1. INTRAPARTAL FETAL ASSESSMENT Developed by D. Ann Currie, R.N., M.S.N.

4. FETAL MONITORING ANTEPARTUM ASSESSMENT-FETAL SURVEILLANCE AND DIAGNOSTICS. INTRAPARTUM ASSESSMENT-FETAL SURVEILLANCE AND DIAGNOSTICS.

5. 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)

6. Auscultation of FHR with Doppler

7. Fetal Acoustic Stimulation Test- FAST

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

9. DISADVANTAGES NOT CONTINOUS NO HARD COPY OR PERMENANT RECORD REQUIRES SKILL TO USE FETOSCOPE UNABLE TO DETERMINE PATTERNS OF FHR UNABLE TO DETERMINE VARIABILITY.

10. ELECTRONICAL FETAL MONITORING (EFM)

12. 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.

13. 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

14. Placement of External Monitor

15. 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

17. 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

18. 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

19. 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

20. Fetal Heart Rate Baseline

21. FHR BASELINE NORMAL -110-160 BRADYCARDIA-UNDER 110 FOR TEN MINUTES TACHYCARDIA-OVER 160 FOR TEN MINUTES

22. 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.

23. 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..

24. Absent Variability

25. Minimal Variability

26. Average Variability

27. 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.

28. ACCELERATIONS TYPES- SHOULDERS-SEEN WITH VARIABLE DECELERATIONS AND INDICATE WELLBEING OVERSHOOTS- SEEN AFTER VARIABLE DECELERATIONS INDICATE DISTRESS. ACCELERATIONS ARE UNDER TEN MINUTES.

29. Accelerations

30. Acelerations

31. EARLY DECELERATIONS REASSURING MECHANISM-FETAL HEAD COMPRESSION.,VAGAL REFLEX. DOCUMENT THEIR PRESENTS TX: NONE.

32. Early Deceleration

33. 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.

34. Late Decelerations

35. 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

36. 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

37. Variable Decelerations

38. 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

39. 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

43. Sinusiodal FHR Pattern

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

45. What do you think of this EFM Strip?

46. MONITORING UTERINE ACTIVITY METHODS EXTERNAL UTERINE MONITORING INTERNAL UTERINE MONITORING

49. UTERINE CONTRACTIONS DEFINIONS OF TERMS FREQUENCY DURATION INTENSITY-1.BY PALPATION 2. IUPC- mmHg.3.MONTEVIDEOUNITS(MVU) RESTING PERIOD RESTING TONE(TONUS) -

50. Uterine Contractions

51. TYPES OF UTERINE ACTIVITY EFFECTIVE UTERINE CONTRACTIONS INEFFECTIVE UTERINE CONTRACTIONS HYERSTIMULATION TETANIC CONTRACTIONS UTERINE IRRITABILITY HYPERTONUS