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Fetal Monitoring Basics

Fetal Monitoring Basics. NUR 134 M. Johnston, RN-BC, M.Ed. Types of Monitoring. Auscultation- listen to fetal heart rate (FHR) Electronic Fetal Monitoring – use of instruments to record FHR and uterine contractions(U/Cs). Auscultation.

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Fetal Monitoring Basics

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  1. Fetal Monitoring Basics NUR 134 M. Johnston, RN-BC, M.Ed.

  2. Types of Monitoring Auscultation- listen to fetal heart rate (FHR) Electronic Fetal Monitoring – use of instruments to record FHR and uterine contractions(U/Cs)

  3. Auscultation • Doppler - ultrasound converts sounds waves to signals of fetal heart • Fetoscope- Like stethoscope, open end pressed on abdomen, used less frequently

  4. Electronic Fetal Monitoring • Measures response of FHR to uterine contractions (U/Cs) • Intermittent or Continuous • External • Ultrasound transducer • Tocotransducer • Internal • Fetal Scalp Electrode • Intrauterine Pressure Catheter

  5. Fetal Heart Rate Characteristics • Evaluate to determine fetal status • NICHD terminology • Baseline Rate • BaselineVariability • Accelerations (present or absent) • Decelerations (present or absent) • Changes or trends over time

  6. Baseline (BL) • Normal range 110-160 bpm • Measure between U/Cs for 10 min. period • Tachycardia - >160 bpm for >10 minutes • Bradycardia - <110 bpm for >10 minutes

  7. Classifications of FHR Variability • Fluctuations in FHR, irregular in frequency and amplitude • Absent 0-2 bpm • Minimal >2 <6 bpm • Moderate 6 -25 bpm • Marked >25 bpm

  8. Accelerations • Abrupt increase in FHR above BL • Present or Absent • < 32 wks gestation • Peak ≥ 10 bpm above BL for at least 10 sec. • >32 wks gestation • Peak ≥ 15 bpm above BL for at least 15 sec. • Accel ≥ 10 min. is defined as BL change

  9. Accelerations • Abrupt increase in FHR above BL • Peak ≥ 15 bpm above BL for at least 15 sec.

  10. Types of Decelerations • Early – Gradual decrease and return to BL,mirrors the U/C • Variable – Abrupt (<30 sec) decrease (≥15 sec down, lasting ≥ 15 sec and <2 min from onset to return to BL) • Late – Gradual decrease (≥30 sec) and gradual return to BL; delayed timing nadir occurs after peak of U/C • Prolonged – Decrease in FHR below BL ≥15 sec, lasting ≥ 2 min. but <10 min.

  11. Early Deceleration • Gradual decrease and return to BL • Mirrors the U/C

  12. Variable Deceleration • Abrupt (<30 sec) decrease (≥ 15 sec down, lasting ≥ 15 sec and < 2 min. from onset to return to BL)

  13. Late Deceleration • Gradual decrease (≥ 30 sec) and gradual return to BL • Delayed timing, nadir occurs after peak of U/C

  14. Prolonged Deceleration • Decrease in FHR below BL ≥ 15 sec, lasting ≥ 2 min. but < 10 min.

  15. FHR Interpretation • Information about fetal oxygenation/placental function • Somewhat subjective • Abnormal patterns may need further testing

  16. Monitoring Uterine Contractions • Assess U/C pattern while assessing FHTs • External • Palpation • EFM Toco measures frequency, duration • Noninvasive • Internal • Intrauterine pressure catheter (IUPC) • Measures exact intrauterine pressure • Invasive

  17. Why Monitor?

  18. Interventions • Abnormal FHR pattern: • Change maternal position • Give oxygen via mask • Increase IV fluids • Consider medication to relax uterus

  19. Other Fetal Surveillance • Non-Stress Test (NST) - EFM • Biophysical Profile (BPP) - U/S • Doppler Flow Studies - U/S • Fetal Movement Count-maternal sensation/palpation

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