E2: Intrapartum Fetal Surveillance

Normal HR Rate:

110-160

What do you assess in the prenatal HR:

Rate and Rhythm

How long do you use a Doppler:

1 minute

Why is important to check mom pulse at the same time?

To make sure that you don’t confuse the two

Maternal cardiopulmonary alterations that affect fetal oxygenation:

hemorrhage and BP Changes **Epidural causes hypotension

Uterine activity that influences fetal oxygenation

hypersonic contractions >90-120 seconds closer than q2

Other pathologic influences on fetal oxygenations

Placental disruptions, Interruptions in umbilical flow, Fetal alterations

Intermittent electric heart monitoring

Doppler assessment of FHR x 1 full minute q 1 hour in early labor (< 4cm), q 15-30 in active labor and q 5-15 min in the second stage.

Intermittent VERSUS Continuous

Research shows no difference in intrapartum fetal death

Ultrasound transducer

records baseline FHE, variability, accelerations and decelerations

Tocotransducer (Toco)

allows for contraction monitoring (uterine pressure, converts it in an electrical signal)

Spiral electrode:

put on kids head to pick up HR

Pressure transducer

place inside uterus

To have internal fetal monitoring what does cervix have to be?

ROM, 2cm, low presenting part, skilled practitioner

FHR baseline:

average heart rate, rounded to 5 bpm, measured over 2 minutes within a 10-minute window.

Whats a key point of fetal heart rate monitoring?

uterus must be at rest

Accelerations

temporary increase in FHR that peaks at least 15 bpm above baseline and lasts at least 15 seconds

Variability

amount of beat to beat changes that the heart does

Absent variability

undetectable

minimal variability

0-5

moderate

6-25

marked

over 25

Early decelerations:

not horrible and it is a mirror image of the contraction (head is probably being squeezed in the vagina)

Variable decelerations:

Sharp or sudden drop in HR that is unrelated to contraction pattern. They look like Vs or Us

What causes variable deceleration?

chord compression

Intervention for chord compression

reposition

Late decelerations

Late decelerations: (worst one)

What causes a late deceleration?

Problem with the placenta (PPP, Placental perfusion problem)

Bradycardia

FHR under 110 for over 10 minutes

Tachycardia

FHR over 160 over 10 minutes

Why might infant be tyachacardic

infection or maternal dehydration

Normal FHR category

category 1

Indeterminate FHR category

category 2

Abnormal FHR category

category 3

Frequency of contraction is measured in:

minutes

Duration of contraction is measured in

seconds

Acme

period where contraction is most intense

What to do if there’s fetal distress:

1. Change maternal position

2. Discontinue Pitocin

3. Admin oxygen

4. Admin fluid

5. Notify health care provider