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.

ELECTRONICAL FETAL MONITORING (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 FHR BASELINE VARIABILITY IS THE VARIABILITY ON BASELINE

Fetal Heart Rate Baseline

FHR BASELINE NORMAL 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 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 BEAT ABOVE BASELINE FOR 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 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