1. Intrapartum Fetal
Surveillance

2. Fetal Oxygenation

3. Placental Physiology
Maternal blood flows through the uterine arteries into the intervillous spaces then return through uterine veins to maternal circulation
Fetal blood flows through the umbilical arteries into the villous capillaries and returns through the umbilical vein to fetal circulation.
Exchange of blood gases depends on an unobstructed blood flow through the placenta.
Explain the process of uteroplacental exchange.

4. Uteroplacental exchange
As the myometrium contracts, the flow of oxygenated blood through the uterine artery may be decreased.
Therefore, the fetus may have less oxygen available.

5. Regulation of
Fetal Heart Rate

6. Regulation of Fetal Heart Rate
Autonomic nervous system
Baroreceptors
Chemoreceptors
Adrenal Gland
Central Nervous System

7. Electronic Fetal Monitoring Standard of Care
“Nurses who care for women during the childbirth process are legally responsible for correctly interpreting FHR patterns, initiating appropriate nursing interventions based on the pattern seen, and documenting the outcome of those interventions.”

8. Electronic Monitoring
Indications for
Electronic Monitoring

9. Indications for Electronic Fetal Monitoring
Previous history of stillbirth
Complications of pregnancy
Induction of Labor
Preterm labor
Nonreassuring fetal status; fetal movement
Meconium staining of amniotic fluid
Who is candidate for electronic monitoring?

10. Methods of
Electronic
Fetal Monitoring

11. Advantages of EFM
Constant sound of FHR is reassuring and comforting to the family
Supplies more data about the fetus and gradual trends in FHR are more apparent
Coach uses strip pattern tracing to assist with support

12. Disadvantages of EFM Reduces patient’s mobility
Requires repositioning of equipment with fetal or maternal movement
Can impart a technical air to the birth process

13. Methods of Fetal Monitoring
Intermittent ausculation by doppler
Continuous external monitoring
Continuous internal monitoring

14. Auscultation by Doppler
Intermittent auscultation can be done with a
Fetascope or
Doppler
for FHT’s

15. External Monitoring
The tocodynamometer (“toco”) is placed over the uterine fundus. The toco provides information that can be used to monitor uterine contractions.
The ultrasound device is placed over the area of the fetal back. This device transmits information about the FHR.
Information from both the toco and the ultrasound device is transmitted to the electronic fetal monitor.
The FHR is displayed in a digital display (as a blinking light), on the special monitor paper, and audibly (by adjusting a button on the monitor). The uterine contractions are displayed on the special monitor paper as well.

16. Internal Monitoring Criteria for Internal Monitoring:
Amniotic membranes must be ruptured
Cervix dilated 2 cm.
Presenting part down against the
cervix
Spiral Electrode is placed on the fetal occiput which allows for more accurate continuous data then external monitoring.
Also is not affected by mom or fetal movement as with external monitoring.

17. The spiral electrode is attached to the
Internal Monitoring
The spiral electrode is attached to the
fetal scalp
Wires that extend from attached spiral electrode are attached to a leg plate and then attached to electronic fetal monitor.

18. Nursing Responsibilities Electronic Fetal Monitoring
Placement of equipment
Teaching the woman about use
Notation of events on the strip
Evaluation of data
Intervention as indicated by data

19. Monitoring Patterns

20. Baseline Fetal Heartrate Normal Pattern
Baseline FHR = 120 – 160 bpm

21. Patterns Tachycardia – baseline above 160 BPM
RT= maternal fever, fetal hypoxia, intrauterine infection, drugs
Bradycardia – baseline below 110 BPM
RT = profound hypoxia, anesthesia, beta-adrenergic blocking drugs

22. Variability
Normal/ increased variability or irregularity of a cardiac rhythm.
Absence or decreased variability, or a smooth flat baseline, is a sign of fetal compromise.

23. Causes of Decreased Variability
Hypoxia and acidosis
Medications
Sleep cycle
Preterm status

24. Accelerations

25. Periodic changes in the FHR
Accelerations – increase in the fetal heart rate with a return to baseline.
Indication of fetal well-being is an acceleration of 15 bpm for 15 seconds.

26. Reassuring Acceleration Pattern
Baseline fetal heart rate is with preserved beat-to-beat variability.
Accelerations last for 15 or more seconds above baseline, and
peak to 15 or more bpm.

27. Decelerations

28. Periodic changes in the FHR Decelerations
Early – related to head compressions. Interventions not necessary
Variable – related to cord compression. Interventions vary, but focus on position changes.
Late – related to uteroplacental insufficiency. Most ominous and need immediate attention.

29. Early Deceleration
The onset and return of the deceleration coincide with the start and end of the contraction.
Fetal Heart Rate
Contractions

30. Early Decelerations Related to Head Compression Intervention
No intervention necessary. Just continue to watch for any changes.

31. Variable Deceleration
Variable decelerations are variable in duration, intensity, and timing

32. Variable Decelerations
Related to cord compression
Intervention
Reposition
Amnioinfusion

33. Late Deceleration
The fetal heart tones return to the baseline AFTER end of contraction

34. Late Decelerations
Related to decreased uteroplacental perfusion

35. Nursing Care for FHR Decelerations
Stop the Pitocin
Reposition - Turn woman to a side-lying position, or knee- chest position. Avoid supine position
Increase rate of the mainline IV
Administer oxygen by mask at 10 L/min.
Give Terbutaline sub-q.

36. Nursing Care Notify the primary care provider
If condition does not improve, then prepare for immediate delivery

37. Fetal Scalp Stimulation
Gently stroke or massage fetal scalp for 15 sec. during a vaginal examination
Assess fetal tracing for signs of accelerations of 15 bpm for 15 sec.
This is a sign of fetal well-being
How is fetal scalp stimulation performed and what is the expected outcome?

38. Fetal Scalp Blood Sampling
Requires rupture of
membranes
Acidosis is present if
the pH is less
than 7.20

39. Cord Blood Analysis Criteria
Significant abnormal FHR
Meconium stained amniotic fluid
Infant is depressed at birth
Small amount of blood obtained from umbilical cord and tested for acidosis
Normal fetal blood pH should be >7.25
Lower level indicate acidosis and hypoxia
When is cord blood analysis performed and what does the test indicate?

40. Montevideo Units
Montevideo units is a measure of uterine contraction intensity during labor.
Units are calculated via internal pressure monitor, measuring uterine contraction peak pressure and subtracting the baseline resting tone. This is done over a 10 minute interval.
Generally, above 200 MVUs is considered necessary for adequate labor to bring about dilation and effacement during the active phase.

41. Review:
Early deceleration

42. Review:
acceleration

43. Review
Late deceleration

44. Review
Variable deceleration

45. The End