Interpretation of Findings

Interpretation of Findings

• Normal FHR 110-160 bpm w/ increases & decreases from baseline.
• Tachycardia greater 160/min, 10 min/longer.
• Bradycardia less 110/min, 10 min/longer.

Non-reassuring FHR associated w/ hypoxia & include

• Fetal bradycardia
• Fetal tachycardia
• Absence of FHR variability
• Late decelerations
• Variable decelerations

FHR Pattern: Bradycardia Causes/Complications:

• Uteroplacental insufficiency
• UC prolapse
• Maternal hypotension
• Prolonged UC compression
• Fetal congenital heart block
• Anesthetic medications
• Viral infection
• Maternal hypoglycemia
• Fetal heart failure
• Maternal hypothermia

FHR Pattern: Bradycardia Interventions

Discontinue oxytocin

Assist Pt to side-lying position

Administer O2 L/min non-rebreather face mask

Insert IV catheter administer maintenance IV fluids

Administer tocolytic medication- delay preterm labor, lung development

Notify provider

FHR Patterns: Tachycardia Causes/Complications:

• Maternal/Fetal infection
• Fetal anemia, dysrhythmias
• Substance use, caffeine
• Maternal dehydration, fever, hyperthyroidism (DFH)

FHR Patterns: Tachycardia Nursing Interventions:

• Prescribed antipyretics for fever
• O2 10 L/min via nonrebreather face mask.
• IV fluid bolus.

FHR Variability

• Fluctuations in FHR baseline; beat-to-beat change
• Absent or undetectable- non-reassuring
• Minimal- detectable but equal to, less than 5/min)
• Moderate- (6 to 25/min – expected FHR variability)
• Marked (greater than 25/min)

Decrease or Loss of FHR Variability Causes

• Meds depress CNS (barbiturates, magnesium sulfate, general anesthetics)
• Fetal hypoxemia, metabolic acidemia
• Fetal sleep cycle (minimal sleep cycles usually no longer than 30 min)
• Congenital abnormalities

Decrease or Loss of FHR Variability Nursing Interventions:

• Stimulate fetal scalp.
• Assist provider w/ application of scalp electrode.
• Pt left-lateral position

FHR Patterns: Accelerations Causes/Complications:

• Healthy fetal/placental exchange
• Spontaneous fetal movement
• Vaginal exam
• Contractions
• Fetal scalp stimulation
• Vibroacoustic stimulation
• Fundal pressure

FHR Patterns: Accelerations Nursing Interventions

Reassuring, no interventions required

Indicates reactive nonstress test

Variable Deceleration of FHR

Transitory, abrupt slowing of FHR 15 bpm or below at least 15 seconds, variable in duration, intensity, timing in relation to contraction

Variable Deceleration of FHR Causes/Complications

• UC compression
• Short cord
• Prolapsed cord
• Knot in cord
• Nuchal cord (fetal neck)

Variable Deceleration of FHR Nursing Interventions

• Reposition Pt side to side / into knee-chest.
• Discontinue oxytocin
• Administer O2 10-15 L/min via non-rebreather
• Perform/Assist w/ vaginal exam
• Assist w/ amnioinfusion if prescribed

Early Deceleration of FHR & Interventions

Slowing of FHR at start of contraction w/ return to baseline at end of contraction

Nursing Interventions: none required

Early Deceleration of FHR Causes/Complications:

Fetal head Compression from:
• Uterine contractions
• Vaginal exam
• Fundal pressure
• Placement internal monitoring

Late Deceleration of FHR (Slowing at contraction end) Causes/Complications:

• Uteroplacental insufficiency- inadequate fetal oxygenation
• Maternal hypotension, placenta previa/abruptio, uterine tachysystole w/ oxytocin
• Preeclampsia
• Late/Post-term pregnancy
• Maternal DM

Late Deceleration of FHR Nursing Interventions:

• Pt side-lying position.
• Insert IV catheter, increase rate
• Discontinue oxytocin
• Administer O2 10-15 L/min via nonrebreather
• Elevate client’s legs
• Notify provider
• Prepare for assisted vaginal birth/C-section

Continuous Internal Fetal Monitoring

Spiral scalp electrode used in conjunction w/ intrauterine pressure catheter (IUPC), to monitor frequency, duration, intensity of contractions

Continuous Internal Fetal Monitoring Advantages

• Early detection of abnormal FHR (non-reassuring)
• Accurate assessment of variability.
• Accurate measurement of contraction intensity.
• Allows greater maternal freedom of movement bc tracing not affected by fetal activity, maternal position, obesity

Continuous Internal Fetal Monitoring Disadvantages

• Membranes must have rupture to use monitoring
• Cervix must be dilated to minimum 2-3 cm.
• Presenting part must descend to place electrode
• Potential risk of fetal injury if electrode not properly applied
• Provider, nurse practitioner/midwife, specially trained RN must perform procedure.
• Potential infection risk to M/B

Category I

• Baseline FHR 110-160/min
• Baseline variability: moderate
• Accelerations: present/absent
• Early decelerations: present/absent
• Variable or late decelerations: absent

Category II Baseline rate & Accelerations

Baseline:

• Tachycardia
• Bradycardia not accompanied by absent baseline variability

Accelerations:

Absence of induced accelerations after fetal stimulation

Category II Baseline FHR variability

• Minimal baseline variability
• Absent baseline variability not accompanied by recurrent decelerations
• Marked baseline variability

Category II Episodic or periodic decelerations

• Prolonged FHR deceleration equal/greater than 2 min, less than 10 min
• Recurrent late decelerations w/ moderate variability
• Recurrent variable decelerations w/ minimal/moderate variability
• Variable decelerations w/ additional characteristics (“overshoots,” “shoulders,”) or slow return to baseline

Category III

• Sinusoidal pattern (anemia, drugs, hypoxia, congenital defects)
• Absent baseline FHR variability &:
- Recurrent variable decelerations
- Recurrent late decelerations
- Bradycardia

Uterine Contractions

• Duration: how long contraction lasts
• Frequency: time from beginning of one contraction to beginning next
• Tachysystole: 5 or more contractions in 10 min averaged over 30-min window

VEAL- FHR pattern

V- variable deceleration

E- early detection

A- acceleration

L- late deceleration

CHOP- cause

C- cord compression

H- head compression

O- okay, oxygenated

P- placental insufficiency

MINE- management

M- maternal repositioning

I- Identify labor progress

N- no interventions

E- execute interventions