetal head position, presentation, and lie. NOTE: Many nurses do the fourth maneuver first to identify the part of the fetus in the pelvic inlet.

16. Figure 23–7 (continued) Leopold’s maneuvers for determining fetal head position, presentation, and lie. NOTE: Many nurses do the fourth maneuver first to identify the part of the fetus in the pelvic inlet.

17. Figure 23–7 (continued) Leopold’s maneuvers for determining fetal head position, presentation, and lie. NOTE: Many nurses do the fourth maneuver first to identify the part of the fetus in the pelvic inlet.

18. Fetal Heart Rate (FHR) • Baseline FHR • Mean FHR during 10 minute period • Must be observed for 2 minutes • Changes in FHR • Episodic – not associated with uterine contractions • Periodic – associated with uterine contractions

19. Figure 23–10 Top, An FHR tracing obtained by internal monitoring. Normal FHR range is 110 to 160 bpm. This tracing indicates an FHR range of 140 to 155 bpm. Bottom, A uterine contraction tracing obtained by external monitoring. Each dark vertical line marks 1 minute, and each small rectangle represents 10 seconds. The contraction frequency is about every 3 minutes, and the duration of the contractions is 50 to 60 seconds.

20. Changes in FHR Baseline • Fetal tachycardia • Baseline greater than 160 bpm for at least a 10-minute period • Fetal bradycardia • Baseline less than 110 bpm for at least a 10-minute period

21. NICHD Classification:Baseline FHR • Tachycardia • Bradycardia • Accelerations • Sinusoidal

22. Figure 23–14 Types of accelerations. A, Episodic accelerations. B, Periodic accelerations.

23. Figure 23–14 (continued) Types of accelerations. A, Episodic accelerations. B, Periodic accelerations.

24. NICHD Classification: Baseline Variability (BV) • Absent – amplitude undetected • Minimal – amplitude range detectable but ≤ 5 bpm • Moderate – amplitude range of 6-25 bpm • Marked – amplitude greater than 25 bpm

25. Figure 23–12A and B, Moderate variability. C, Minimal variability. D, Absent variability.

26. Figure 23–12 (continued)A and B, Moderate variability. C, Minimal variability. D, Absent variability.

27. Figure 23–12 (continued)A and B, Moderate variability. C, Minimal variability. D, Absent variability.

28. Figure 23–12 (continued)A and B, Moderate variability. C, Minimal variability. D, Absent variability.

29. NICHD Classifications: Decelerations • Rate of descent • Episodic • Periodic • Early • Late • Variable

30. Figure 23–17 Early decelerations. Baseline FHR is 150 to 155 bpm. Nadir (lowest point) of decelerations is 130 to 145 bpm.

31. Figure 23–19 Late decelerations. Baseline FHR is 130 to 148 bpm. Nadir (lowest point) of decelerations is 110 to 120 bpm. Absent variability.

32. Figure 23–20 Variable decelerations with overshoot. The timing of the decelerations is variable, and most have a sharp decline. A rebound acceleration (overshoot) occurs after most of the decelerations. Baseline FHR is 115 to 130 bpm. Nadir of decelerations is 55 to 80 bpm. Variability is minimal.

33. Intrapartal high-risk factors

34. Intrapartal high-risk factors

35. Frequency of maternal-fetal assessment

36. Contraction and labor progress

37. Frequency of auscultation

38. Electronic fetal monitoring

39. Fetal Dysrhythmias

40. Management of Deceleration

41. Evaluation of Fetal Monitoring: Uterine Contractions • Determine the uterine resting tone • Assess the contractions • What is the frequency? • What is the duration? • What is the intensity (if internal monitoring)?

42. Evaluation of Fetal Monitoring: FHR • Determine the baseline • Determine FHR variability • Determine whether a sinusoidal pattern is present • Determine whether there are periodic changes

43. Nonreassuring Patterns • Variable decelerations • Late decelerations of any magnitude • Absence of variability • Prolonged deceleration • Severe (marked) bradycardia

44. Nursing Interventions for Nonreassuring Patterns • Notify MD/Midwife and document • Change position • Increase IV fluids • Provide oxygen • Tocolytics • Prepare for cesarean or vacuum birth

45. Scalp Stimulation • Direct stimulation to fetal scalp to elicit an acceleration • Uncompromised fetuses will elicit acceleration of at least 15 bpm for 15 • seconds

46. Causes and Sources of Hemorrhage

47. Classification of Abruption

48. Placenta Previa

49. Variations

50. Clues to Contractures