Fetal Heart Rate Interpretation Adaptation to Labor
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Transcript of Fetal Heart Rate Interpretation Adaptation to Labor
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Fetal Adaptation toLabor
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+Basis for Monitoring
Physiologic stress to the fetus
Fetal oxygen supply must bemaintained during labor
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+Monitoring Techniques
Intermittent auscultation
• Pinard stethoscope
• Doppler ultrasound
• ltrasound stethoscope
• DeLee! "illis fetoscope
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+Monitoring Techniques
#lectronic Fetal Monitoring
#xternal !! ltrasound transducer$ Tocotransducer
Internal !! %calp electrode$ IP&
cer'ix must be dilatedmembranes must be ruptured
fetal descent at !( station
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+#lectronic Fetal
Monitoring
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+Assessment of terine
&ontractionsPalpation
#xternal tocotransducer
IP&
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+%ystematic #'aluation of
Fetal "eart )ate Tracing
Fetal %tatus• Baseline Fetal "eart )ate• *ariability
• Accelerations
• Decelerations
• #arly
• Late
• *ariable
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+Baseline F")
Bet+een &ontractions
,!(- minute segment
Document as range
.ormal is ((-!(/-
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+ *A)IABILIT0
The most reliable indicator of Fetal Well-being
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+*ariability
undetectable -!, bpm
/!1, bpm 21, bpm
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+Periodic and #pisodic
&hangesPeriodic
In response to contractions
#pisodic
.o relationship to uterine contractions
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+Acceleration
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+#tiology of Accelerations
Fetal mo'ement
terine contractions
*aginal exam
I%# application
Fetal scalp stimulation
Partial cord compression
Breech presentation
ALWAYS
REASSURRIN!
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+Accelerations
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+#tiology of Decelerations
• "ead &ompression#arly
• teroplacentalInsu3ciencyLate
•&ord &ompression*ariable
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+Periodic F") &hanges
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+#arly deceleration
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+Periodic F") &hanges
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+Late deceleration
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+Periodic F") &hanges
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+*ariable deceleration
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+ 4!Tier Fetal "eart )ateInterpretation %ystem
&ategory I
&ategory II
&ategory III
.ormal
.ot predicti'e ofabnormal fetal acid basestatus but can5tcategori6e I or III
Abnormal fetal acid!basestatus
N" A#TI"N RE$UIRE%
A#TI"N RE$UIRE%
Re-e&al'ation( intra-'tero t) and contin'eds'r&eillance
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+&ategory I
N" A#TI"N RE$UIRE%
.ormal
Must include ALL7
Baseline ((-!(/-Moderate 'ariability
.o late decelerations#arly decelerations 89!Accelerations 89!
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+&ategory II
.otpredicti'e
ofabnormalfetal acidbasestatus but
can5tcategori6eI or III
Re-e&al'ation( intra-'tero t) and contin'eds'r&eillance
#'erything that notcategori6ed as either&ategory I or III
#xamples 7 Tachycardia$bradycardia +ithnormal 'ariability
Absent 'ariability$mar:ed 'ariability
Lates 8 'ariability$unusual 'ariables
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+&ategory III
Abnormalfetal acid!base status
A#TI"N RE$UIRE%
Absent 'ariability$ pluseither;
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+Management for AbnormalFetal "eart )ate Patterns
)eposition=>pposite lateral$ ?nee!chest$ Trendelenberg
)elax
)emo'e Pitocin
)ehydrate
)eoxygenate =@!(- Liters 'ia face mas:
)eport to MD
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+.ursing &are for Acti'e Labor
*ital signs =temperature$ pulse$ respirations and bloodpressure
"ydration =>ral inta:e and Intra'enous inta:e
#limination =#ncourage 'oiding q 1hr$ pt may recei'eenema
Ambulation and positioning=#ncourage ambulation if
possible$ if not$ position change q 4-!/- mins$ +ith sidelying position preferred
eneral hygiene!>Cer +arm sho+er or bath possible<
#ncourage +omen to +ash hands after 'oiding andperform self hygiene< &hange linen as needed for soiledpads and sheets
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+.ursing &are for Acti'e Labor
Leopold5s Maneu'ers
Amniotic membrane status=Document time$ type$ color$amount$ and odor< Temp q 1hr
*aginal exam=dilation$ eCacement$ station$ position$and presenting part
.eurological exam=L>&$ DT)$ clonus
Laboratory data=rine specimen$ &B&$ type and screen
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+%econd %tage of Labor
Maternal positioning! =%upine$ semirecumbent$ or lithotomy
>pen!glottis pushing= #ncourage+omen to push as they feel li:e
pushing +hich is instincti'e$spontaneous pushing
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+Amnioinfusion
Treatment of 'ariable decels during labor
Dilute meconium!stained uid
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+>perati'e *aginal Birth
Forceps
*acuum assisted
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+&esarean Birth
Planned$ unplanned$ or electi'e
%urgical technique
&omplications
Anesthesia
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+*BA&
Approximately E-!@- success rate
*aginal deli'ery after cesarean criteria• >ne pre'ious lo+!trans'erse cesarean birth
•
&linically adequate pel'is• .o hx of uterine rupture or uterine scars
• MD immediately a'ailable
• Anesthesia a'ailable
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+>bstetric #mergencies
Meconium!stained amniotic uid
%houlder dystocia
Prolapsed umbilical cord
terine )upture
Amniotic uid embolism