basic fetal monitoring review
DESCRIPTION
Basic Fetal Monitoring Review. Ana H. Corona, FNP-C Nursing Instructor February 2009. Electronic Fetal Monitoring. Definition of fetal monitoring Method of assessing fetal status before and during labor Why is fetal monitoring important To provide insight that may affect fetal outcomes - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Basic Fetal Monitoring Review](https://reader036.vdocuments.mx/reader036/viewer/2022081416/56812b32550346895d8f3a65/html5/thumbnails/1.jpg)
Basic Fetal MonitoringReview
Ana H. Corona, FNP-CNursing Instructor
February 2009
![Page 2: Basic Fetal Monitoring Review](https://reader036.vdocuments.mx/reader036/viewer/2022081416/56812b32550346895d8f3a65/html5/thumbnails/2.jpg)
04/19/23 2
Electronic Fetal Monitoring
• Definition of fetal monitoring– Method of assessing fetal status before
and during labor• Why is fetal monitoring important
– To provide insight that may affect fetal outcomes
• Information is recorded on graph paper • Information is permanent part of the
maternal medical record• Information is retrievable for litigation
![Page 3: Basic Fetal Monitoring Review](https://reader036.vdocuments.mx/reader036/viewer/2022081416/56812b32550346895d8f3a65/html5/thumbnails/3.jpg)
04/19/23 3
Normal Assessment Findings
• FHR between 110-160 in gestations 32-40+ weeks– Rates slightly above 160 are normal in
gestations less than 32 weeks.
• Regular rhythm
• Increases in the FHR associated with fetal movement that return to original rate range
![Page 4: Basic Fetal Monitoring Review](https://reader036.vdocuments.mx/reader036/viewer/2022081416/56812b32550346895d8f3a65/html5/thumbnails/4.jpg)
04/19/23 4
Electronic Fetal Monitoring Clarification
• Information for students is for educational purposes only
• Students should not assume any responsibility for interpretation of fetal monitor tracings
• It takes months to years of experience to be prepared to interpret fetal monitor tracings
![Page 5: Basic Fetal Monitoring Review](https://reader036.vdocuments.mx/reader036/viewer/2022081416/56812b32550346895d8f3a65/html5/thumbnails/5.jpg)
04/19/23 5
Methods of Electronic Fetal Monitoring
• External– Noninvasive method– Utilizes an
ultrasonic transducer to monitor the fetal heart
– Utilizes the tocodynamometer (toco) to monitor uterine contraction pattern
![Page 6: Basic Fetal Monitoring Review](https://reader036.vdocuments.mx/reader036/viewer/2022081416/56812b32550346895d8f3a65/html5/thumbnails/6.jpg)
04/19/23 6
Methods of Electronic Fetal Monitoring
• Internal Fetal Monitoring– Invasive– FHR is monitored via a
fetal scalp electrode– Uterine activity is
monitored by an intrauterine pressure catheter (IUPC)
• A combination of external and internal fetal monitoring is common practice
![Page 7: Basic Fetal Monitoring Review](https://reader036.vdocuments.mx/reader036/viewer/2022081416/56812b32550346895d8f3a65/html5/thumbnails/7.jpg)
04/19/23 7
Advantages and Disadvantages of Internal Fetal Monitoring
• Advantages– Patient can move without much interference in data
transmission– More accurate measurement of data– Data less likely to be affected by artifact
• Disadvantages– Invasive– Membranes have to be ruptured and cervix dilated– Application requires more skill– Procedure is uncomfortable for the mother– Risk of trauma and infection for mother and fetus
![Page 8: Basic Fetal Monitoring Review](https://reader036.vdocuments.mx/reader036/viewer/2022081416/56812b32550346895d8f3a65/html5/thumbnails/8.jpg)
04/19/23 8
Components of the Fetal Monitor Paper Tracing
• Strip has two components• Upper graph - records FHR data• Small squares represent 10 bpm
increases as well as 10 seconds duration • Lower graph records contraction data• Small squares represent 10 second
duration or 10 mmHg intensity – Dark line to dark line represents one
minute of time
![Page 9: Basic Fetal Monitoring Review](https://reader036.vdocuments.mx/reader036/viewer/2022081416/56812b32550346895d8f3a65/html5/thumbnails/9.jpg)
04/19/23 9
Baseline FHR
• Normal baseline FHR in a term fetus 37 completed weeks or more is 110-160 bpm.
– Determination of the baseline FHR is done between contractions
– Baseline is rounded in increments of 5 bpm example; if the FHR is running 125-135 then the baseline FHR should be documented as 130
![Page 10: Basic Fetal Monitoring Review](https://reader036.vdocuments.mx/reader036/viewer/2022081416/56812b32550346895d8f3a65/html5/thumbnails/10.jpg)
![Page 11: Basic Fetal Monitoring Review](https://reader036.vdocuments.mx/reader036/viewer/2022081416/56812b32550346895d8f3a65/html5/thumbnails/11.jpg)
04/19/23 11
FHR Variability
• Normal changes and fluctuations in the FHR over time.
• Best assessed between contractions
• Considered to be the best indicator of fetal well-being
• Variability can be influenced by hypoxic events, maternal hemodynamic issues, drugs, etc.
![Page 12: Basic Fetal Monitoring Review](https://reader036.vdocuments.mx/reader036/viewer/2022081416/56812b32550346895d8f3a65/html5/thumbnails/12.jpg)
04/19/23 12
Examples of Variability
• Absent: Not detectable from baseline
• Minimal: Less than 5 bpm from baseline
– May occur with:
– normal fetal sleep patterns
– mother has received analgesia for pain
• Moderate : 6-25 bpm from baseline (optimal pattern)
• Marked: More than 25 bpm from baseline
![Page 13: Basic Fetal Monitoring Review](https://reader036.vdocuments.mx/reader036/viewer/2022081416/56812b32550346895d8f3a65/html5/thumbnails/13.jpg)
How Do Uterine Contractions Affect Fetal Heart Rate? • Can affect FHR by increasing or decreasing the rate in
association with any given contraction. • 3 primary mechanisms by which UCs can cause a
decrease in FHR 1. Fetal head 2. Umbilical cord3. Uterine myometrial vessels
![Page 14: Basic Fetal Monitoring Review](https://reader036.vdocuments.mx/reader036/viewer/2022081416/56812b32550346895d8f3a65/html5/thumbnails/14.jpg)
04/19/23 14
Periodic and Episodic FHR Characteristics
• Periodic: Refers to changes in the FHR that occur with or in relationship to contractions
• Episodic: Refers to changes in the FHR that occur independent of contractions
![Page 15: Basic Fetal Monitoring Review](https://reader036.vdocuments.mx/reader036/viewer/2022081416/56812b32550346895d8f3a65/html5/thumbnails/15.jpg)
04/19/23 15
Examples of Periodic Changes
• Variable decelerations: Result from some type of cord compression.– Nuchal cord, True knot– Decreased amniotic fluid
![Page 16: Basic Fetal Monitoring Review](https://reader036.vdocuments.mx/reader036/viewer/2022081416/56812b32550346895d8f3a65/html5/thumbnails/16.jpg)
04/19/23 16
Severe Variable DecelerationsNote the depth from the baseline
Baseline
![Page 17: Basic Fetal Monitoring Review](https://reader036.vdocuments.mx/reader036/viewer/2022081416/56812b32550346895d8f3a65/html5/thumbnails/17.jpg)
04/19/23 17
Early Deceleration
• Occur as a result of vagal stimulation to the fetal head during contractions which push the fetal head toward the pelvis.
![Page 18: Basic Fetal Monitoring Review](https://reader036.vdocuments.mx/reader036/viewer/2022081416/56812b32550346895d8f3a65/html5/thumbnails/18.jpg)
04/19/23 18
Late Decelerations
• Occur in response to utero-placental insufficiency. Blood flow to the fetus is compromised and there is less oxygen available to the fetus)
![Page 19: Basic Fetal Monitoring Review](https://reader036.vdocuments.mx/reader036/viewer/2022081416/56812b32550346895d8f3a65/html5/thumbnails/19.jpg)
04/19/23 19
Late Decelerations with Absent Variability
• Note the smoothness of the FHR pattern
• Decreased FHR caused by utero-placental insufficiency
• Compromised blood flow to fetus
![Page 20: Basic Fetal Monitoring Review](https://reader036.vdocuments.mx/reader036/viewer/2022081416/56812b32550346895d8f3a65/html5/thumbnails/20.jpg)
04/19/23 20
Prolonged Deceleration
• Deceleration of the FHR from the baseline lasting more than 2 minutes but less than 10 minutes.
• No explanation for why these occur
• Commonly associated with uterine hyperstimulation.
• Can also occur without any uterine activity
![Page 21: Basic Fetal Monitoring Review](https://reader036.vdocuments.mx/reader036/viewer/2022081416/56812b32550346895d8f3a65/html5/thumbnails/21.jpg)
04/19/23 21
Example Prolonged Deceleration• Note the duration of the deceleration lasts more
than 2 minutes.
![Page 22: Basic Fetal Monitoring Review](https://reader036.vdocuments.mx/reader036/viewer/2022081416/56812b32550346895d8f3a65/html5/thumbnails/22.jpg)
04/19/23 22
FHR Accelerations
• Are the most common type of FHR changes
• Are abrupt changes and will increase from the baseline 15 bpm lasting 15 seconds before return to the baseline in a healthy gestation more than 32 weeks.
• Less than 32 weeks increases of 10 bpm lasting 10 seconds are indication of a well oxygenated fetus.
![Page 23: Basic Fetal Monitoring Review](https://reader036.vdocuments.mx/reader036/viewer/2022081416/56812b32550346895d8f3a65/html5/thumbnails/23.jpg)
04/19/23 23
Example Accelerations• Note the increase from the fetal heart baseline
![Page 24: Basic Fetal Monitoring Review](https://reader036.vdocuments.mx/reader036/viewer/2022081416/56812b32550346895d8f3a65/html5/thumbnails/24.jpg)
04/19/23 24
Sinusoidal Pattern• Persistent wave variation of the baseline only seen
in about 2% of patients.• Related to severe fetal anemia, hypoxia, or
acidosis.
![Page 25: Basic Fetal Monitoring Review](https://reader036.vdocuments.mx/reader036/viewer/2022081416/56812b32550346895d8f3a65/html5/thumbnails/25.jpg)
04/19/23 25
Uterine Activity Assessment
• Periodic tightening and relaxing of the uterine muscle.
• Pituitary gland is triggered to release a hormone called oxytocin that stimulates the uterine tightening.
• Difference in Braxton Hicks contractions and true labor is the strength of the contractions and the changes in the cervix.
![Page 26: Basic Fetal Monitoring Review](https://reader036.vdocuments.mx/reader036/viewer/2022081416/56812b32550346895d8f3a65/html5/thumbnails/26.jpg)
04/19/23 26
Characteristics of Contractions• Frequency: How often they occur? They are
timed from the beginning of a contraction to the beginning of the next contraction.
• Regularity: Is the pattern rhythmic?• Duration: From beginning to end - How long
does each contraction last?• Intensity: By palpation mild, moderate, or
strong.– By IUPC intensity in mmHg– Subjectively: Patient description
![Page 27: Basic Fetal Monitoring Review](https://reader036.vdocuments.mx/reader036/viewer/2022081416/56812b32550346895d8f3a65/html5/thumbnails/27.jpg)
Uterine Contraction
![Page 28: Basic Fetal Monitoring Review](https://reader036.vdocuments.mx/reader036/viewer/2022081416/56812b32550346895d8f3a65/html5/thumbnails/28.jpg)
Segments of Contractions
• Increment: Beginning, building of pressure• Acme: Most intense part of the contraction• Decrement: Diminishing of the contraction• Rest: Period of time between contractions
![Page 29: Basic Fetal Monitoring Review](https://reader036.vdocuments.mx/reader036/viewer/2022081416/56812b32550346895d8f3a65/html5/thumbnails/29.jpg)
04/19/23 29
Assessment of Contractions
• Palpation: Use the fingertips to palpate the fundus of the uterus– Mild: Uterus can be indented with gentle
pressure at peak of contraction– Moderate: Uterus can be indented with firm
pressure at peak of contraction– Strong: Uterus feels firm and cannot be
indented during peak of contraction
![Page 30: Basic Fetal Monitoring Review](https://reader036.vdocuments.mx/reader036/viewer/2022081416/56812b32550346895d8f3a65/html5/thumbnails/30.jpg)
Variable decelerations in FHR during labor are severe dips occurring at the peak of contraction. This FHR problem is associated with which one of the following conditions?
1. Utero-placental insufficiency
2. Fetal head compression
3. Uterine insufficiency
4. Pressure on the umbilical cord
![Page 31: Basic Fetal Monitoring Review](https://reader036.vdocuments.mx/reader036/viewer/2022081416/56812b32550346895d8f3a65/html5/thumbnails/31.jpg)
Answer is D
• These decelerations are common during labor.
• The FHR drops during the contraction resulting from stimulation from chemoreceptors and baroreceptors as the cord is compressed.
• The nurse should recognize these readings on the fetal monitor as normal.
![Page 32: Basic Fetal Monitoring Review](https://reader036.vdocuments.mx/reader036/viewer/2022081416/56812b32550346895d8f3a65/html5/thumbnails/32.jpg)
A nurse is caring for a client in labor and is monitoring the FHR patterns. The nurse notes the presence of episodic accelerations on the electronic fetal monitor tracing. Which of the
following actions is most appropriate?
1. Document the findings and tell the mother that the monitor indicates fetal well-being
2. Take the mothers vital signs and tell the mother that bed rest is required to conserve oxygen.
3. Notify the physician of the findings. 4. Reposition the mother and check the
monitor for changes in the fetal tracing
![Page 33: Basic Fetal Monitoring Review](https://reader036.vdocuments.mx/reader036/viewer/2022081416/56812b32550346895d8f3a65/html5/thumbnails/33.jpg)
Answer is 1
• Accelerations are transient increases in the fetal heart rate that often accompany contractions or are caused by fetal movement.
• Episodic accelerations are thought to be a sign of fetal-well being and adequate oxygen reserve.
![Page 34: Basic Fetal Monitoring Review](https://reader036.vdocuments.mx/reader036/viewer/2022081416/56812b32550346895d8f3a65/html5/thumbnails/34.jpg)
A nurse is admitting a pregnant client to the labor room and attaches an external electronic fetal monitor to the client’s abdomen. After attachment of the monitor, the initial nursing assessment is which of the
following? 1. Identifying the types of accelerations 2. Assessing the baseline fetal heart rate 3. Determining the frequency of the
contractions 4. Determining the intensity of the
contractions
![Page 35: Basic Fetal Monitoring Review](https://reader036.vdocuments.mx/reader036/viewer/2022081416/56812b32550346895d8f3a65/html5/thumbnails/35.jpg)
Answer is 2
• Assessing the baseline fetal heart rate is important so that abnormal variations of the baseline rate will be identified if they occur.
• Options 1 and 3 are important to assess, but not as the first priority.
![Page 36: Basic Fetal Monitoring Review](https://reader036.vdocuments.mx/reader036/viewer/2022081416/56812b32550346895d8f3a65/html5/thumbnails/36.jpg)
A nurse is monitoring a client in labor. The nurse suspects umbilical cord compression if which of the following is noted on the external
monitor tracing during a contraction?
1. Early decelerations
2. Variable decelerations
3. Late decelerations
4. Short-term variability
![Page 37: Basic Fetal Monitoring Review](https://reader036.vdocuments.mx/reader036/viewer/2022081416/56812b32550346895d8f3a65/html5/thumbnails/37.jpg)
Answer is 2
• Variable decelerations occur if the umbilical cord becomes compressed, thus reducing blood flow between the placenta and the fetus.
• Early decelerations result from pressure on the fetal head during a contraction.
• Late decelerations are an suggests utero-placental insufficiency during a contraction.
• Short-term variability refers to the beat-to-beat range in the fetal heart rate.
![Page 38: Basic Fetal Monitoring Review](https://reader036.vdocuments.mx/reader036/viewer/2022081416/56812b32550346895d8f3a65/html5/thumbnails/38.jpg)
The physician asks the nurse the frequency of a laboring client’s contractions. The nurse assesses the client’s contractions by timing
from the beginning of one contraction:
1. Until the time it is completely over
2. To the end of a second contraction
3. To the beginning of the next contraction
4. Until the time that the uterus becomes very firm
![Page 39: Basic Fetal Monitoring Review](https://reader036.vdocuments.mx/reader036/viewer/2022081416/56812b32550346895d8f3a65/html5/thumbnails/39.jpg)
Answer is 3
• This is the way to determine the frequency of the contractions
![Page 40: Basic Fetal Monitoring Review](https://reader036.vdocuments.mx/reader036/viewer/2022081416/56812b32550346895d8f3a65/html5/thumbnails/40.jpg)
When monitoring the FHR of a client in labor, the nurse identifies an elevation of 15 beats above the baseline rate of 135 beats per minute lasting for 15 seconds. This should be
documented as:
1. An acceleration
2. An early elevation
3. A sonographic motion
4. A tachycardic heart rate
![Page 41: Basic Fetal Monitoring Review](https://reader036.vdocuments.mx/reader036/viewer/2022081416/56812b32550346895d8f3a65/html5/thumbnails/41.jpg)
Answer is 1
• An acceleration is an abrupt elevation above the baseline of 15 beats per minute for 15 seconds; if the acceleration persists for more than 10 minutes it is considered a change in baseline rate.
• A tachycardic FHR is above 160 beats per minute.
![Page 42: Basic Fetal Monitoring Review](https://reader036.vdocuments.mx/reader036/viewer/2022081416/56812b32550346895d8f3a65/html5/thumbnails/42.jpg)
Which of the following findings meets the criteria of a reassuring FHR
pattern?
1. FHR does not change as a result of fetal activity
2. Average baseline rate ranges between 100 - 140 BPM
3. Mild late deceleration patterns occur with some contractions
4. Variability averages between 6 - 10 BPM
![Page 43: Basic Fetal Monitoring Review](https://reader036.vdocuments.mx/reader036/viewer/2022081416/56812b32550346895d8f3a65/html5/thumbnails/43.jpg)
Answer is 4
• Variability indicates a well oxygenated fetus with a functioning autonomic nervous system.
• FHR should accelerate with fetal movement. • Baseline range for the FHR is 120 to 160 beats
per minute. • Late deceleration patterns are never
reassuring, though early and mild variable decelerations are expected, reassuring findings.
![Page 44: Basic Fetal Monitoring Review](https://reader036.vdocuments.mx/reader036/viewer/2022081416/56812b32550346895d8f3a65/html5/thumbnails/44.jpg)
04/19/23 44
References
• AWHONN Clinical Position Statement
• P. Burroughs, MSN, RN
• Martin, E.J., (2002) Intrapartum Management Modules: A Perinatal Education Program. (pp 119-123). Lippincott Williams & Wilkins 3rd Edition.
• Simpson, I., & Creehan, P. (2001) Perinatal Nursing 2nd Edition, (pp 379-383). Philadelphia, New York, Baltimore, Lippincott.