Electronic Fetal Monitoring PDF

Electronic Fetal Monitoring DAVIS CHP 7, PAGES 203-216  Continuous tracing of F H R Observation, evaluation ELECTRONIC Ongoing monitoring and interpretation of FETAL data MONITORING Advanced assessment (EFM) Healthcare professional with educati...

Electronic Fetal Monitoring DAVIS CHP 7, PAGES 203-216  Continuous tracing of F H R Observation, evaluation ELECTRONIC Ongoing monitoring and interpretation of FETAL data MONITORING Advanced assessment (EFM) Healthcare professional with education, skills Three-tiered categorization of E F M patterns EXTERNAL MONITORING US transducer ◦ Doppler Placed on maternal abdomen over fetal back Produces continuous graphic recording Susceptible to interference from maternal and fetal movement INTERNAL MONITORING Fetal scalp electrode (F S E) Cervix must be dilated at least 2 c m Membranes must be ruptured Electrode attached to presenting part Risk of transmission of known maternal infections Instantaneous, continuous recording FETAL HEART RATE PATTERNS Interval between fetal heartbeats ◦ Continually measured Described by: ◦ Baseline rate ◦ Variability ◦ Periodic and Episodic Changes ◦ Accelerations ◦ Deceleration Baseline Fetal Heart Rate Mean F H R during 10-minute period ◦ Rounded to 5 beats per minute (b p m) ◦ Accelerations, decelerations, excluded Must be observed for 2 minutes Normal baseline 110 to 160 b p m Baseline Fetal Heart Rate Tachycardia ◦ Baseline F H R over 160 b p m over 10 minutes ◦ Maternal, fetal causes ◦ Nonreassuring with other F H R patterns ▪ Late or severe variable decelerations ▪ Decreased or absent variability Baseline Fetal Heart Rate Bradycardia ◦ Baseline under 110 b p m for at least a 10-minute period ◦ Causes can include: ▪ Vagus nerve stimulation ▪ Drugs ▪ Maternal hypotension ▪ Fetal hypoxemia or dysrhythmia  Sinusoidal fetal heart rate pattern BASELIN ◦ Smooth, wavelike, undulating sine pattern E FETAL ◦ Benign or pathological HEART ◦ Causes can include: ◦ Fetal anemia RATE ◦ Chronic fetal bleeding ◦ Fetal isoimmunization Sinusoi dal Pattern Baseline Variability Variability Variability Fetal Heart Rate Changes May exhibit intermittent, transient deviations ◦ Accelerations ◦ Decelerations Episodic changes ◦ Not associated with uterine contractions Periodic changes ◦ With 50% or more of U Cs in 20-minute period, categorized as recurrent Fetal Heart Rate Changes Accelerations ◦ Also called accels ▪ Visually apparent increase in baseline FHR ◦ Prolonged ▪ For 2 minutes but less than 10 minutes  Decelerations Fetal ◦ Also called decels Heart Rate ◦ Decreases in F H R below baseline ◦ Characteristics Changes ◦ Episodic or periodic decelerations Decelerations Decelerations Fetal Heart Rate Changes Decelerations ◦ Early decelerations ▪ Usually symmetric, gradual decrease ▪ Calculated from onset to nadir ▪ Nadir occurs at same time as peak of contraction ▪ Result of vagal nerve stimulation ▪ Normally reassuring Fetal Heart Rate Changes ◦ Late decelerations ▪ Usually symmetric, gradual decrease ▪ Associated with uterine activity ▪ Nadir occurring after peak of contraction ▪ Result of uteroplacental insufficiency  ◦ Late decelerations ▪ Immediate interventions Fetal ◦ Position change ◦ Increase I V fluids Heart Rate ◦ Oxygen via face mask Changes ◦ Stop I V Pitocin if infusing ◦ Notify physician, certified nurse- midwife Fetal Decelerations ◦ Prolonged decelerations Heart ▪ Decrease in FHR of 15 bpm or more below BL Rate ▪ More than 2 minutes, less than 10 Changes  Fetal Heart Rate Changes ◦ Variable decelerations ▪Abrupt decrease in FHR ▪Not usually concerning unless: ◦ Less than 70 bpm ◦ Lasts more than 60 seconds ◦ Slow to return to baseline Hyperstimulatio Hyperstimulation is a single contractions lasting 2 minutes or more, or five or more n (Tachysystole) contractions in a 10- minute period averaged over 30 minutes Interpretation of Fetal Heart Rate Patterns Three-Tier Fetal Heart Rate Interpretation system ◦ Labor and birth nurses evaluate F HR ▪Skilled, competent, responsive ▪Categorize tracing: Category I, II, III ▪Category I: FHR tracing is normal ▪Baseline 110 to 160I beats/min ▪Baseline FHR variability moderate ▪Late or variable decelerations absent ▪Early decelerations present or absent ▪Accelerations present or absent  Three-Tier Fetal Heart Rate Interpretation system ◦ Category II: Indeterminate ◦Any tracing that does not meet Interpretat the criteria of category I or III ion of ◦ Category III: Abnormal Fetal ◦Absent baseline FHR and any of the following Heart Rate ◦Recurrent late decelerations Patterns ◦Recurrent variable decelerations ◦Bradycardia ◦Sinusoidal pattern Decision Making in FHR assessment p. 214