1. Fetal Monitoring Ann Hearn RNC, MSN 2010

2. 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.”

3. Placental Physiology Maternal blood flow Fetal blood flow Gas/substance Exchange –Contraction’s affect

4. Placental Physiology

5. Fetal Heart Rate Monitoring Devices Fetoscope Hand held dopple

6. Electronic Fetal Monitor

7. Methods of Fetal Monitoring Intermittent auscultation Continuous external Continuous internal

8. Patterns of Fetal Heart Rate Monitoring

9. Fetal Heart Rate Baseline FHR = 110 – 160 bpm –Average rate over 10 minutes 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

10. Electronic Fetal Monitor Paper

11. Fetal Heart Rate Variability Normal irregularity of the cardiac rhythm. Absence of variability, or a smooth flat baseline is a sign of fetal compromise. A determinant of fetal wellbeing.

12. Fetal Heart Rate Variability

13. Periodic Changes of FHR Acceleration Deceleration

14. Acceleration Increase in the fetal heart rate from baseline by 15 bpm lasting 15 seconds or more. A determinant of fetal wellbeing

15. Reassuring Fetal Heart Rate Pattern

16. Deceleration Decreases in the fetal heart rate from the normal baseline. –Variable –Early –Late –Prolong

17. Deceleration Variable – related to cord compression. Interventions vary. Late – related to utero-placental insufficiency. Immediate intervention. Early – related to head compressions. Interventions not necessary. Prolong – lasts > 2 minutes. Interventions necessary.

18. Early Deceleration

19. Variable Deceleration

20. Late Deceleration

21. Prolong Deceleration Fetal heart rate deceleration that lasts greater than 2 minutes. Sinusoidal Pattern (Undulating) Fetal heart rate repeating cycle of upward increase in the heart rate followed by a decrease in the rate.

22. Prolonged Deceleration Sinusoidal Pattern

23. Nursing Care for FHR Decelerations Reposition: Turn woman to a side-lying position, or knee- chest position. Avoid supine position Hydrate: Increase rate of mainline IV Decrease uterine activity: –Stop Pitocin infusion –Give Terbutaline sub-q. Oxygenate: Provide oxygen by mask at 10 L/min.

24. VEAL CHOP V ariable E arly A cceleration L ate C ord H ead O kay P lacenta

25. Review

29. Review:

34. The End