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NUR 134

M. Johnston, RN-BC, M.Ed.


Types of Monitoring
Auscultation- listen to fetal heart rate (FHR)

Electronic Fetal Monitoring – use of instruments to record


FHR and uterine contractions(U/Cs)
Auscultation
 Doppler - ultrasound converts sounds waves to signals of
fetal heart
 Fetoscope - Like stethoscope, open end pressed on
abdomen, used less frequently
Electronic Fetal Monitoring
 Measures response of FHR to uterine contractions (U/Cs)
 Intermittent or Continuous
 External
 Ultrasound transducer
 Tocotransducer
 Internal
 Fetal Scalp Electrode
 Intrauterine Pressure Catheter
Fetal Heart Rate Characteristics
 Evaluate to determine fetal status
 NICHD terminology
 Baseline Rate
 Baseline Variability
 Accelerations (present or absent)
 Decelerations (present or absent)
 Changes or trends over time
Baseline (BL)
 Normal range 110-160 bpm
 Measure between U/Cs for 10 min. period
 Tachycardia - >160 bpm for >10 minutes
 Bradycardia - <110 bpm for >10 minutes
Classifications of FHR Variability
 Fluctuations in FHR, irregular in frequency and amplitude
 Absent 0-2 bpm
 Minimal >2 <6 bpm
 Moderate 6 -25 bpm
 Marked >25 bpm
Accelerations
 Abrupt increase in FHR above BL
 Present or Absent
 < 32 wks gestation
 Peak ≥ 10 bpm above BL for at least 10 sec.
 >32 wks gestation
 Peak ≥ 15 bpm above BL for at least 15 sec.

 Accel ≥ 10 min. is defined as BL change


Accelerations
 Abrupt increase in FHR above BL
 Peak ≥ 15 bpm above BL for at least 15 sec.
Types of Decelerations
 Early – Gradual decrease and return to BL, mirrors the
U/C
 Variable – Abrupt (<30 sec) decrease (≥15 sec down,
lasting ≥ 15 sec and <2 min from onset to return to BL)
 Late – Gradual decrease (≥30 sec) and gradual return to
BL; delayed timing nadir occurs after peak of U/C
 Prolonged – Decrease in FHR below BL ≥15 sec, lasting ≥ 2
min. but <10 min.
Early Deceleration
 Gradual decrease and return to BL
 Mirrors the U/C
Variable Deceleration
 Abrupt (<30 sec) decrease (≥ 15 sec down, lasting ≥
15 sec and < 2 min. from onset to return to BL)
Late Deceleration
 Gradual decrease (≥ 30 sec) and gradual return to BL
 Delayed timing, nadir occurs after peak of U/C
Prolonged Deceleration
 Decrease in FHR below BL ≥ 15 sec, lasting ≥ 2 min.
but < 10 min.
FHR Interpretation
 Information about fetal oxygenation/placental function
 Somewhat subjective
 Abnormal patterns may need further testing
Monitoring Uterine Contractions
 Assess U/C pattern while assessing FHTs

 External
 Palpation
 EFM Toco measures frequency, duration
 Noninvasive

 Internal
 Intrauterine pressure catheter (IUPC)
 Measures exact intrauterine pressure
 Invasive
Why Monitor?
Interventions
 Abnormal FHR pattern:
 Change maternal position
 Give oxygen via mask
 Increase IV fluids
 Consider medication to relax uterus
Other Fetal Surveillance
 Non-Stress Test (NST) - EFM
 Biophysical Profile (BPP) - U/S
 Doppler Flow Studies - U/S
 Fetal Movement Count-maternal sensation/palpation