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INTRAPARTAL FETAL ASSESSMENT

INTRAPARTAL FETAL ASSESSMENT. Developed by D. Ann Currie, R.N., M.S.N. FETAL MONITORING. ANTEPARTUM ASSESSMENT-FETAL SURVEILLANCE AND DIAGNOSTICS. INTRAPARTUM ASSESSMENT-FETAL SURVEILLANCE AND DIAGNOSTICS. ANTEPARTUM ASSESSMENT OF FETAL HEART RATE. AUSCULTATION-WITH FETOSCOPE OR DOPPLER.

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INTRAPARTAL FETAL ASSESSMENT

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  1. INTRAPARTAL FETAL ASSESSMENT Developed by D. Ann Currie, R.N., M.S.N.

  2. FETAL MONITORING • ANTEPARTUM ASSESSMENT-FETAL SURVEILLANCE AND DIAGNOSTICS. • INTRAPARTUM ASSESSMENT-FETAL SURVEILLANCE AND DIAGNOSTICS.

  3. ANTEPARTUM ASSESSMENT OF FETAL HEART RATE • AUSCULTATION-WITH FETOSCOPE OR DOPPLER. • ELECTRONICAL(EFM)- • NST(NONSTRESS TEST) • CST(CONTRACTION STRESS TEST) • FAST(FETAL ACOUSTIC STIMULATION TEST)

  4. Auscultation of FHR with Doppler

  5. Fetal Acoustic Stimulation Test-FAST

  6. AUSCULTATION OF FHR • FETOSCOPE- • ADVANTAGES-CHEAP • CAN BE DONE ANYWHERE • NO ELECTRICITY

  7. DISADVANTAGES • NOT CONTINOUS • NO HARD COPY OR PERMENANT RECORD • REQUIRES SKILL TO USE FETOSCOPE • UNABLE TO DETERMINE PATTERNS OF FHR • UNABLE TO DETERMINE VARIABILITY.

  8. ELECTRONICALFETALMONITORING(EFM)

  9. EXTERNAL EFM • NONINVASIVE METHOD OF ASSESSING FHR • PERMENANT RECORD OF FHR • CAN BE USED IN THE OUTPATIENT AREAS AND IN THE HOSPITALS. • MOST EQUIPMENT(EFM) IN EL PASO ARE ULTRASOUND TRANSDUCERS.

  10. DISADVANTAGES OF EXTERNAL EFM • NOT AS ACCURRATE AS INTERNAL EFM • CAN ONLY DETERMINE LTV(LONG • TERM VARIABILITY) • IF FETUS OR MOTHER MOVES IT MAY INTERUPT EFM STRIP…READJUST FREQ. • RESTRICTION OF CLIENT’S MOVEMENT

  11. Placement of External Monitor

  12. INTERNAL FETAL MONITORING • FETAL SCALP ELECTRODE • ADVANTAGES- DIRECT FHR • MORE ACCURATE FHR-CLEAR BASELINE,VARIABLITY-STV&LTV • MATERNAL COMFORT • DISADVANTAGES-MUST HAVE ROM. • INCREASE RISK OF INFECTIONS

  13. INTERNAL EFM • CONT. • CAN ONLY BE PLACED IF PRESENTATION IS KNOWN • NO FACE PRESENTATIONS,NO EYES,NOT OVER FONTANELLES,OR ON GENITALS. • CAN NOT BE PLACED WITH MATERNAL HX OF STI’S OR INFECTIONS

  14. INTERNAL EFM • CONT. • CAN NOT BE USED IF PLACENTA LOCATION IS NOT KNOWN OR WITH PLACENTA PREVIA. • PERSONNEL NEEDS TO BE TRAINED TO PLACE INTERNAL SCALP ELECTRODE • STERILE PROCEDURE

  15. FHR BASELINE • FHR BASELINE IS DETERMINED WHEN THERE IS NO CHANGES IN THE FHR- NO ACCELERATIONS OR DECELERATIONS. • FHR BASELINE RATE IS THE RANGE OF FHR-NORMAL IS 110-160. • FHR BASELINE VARIABILITY IS THE VARIABILITY ON BASELINE

  16. Fetal Heart Rate Baseline

  17. FHR BASELINE • NORMAL -110-160 • BRADYCARDIA-UNDER 110 FOR TEN MINUTES • TACHYCARDIA-OVER 160 FOR TEN MINUTES

  18. FHR BASELINE VARIABILITY • SHORT TERM VARIABILITY(STV)-ALSO CALLED BEAT TO BEAT. • ONLY DETERMINED BY INTERNAL EFM • IT IS PRESENT OR NOT. • DOCUMENTING STV-PRESENT OR ABSENT.

  19. FHR BASELINE VARIABILITY • LONG TERM VARIABILITY(LTV)- • RHYTHMIC CYCLES -3-5 CYCLES LONG TERM VARIABILITY(LTV)- • RHYTHMIC CYCLES -3-5 CYCLES PER MINUTE • DESCRIBED AS ABSENT 0-2 BPM ,MINIMAL 3-5BPM, AVE. 6-25 BPM,INCREASED/MARKED OVER 25BPM. • .

  20. Absent Variability

  21. Minimal Variability

  22. Average Variability

  23. PERIODIC FHR CHANGES • ACCELERATIONS- NOTE IN THIS COURSE JUST NOTE THAT THEY ARE PRESENT OR ABSENT. • ACCELERATIONS OF FHR SHOULD GO UP 15-20 BEAT ABOVE BASELINE FOR 15-20 SECONDS. • ACCCELERATIONS INDICATE FETAL WELL-BEING.

  24. ACCELERATIONS • TYPES- SHOULDERS-SEEN WITH VARIABLE DECELERATIONS AND INDICATE WELLBEING • OVERSHOOTS- SEEN AFTER VARIABLE DECELERATIONS INDICATE DISTRESS. • ACCELERATIONS ARE UNDER TEN MINUTES.

  25. Accelerations

  26. Acelerations

  27. EARLY DECELERATIONS • REASSURING • MECHANISM-FETAL HEAD COMPRESSION.,VAGAL REFLEX. • DOCUMENT THEIR PRESENTS • TX: NONE.

  28. Early Deceleration

  29. LATE DECELERATIONS • NONREASSURING • MECHANISM: UTERINE PLACENTA INSUFFICIENCY-FETAL HYPOXIA. • CAUSES: UTERINE HYPERACTIVITY,SUPINE HYPOTENSION, COMPLICATIONS-SLE,DM ETC. • TX:TURN TO SIDE FIRST LEFT IS BEST.

  30. Late Decelerations

  31. LATE DECELERATIONS • TX: TURN TO SIDE, INCREASE FLUID IF OK WITH CLIENT’S CONDITION, OXYGEN,IF PITOCIN RUNNING STOP, NOTIFY DR. IF LATE CONT. BE PREPARED FOR DELIVERY OR C/SECTION, NOTIFY ICN. • DOCUMENT

  32. VARIABLE DECELERATIOS • ABURPT DROP IN FHR AND RETURNS TO BASELINE ABURPTLY • MOST COMMON OR FREQUENT SEEN TYPE OF DECELERATION • MECHANISM: UMBILICAL COMPRESSION. • TX: TURN CLIENT OFF CORD-EITHER TO SIDE OR OTHER POSITIONS

  33. Variable Decelerations

  34. REASSURING FHR PATTERN • BASELINE RATE-110-160 • BASELINE VARIABILITY-AVERAGE • ACCELERATIONS WITH FM OR UC OR STIMULATION. • EARLY DECELERATIONS • NO LATE DECELERATIONS • NO MODERATE OR SEVERE VARIABLE DECELERATIONS

  35. NONREASSURING FHR PATTERN • BASELINE RATE BELOW 110 OR ABOVE160 FOR 10 MINUTES. • BASELINE VARIABILITY-MINIMAL,ABSENT,OR INCREASED. • DECELERATIONS-LATES, MOD-SEVERE VARIABLES,PROLONGED. • NO ACCELERATIONS WITH UC, FM • OVERSHOOTS. • SINUSIODAL PATTERN

  36. Sinusiodal FHR Pattern

  37. Evaluate this EFM strip/What do you think is happening?

  38. What do you think of this EFM Strip?

  39. MONITORING UTERINE ACTIVITY METHODS • EXTERNAL UTERINE MONITORING • INTERNAL UTERINE MONITORING

  40. UTERINE CONTRACTIONS • DEFINIONS OF TERMS • FREQUENCY • DURATION • INTENSITY-1.BY PALPATION 2. IUPC-mmHg.3.MONTEVIDEOUNITS(MVU) • RESTING PERIOD • RESTING TONE(TONUS) -

  41. Uterine Contractions

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