electronic fetal monitoring

why is efm done

to know if the baby is getting O2 to cells to prevent metabolic acidosis

pathway to fetal injury

• hypoxemia

  • reduced o2 in fetal blood

• hypoxia

  • reduced o2 in fetal tissue

• metabolic acidosis

  • lactic acid builds up in blood

• asphyxia

  • central organ damage

when is labor a problem for o2

• fetal reserve diminished

  • placental insufficiency, vasoconstriction

  • tachysystole

  • umbilical cord compressed

why does ph matter

• lack of o2

• anaerobic respiration

• lactic buildup

• metabolic acidosis

DR stands for

• determine risk

• pre labor

  • preeclampleisa, diabetic, anemic, placental abruption

• intrapartum

  • chorioamniotis, prolonged labor

C stands for

• contractions

• bottom part of tracing

• frequency

• duration

• intensity

• presence of tachysystole

BRa stands for

• baseline rate

• 110 - 160 BPM

V stands for

• variability

• absent (hypoxia)

• minimal (sleeping, narcotic, mag sulfate)

• moderate (best, 6-25 bpm)

A stands for

• accelerations

• >15 bpm above baseline, lasts >15 seconds

d stands for

• decelerations

• early, late, variable

O stands for

• overall assessment

• category 1, 2, or 3

tachycardia is

• >160 for >10 minutes

• not immediately dangerous but requires evaluation

bradycardia is

• <110 for >10 mins

• more concerning

fetal heart rate <100 is

category 3, immediate action required

accelerations can indicate

absence of significant hypoxia/acidosis

early decelerations are

• mirror image of contraction

• slow drop, U like, gradual

• Cat 1 finding

early deccelerations indicate

fetal head compression

variable decelerations are

• abrupt drop to nater

• looks like a V

variable decelerations indicate

cord compression

late decelerations are

• after contractions starts

• significant concern if recurrent

• category 3

late decelerations indidcate

placental oxygen deprivation

prolonged decelerations are

• >15 bpm below baseline, lasts >2 mins but <10 mins

• maybe cord prolapse

• emergent

category one includes

• FHR 110-160 bpm

• moderate variability (6-25)

• early decelerations: P or A

• accelerations: P or A

category 3 includes

• absent variability with

• recurrent late decels or

• recurrent variable decels or

• fetal bradycardia

category 3 requires

• immediate action

• intrauterine resuscitation

• prepare for possible emergent delivery

intrauterine resuscitation is done to

correct reversible cause of fetal compromise and restore O2

intrauterine rescution steps

• maternal repositioning

  • left lateral

• discontinue uterine stimulants

  • only if on medication

  • oxytocin, cervidil

  • if on meds, stop first before positioning

• IV fluid bolus

• maternal oxygen

• tocolysis (terbutaline 0.25 mg)

• vaginal exam

amnioinfusion is for

variable decelerations, repairs amniotic fluid volume via intrauterine pressure catheter

requirements for amnioinfusion

• ruptured membranes

• sufficent cervical dilation

• isotonic solution