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. ELECTRONICAL(EFM)- NST(NONSTRESS TEST) CST(CONTRACTION STRESS TEST) FAST(FETAL ACOUSTIC STIMULATION

TEST)

Auscultation of FHR with Doppler

Fetal Acoustic Stimulation Test-FAST

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

DISADVANTAGES NOT CONTINOUS NO HARD COPY OR PERMENANT

RECORD REQUIRES SKILL TO USE FETOSCOPE UNABLE TO DETERMINE PATTERNS OF

FHR UNABLE TO DETERMINE VARIABILITY.

ELECTRONICALFETALMONITORING(EFM)

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.

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

Placement of External Monitor

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

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

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

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

Fetal Heart Rate Baseline

FHR BASELINE NORMAL -110-160 BRADYCARDIA-UNDER 110 FOR TEN

MINUTES TACHYCARDIA-OVER 160 FOR TEN

MINUTES

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.

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.

.

Absent Variability

Minimal Variability

Average Variability

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.

ACCELERATIONS TYPES- SHOULDERS-SEEN WITH

VARIABLE DECELERATIONS AND INDICATE WELLBEING

OVERSHOOTS- SEEN AFTER VARIABLE DECELERATIONS INDICATE DISTRESS.

ACCELERATIONS ARE UNDER TEN MINUTES.

Accelerations

Acelerations

EARLY DECELERATIONS REASSURING MECHANISM-FETAL HEAD

COMPRESSION.,VAGAL REFLEX. DOCUMENT THEIR PRESENTS TX: NONE.

Early Deceleration

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.

Late Decelerations

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

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

Variable Decelerations

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

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

Sinusiodal FHR Pattern

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

What do you think of this EFM Strip?

MONITORING UTERINE ACTIVITY METHODS EXTERNAL UTERINE MONITORING INTERNAL UTERINE MONITORING

UTERINE CONTRACTIONS DEFINIONS OF TERMS FREQUENCY DURATION INTENSITY-1.BY PALPATION 2. IUPC-

mmHg.3.MONTEVIDEOUNITS(MVU) RESTING PERIOD RESTING TONE(TONUS)

-

Uterine Contractions

TYPES OF UTERINE ACTIVITY EFFECTIVE UTERINE CONTRACTIONS INEFFECTIVE UTERINE

CONTRACTIONS HYERSTIMULATION TETANIC CONTRACTIONS UTERINE IRRITABILITY HYPERTONUS