Intrapartum Fetal Assessment Quiz

Intrapartum Fetal Assessment

• Labor is a time of physiological stress for the fetus.
• Fetal oxygen supply must be maintained to prevent fetal compromise.
• Fetal monitoring is crucial to determine how the fetus is tolerating labor.
• Non-reassuring or abnormal fetal heart rate (FHR) patterns indicate potential fetal compromise.
• Early identification allows for interventions to improve fetal oxygenation and prevent complications.

Fetal Oxygen Supply Compromises

• Changes in maternal blood flow (hypertension, hypotension, hypovolemia) affect fetal blood flow.
• Umbilical cord compression, placental separation/abruption, or head compression can impact fetal circulation.
• Placental compromise (hypertonic uterus or placental deterioration) reduces blood flow.
• Abnormal FHR patterns are linked to fetal hypoxia and metabolic acidosis.

Monitoring Methods

• Intermittent monitoring involves periodic assessment (e.g., before, during, after contractions).

  • Suitable for low-risk pregnancies, allowing for greater movement.

• Continuous monitoring provides a continuous tracing.

  • Necessary for high-risk pregnancies or when fetal status changes.

• External monitoring uses a device that is applied externally.

  • Measures uterine activity by tocodynamometer or fetal heart rate via ultrasound.

• Internal monitoring involves inserting a device directly into the mother's body.

  • Intrauterine pressure catheter (IUPC) monitors contractions, and fetal scalp electrode (FSE) measures FHR (needs an intact membrane).

Uterine Activity Assessment

• Uterine activity is assessed by frequency, duration, intensity, and resting tone.
• Tachysystole is defined as more than 5 contractions in 10 minutes averaged over a 30-minute window.

Fetal Heart Rate (FHR) Patterns

• Baseline FHR: Average rate over a 10-minute period, excluding periodic changes, and baseline fluctuations larger than 25 bpm.

  • Normal baseline is 110–160 bpm.
  • Bradycardia: FHR below 110 bpm, could indicate fetal cardiac issues, maternal hypoglycemia/hypothermia, or infections.
  • Tachycardia: FHR above 160 bpm, often due to maternal fever, infections, or fetal anemia.

• Variability is the fluctuation in FHR.

  • Absent variability is rare, and problematic.
  • Moderate variability is a sign of physiological well-being
  • Marked variability shows good oxygen status in the baby.
  • Minimal variability means something is affecting the baby's normal rhythm (a concern).

• Accelerations: Increases in FHR above the baseline, often in response to fetal movement or uterine contractions.

  • Typically indicate well-oxygenated fetus

• Decelerations: Decreases in FHR below the baseline.

  • Early decelerations: Associated with fetal head compression during uterine contractions, usually benign.
  • Late decelerations: Occur after the start of the contraction and indicate placental insufficiency.
  • Variable decelerations: Abrupt, short, and unpredictable decreases in the FHR. These may indicate umbilical cord compression.
  • Prolonged decelerations: Lasts more than 2 minutes and suggests significant fetal compromise.

Fetal Distress

• Signs of fetal distress include FHR outside the normal range, lack of variability, recurrent decelerations, or prolonged decelerations.
• Nursing interventions include monitoring maternal and fetal status, repositioning the patient, adjusting medications and fluid administration, preparing for a C-section.