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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

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

9. 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

10. 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)?

13. 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)

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

15. 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

16. 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

18. Biophysical Profile

19. 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

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

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

22. 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).

23. 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

24. 16–6 Lecithin / Sphingomyelin (L/S) Ratio and Phophatidylglycerol (PG)

25. 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.