Intraparutm PDF

1/19/2025 intrapartum the family during birth 1 Fetal assessment during labor Labor is a time of physiologic stress for the fetus Fetal oxygen supply must be maintained during...

1/19/2025 intrapartum the family during birth 1 Fetal assessment during labor Labor is a time of physiologic stress for the fetus Fetal oxygen supply must be maintained during labor to prevent fetal compromise and promote newborn health after birth Fetal monitoring during labor is the only way to determine (or “see”) how the fetus is tolerating labor Non-reassuring/abnormal FHR patterns can be indicative of fetal compromise Early identification allows for interventions to be implemented to improve fetal oxygenation and prevent complications 2 1  1/19/2025 What compromises the fetal oxygen supply? Change in blood flow through the umbilical cord d/t changes in maternal hypertension, hypotension, or hypovolemia Changes in fetal circulation d/t compression of the umbilical cord, placental separation/abruption, head compression Reduction in blood flow d/t placental compromise from hypertonic uterus or deterioration of the placenta Abnormal FHR patterns are associated with fetal hypoxemia that can lead to hypoxia and metabolic acidosis 3 Intermittent vs continuous monitoring Internal vs external monitoring Uterine activity: tocodynamometer (external) Intermittent auscultation: assessing at or intrauterine pressure catheter/IUPC (internal) periodic intervals (before, during and Fetal heart rate: ultrasound (external – use after a contraction) Leopold’s maneuvers, p386) or fetal scalp electrode (internal) Low-risk women, easy to perform, less invasive, allows for more freedom of movement Continuous monitoring: provides a continuous “picture” or tracing High-risk (medications, multiples, maternal complications, changes in fetal status 4 2  1/19/2025 Assessment of uterine activity: frequency, duration, intensity uterine resting tone is relaxation of uterus, return of normal blood flow to fetus tachysystole: more than 5 contractions in 10 minutes averaged over 30 minute window 5 Assessment of Fetal Heart Rate Patterns Identification Presence of of FHR baseline Variability acceleration deceleration s s 6 3  1/19/2025 FHR baseline is the average rate during a 10 minute period that excludes periodic or episodic changes, periods of marked variability and segments of the baseline that differ by more than 25 beats/min. Baseline is identified over 2 minutes of data Bradycardia: FHR below 110 bpm. True FHR Baseline bradycardia is different from a prolonged deceleration. Associated with fetal cardiac problem or structural defect, viral infections, maternal hypoglycemia or hypothermia Tachycardia: FHR above 160 bpm. Often caused by maternal fever/infection or fetal anemia, can be in response to some meds or illicit drugs 7 8 4  1/19/2025 Moderate variability = reliable predictor of normal fetal acid-base Variability balance Fluctuation of the fetal heart rate (not including accelerations or decelerations Causes of decreases/minimal variability in fetal heart rate variability – how squiggly is the line? Sleep cycle Early gestational age ** most important indicator of adequate Medications causing CNS depression (ie: MgSO4, opioids) fetal oxygenation ** Fetal anomalies 9 Increase in FHR above the baseline accelerations 15 x 15 or 10 x 10 depending on GA Indicative of a well-oxygenated fetus 10 5  1/19/2025 decelerations Can be periodic (occur with uterine contractions) or episodic (not associated with uterine contractions) May be benign or abnormal Described by shape and their relationship to the start and end of a contraction 11 Early decelerations Late decelerations Gradual decrease (onset to nadir > 30 seconds) in Gradual FHR decrease (onset to nadir > 30 seconds) FHR starts WITH the contractions and returns to AFTER the contraction has started with return to baseline at end of contraction baseline after the contraction has ended Box 18.5 Box 18.6 12 6  1/19/2025 Variable Prolonged decelerations decelerations Abrupt decrease (onset to nadir < 30 seconds) in FHR Decrease in FHR of at least 15 bpm from baseline, of at least 15 bpm from baseline, lasts at least 15 lasts more than 2 minutes but not more than 10 seconds and returns to baseline in less than 2 minutes minutes Box 18.7 Occurring when the variable or late deceleration last for more than 2 minutes 13 14 7  1/19/2025 15 16 8  1/19/2025 Basic Intrauterine Address underlying cause resuscitation Pattern recognition Correct maternal hypotension Decrease/stop uterine activity and interpretation Maternal reposition Increase IV fluid Adjust 2nd stage pushing administration techniques Box 18.9 17 Pattern recognition and interpretation VEAL CHOP MINE Variable Cord compression Move mom deceleration Intervention not Early deceleration Head compression needed/identify labor progress No intervention Acceleration OK needed Placental Evaluate and Late deceleration insufficiency execute intervention 18 9  1/19/2025 Fetal distress EFM is used to help identify fetal distress early to intervene and prevent complications Nursing interventions Signs of fetal distress Monitor maternal vital signs FHR below 110 bpm or above 160 bpm Monitor FHR and uterine activity No fetal activity or fetal hyperactivity Reposition patient Decreased or Absent variability Discontinue oxytocin Recurrent late decelerations Increase IV fluids (esp with Recurrent variables maternal hypotension) Prolonged decelerations Cesarean section preparations if indicated 19 10