Fetal heart assessment during labor

determining fetal position

Leopold’s maneuver (inspection, palpation)

Vaginal examination

Ultrasound

ways to determine fetal heart rate

handheld Doppler- intermittent data

electronic fetal monitoring- continuous data

indications for EFM

hx of stillbirth greater than 38 weeks of gestation

presence of complication of pregnancy

induction of labor

decreased fetal movement

nonreassuring fetal status

meconium staining of amniotic fluid

maternal fever

trial of labor following previous cesarean birth

placental problems

ultrasound EFM

separate FHR from maternal

telemetry, may be in water

internal fetal spiral electrode “FSE”

membranes must be ruptured

cervix at least 2cm dilated

more effective, provides more accurate fetal tracing

can injure fetus

normal FHR

110-160 bpm

wandering baseline

120-160 bpm

associated with neurologic impairment or preterminal event

immediate intervention needed to enhance fetal oxygenation

fetal tachycardia

sustained 161bpm or above

marked tach: 180bpm and up

early fetal hypoxia

maternal fever

maternal dehydration

beta-sympathomimetic drugs

chorioamnionitis

maternal hyperthyroidism

fetal anemia

tachydysrhythmias

fetal bradycardia

110 bpm less during 10 min or greater

late/profound fetal hypoxia

maternal hypotension

prolonged umbilical cord compression

congenital heart block in fetus

uterine tachysystole

abruptio placentae

uterine rupture

vagal stimulation

maternal hypothermia

nonreassuring FHRs

severe variable decelerations

late decels of any magnitude

absence of variability

prolonged deceleration

severe bradycardia

nonreassuring patterns may require continuous monitoring