EFM II

maternity exam 3

accelerations

abrupt temporary increase

32 wks: greater than or equal to 15 bpm increase over 15 or more seconds

below 32 wks: ≥ 10 bpm X 10 seconds

prolonged: 2-10 minutes

decelerations

nadir is lowest

duration: beginning to end

frequency:

• recurrent - greater than or equal to 50% of contractions in 20 min

• intermittent: less than 50% of contractions in 20 minutes

early decelerations

gradual decrease and return to baseline

associated with contractions

• mirror contractions

• nadir occurs with peak of contractions

caused by head compression

variable decelerations

abrupt decrease

decrease >15 bpm, lasting >15 seconds

—Duration < 2 minutes

may be or not be associated with contraction

U, V, or W shape

caused by umbilical cord compression

nursing interventions for variable decels

try to change position to alleviate cord compression

intrauterine resuscitation

amnioinfusion - trying to expand uterus

tocolytics

prepare for delivery

late decels

gradual decrease and return to baseline FHR associated with contraction

delayed timing

nadir occurs after peak of contraction

caused by uteroplacental insufficiency - some sort of oxygen depletion

can be with hypo or hypertension, placental abruption

nursing interventions for late decelerations

intrauterine resuscitation - changing moms position, give oxygen if low

tocolytics

delivery

need to intervene bc showing oxygenation insufficiency

prolonged decels

decrease in FHR

decrease greater than or equal to 15 bpm

lasts longer than 2 minutes but less than 10

what causes prolonged decels

caused by significant change in O2

• interrupted uteroplacental perfusion

• interrupted umbilical blood flow - baby laying on cord

• vagal stimulation - sometimes mom dilated super quick and baby drops fast causing significant head compression and this can happen

if dont fix late decels this will happen

nursing interventions for prolonged decels

treat underlying cause

prep for delivery

NST

non-stress test

reactive = 2 accelerations within 20 minutes = good!

nonreactive = insufficient accelerations or repetitive decelerations greater than 30 seconds

VEAL CHOP MINE

VAS

vibroacoustic stimulation

assess fetal well-being with non-reactive NST if FHR baseline is normal

activate near fetal head for 1 sec

may repeat q1min x 3

put next to babies head to try to wake them up

contraction stress test (CST)

simulates labor to see how the baby will react

term gestation, non-reactive NST

need 3 ctx/10-20 min

no variable or late decels = NEGATIVE/NORMAL

late decels with 50% of ctx = POSITIVE

intermittent late/variable decels = EQUIVOCAL

rarely done

NICHD three-tier FHR interpretation system

category 1 = normal

category 2 = indeterminate

category 3 = abnormal

category 1 FHR interpretation

FHR baseline 110-160

moderate baseline variability

no late or variable decels

accelerations or early decelerations present or absent

category 2

indeterminate

all FHR tracings not category 1-3

if doesnt fit in one category or the other then its this

category 3

abnormal

absent variability with recurrent late decels, recurrent variable decels or bradycardia

OR

sinusoidal pattern - symmetric up and down pattern, not like mod variability its completely perfect up and down, very very bad need emergent c section, indicates oxygenation is not happening or neurological concern

preterm fetus monitoring considerations

•FHR baseline higher

•Accelerations =  10 bpm X 10 sec

•Decreased variability

•Variable decelerations common

•Deteriorates more rapidly