Fetal Well-being and Electronic Fetal Monitoring Fetal Tests Fetal Heart Rate Decelerations Variability Fetal Movement Counts

Ultrasound Confirmation of pregnancy and fetal presentation Evaluation of fetal heartbeat and fetal respiration Identification of more than one embryo/fetus For examination of anatomical fetal structures To estimate gestational age, fetal weight, and growth Location of the placenta and amniotic fluid volume Accompanying invasive procedures

Fetal Activity Vigorous fetal activity - provides reassurance of fetal well-being Marked decrease or cessation in activity May indicate possible fetal compromise May require immediate follow-up Assessment of fetal activity (from week 28 to week 38) - noninvasive method of monitoring the fetus

Fetal Movement Counts Daily record beginning at 27 weeks gestation Count at same time each day – 1 hour after meals Lie in side-lying position Contact health care provider when: <10 movements in 3 hours using Cardiff card < 3 movements in 8 hours using daily movement record No fetal movement in AM Fetal movements becoming slower

Electronic Fetal Monitoring Provides continuous data and is routine for high-risk clients Also used for women experiencing an induction of labor May be done externally or with an internal monitor

Electronic Fetal Monitoring - Indications for: Previous history of stillborn Presence of complication Induction of labor, preterm labor Decreased fetal movement Non-reassuring fetal status Meconium staining of amniotic fluid Trial of labor following a C-section

Electronic Fetal Monitoring Fetal Heart Rate – 110 – 160 bpm Fetal Tachycardia Sustained rate of 161 bpm or above If rate is 180 bpm or above, is marked tachycardia Causes Early fetal hypoxia Maternal fever Maternal dehydration Chorioamnionitis Maternal hyperthyroidism Beta-sympathomimetic drugs Fetal anemia

Fetal Tachycardia Ominous sign if tachycardia is accompanied by Late decelerations Severe variable decelerations Decreased variability

Fetal Bradycardia Fetal Bradycardia Causes less than 110 bpm during a 10-minute period or longer Causes Profound hypoxia in fetus Maternal hypotension Prolonged umbilical cord compression Fetal arrhythmias Uterine hyperstimulation Abruptio placentae Uterine rupture Vaginal stimulation in second stage of labor

Evaluate Fetal Monitoring Is baseline within normal limits? Is there tachycardia or bradycardia? Is variability present or absent? If present, is variability Minimal (≤ 5 bpm)? Moderate (6-25 bpm)? Marked (> 25 bpm)? Are there accelerations or decelerations (early, late, variable, prolonged) (prolonged = decrease ≥ 15 bpm for ≥ 2 min but < 10 min)?

EFM Categories Category 1 - Normal Category 3 – Abnormal FHR 110 – 160 No late or variable decelerations May see early decelerations Category 3 – Abnormal Absent variability and any of following: Recurrent and variable decelerations Bradycardia Sinusoidal pattern (cycle frequency 3 – 5 minutes for >= 20 minutes)

EFM Categories Category 2 – Indeterminate Any fetal heart rate pattern not in Category 1 or Category 2

Nursing Interventions for Nonreassuring FHR Optimize maternal positioning – side-lying Discontinue oxytocin if indicated Give supplemental oxygen if indicated Notify physician or midwife Administer IV fluids as needed Monitor maternal v/s for hypotension and treat Elevate HOB 30 degrees Initiate continuous monitoring

Nursing Interventions for Nonreassuring FHR Assist with internal monitors as appropriate Perform vaginal exam to assess for prolapsed cord or labor progress Assist physician with fetal blood sampling Prepare for expeditious birth Provide client and family with explanation Administer tocolytic as ordered

Biophysical Profile

Non-Stress Test Used to assess fetal status using an electronic fetal monitor Based on the knowledge Well-oxygenated fetus has adequate oxygenation Intact central nervous system Increase in fetal heart rate (FHR) with fetal movement Reactive NST: Two accelerations of FHR over 20 minutes Nonreactive: Less than 2 accelerations over 40 minutes Unsatisfactory: Cannot be interpreted

Non-Stress Test Example of a reactive nonstress test (NST). Accelerations of 15 beats per minute lasting 15 seconds with each fetal movement (FM).

Non-Stress Test Example of a nonreactive NST. There are no accelerations of FHR with FM.

Contraction Stress Test Example of a positive contraction stress test (CST). Repetitive late decelerations occur with each contraction. Note that there are no accelerations of FHR with three fetal movements (FM).

Amniocentesis Nursing care: Assist the physician during amniocentesis Support the woman undergoing the procedure Obtain informed consent Clarify the physician’s instructions or explanations Obtain baseline vital signs Obtain baseline fetal heart rate After procedure, review reportable side effects Assess vital signs and fetal heart rate

16–6 Lecithin / Sphingomyelin (L/S) Ratio and Phophatidylglycerol (PG)

NCLEX Question A biophysical profile result of 4 is reported to the physician. Which intervention should the nurse plan to do? Schedule a repeat BPP for later today. Schedule a contraction stress test. Instruct in fetal movement counts. Prepare for delivery of fetus.