Fetal Health Surveillance

FHR Variability Absent

0-2 BPM

FHR Variability Minimal

5 or less BPM

FHR Variability Moderate

6-25 BPM

FHR Variability Marked

25 or more BPM

Possible causes of minimal FHR variability

• Fetal hypoxia

• Metabolic acidemia

• Fetal sleep

• Tachycardia

• Medications

• Fetal prematurity

• Congenital abnormalities

• Fetal anemia

• Cardiac arrhythmias

• Infections

• Neurological injuries

Possible cause of marked FHR variability

Interruption of oxygenation

FHR Variability

Fluctuations in baseline that are irregular in amplitude and frequency

Baseline FHR

Average in 10 mins, rounded to increments of 5.

What does baseline FHR exclude?

• Accelerations

• Decelerations

• Variability

What is normal baseline FHR?

110-160 BPM

What is baseline FHR tachycardia?

Baseline more than 160 BPM for 10 min or more

What is baseline FHR bradycardia?

Baseline less than 110 BPM for 10 min or more

What could FHR bradycardia be attributed to?

• Maternal position

• Maternal hypotension

• Epidural

• Cord prolapse

What are the FHR Patterns?

• Normal

• Atypical

• Abnormal

What does normal FHR patterns require?

No intervention

What does atypical FHR patterns require?

Vigilance and ongoing monitoring

What does abnormal FHR patterns require?

Interventions and possibly expediting the birth

What can abnormal FHR patterns be associated with?

Hypoxemia, or arterial blood oxygen deficiency

How can Uterine activity (UA) by assessed?

Palpation or intrauterine pressure catheter (IUPC)

What does uterine activity include?

• Frequency

• Duration

• Intensity

• Resting tone

What is the normal rate for contractions?

5 or less contractions in 10 mins

What is the risk of Electronic fetal monitoring (EFM)?

Increases risk of c-section and other interventions

What type of pregnancies is EFM used for?

High risk pregnancies

What do we need to educate parents about before starting EFM?

That the risk of c-section and instrumental birth increase. Also babies usually have lower APGAR scores after birth.

What type of pregnancies is intermittent auscultation (IA) reccommended for?

• Healthy, low risk pregnancies

• That are in spontaneous labor

• That are between 37 and 41+3 weeks gestation

What tools are used for IA?

• Doptone most common

• Fetoscope

• Stethoscope

What should the nurse do if an irregular heart rate is heard through IA?

Start EFM

How frequent is IA in latent phase of labor?

Every hour

How frequent is IA in first active stage of labor?

Every 15-30 mins

How frequent is IA in second active phase of labor?

Every 5 mins or after each contraction

What tools are used in External fetal monitoring?

• Ultrasound transducer (FHR)

• Tocotransducer (UA)

What tools are used in internal fetal monitoring?

• Spiral electrode (inserted in presenting part. Ex - head)

• Intrauterine pressure catheter

Are admission fetal monitor strips reccommended for low risk pregnancies?

No

FHR accelerations

Abrupt increase in FHR above baseline, at least 15 BPM lasting at least 15 seconds.

Prolonged FHR accelerations/decelerations time

Lasts longer than 2 mins but less than 10 mins

FHR decelerations

Abrupt drop in FHR below baseline, at least 15 BPM drop lasting at least 15 seconds

Early deceleration

Happen with contractions. Normal

Late decelerations

Happen after the contraction. Not normal

Late decelerartions nursing interventions

• Change moms position

• Give mom something cold to wake up baby (ice chips or popsicle)

• Check transducers

• Check moms radial pulse to make sure the machine is picking up fetal pulse, not moms

• Ask doctor if fluids can be given

• Give oxygen

• Ask mom to stop or modify pushing

• Perform vaginal exam to rule out a cord prolapse

Tachysystole

More than 5 contractions in 10 min period

How long of a break should mom have between contractions?

2 minutes

What should we do if mom is in tachysystole?

Stop oxytocin drips

What is the most common type of decelerations?

Variable decelerations

What is the cause of variable decelerations?

Umbillical cord compression

Amnioinfusion

infusion of body temp isotonic fluid into uterine cavity when amniotic fluid volume is low