EFM 2024

Page 1: Introduction to Fetal Surveillance

  • Date & Presenter: 7/30/2024, R.K. Valdes MSN, RN, Los Angeles County College of Nursing & Allied Health

  • Learning Objectives:

    • Identify and discuss fetal surveillance, including its purpose, mechanism, methods, benefits, disadvantages, documentation, nursing interventions, and responsibilities.

  • Antepartum Fetal Surveillance:

    • Purpose of Fetal Surveillance:

      • Determine fetal well-being

      • Decrease perinatal mortality and morbidity

      • Guide interventions

Page 2: Factors Related to Fetal Well-Being

  • Key Factors:

    • Normal and adequate flow of oxygenated maternal blood into the placenta

    • Normal exchange within the placenta

    • Patent umbilical cord vessels

    • Normal fetal circulation

    • Effective oxygen carrying function

  • What Can Be Monitored?

    • Fetal heart rate

    • Uterine contractions

Page 3: Intermittent Auscultation (IA) & Palpation

  • Methods:

    • Fetoscope

    • Doppler transducer

    • Palpation

    • Ultrasound with Doppler color study

  • Pros and Cons of Intermittent Auscultation (IA) & Palpation:

    • Pros:

      • Allows for mobility, which can expedite labor

      • Best suited for low-risk mothers

    • Cons:

      • Provides only a snapshot of fetal status—not recommended for high-risk mothers

      • Requires more staff resources

Page 4: Electronic Fetal Monitoring (EFM)

  • Overview of EFM:

    • Types: Internal and External monitoring

    • Originated in the 1960s

    • Data interpretation is highly subjective

    • NICHD Workshop (2008) updated definitions and terminology, developed categories for interpretation

  • Categories of Fetal Tracing:

    • Category I:

      • Normal fetal tracing, reassuring

      • Strongly predictive of normal fetal acid-base status

    • Category II:

      • Indeterminate tracing, requires continuous surveillance and reevaluation

    • Category III:

      • Predictive of abnormal fetal acid-base status, requires immediate intervention

  • Possible Interventions for Abnormal Patterns:

    • Maternal repositioning

    • Notify healthcare provider

    • Vaginal examination

    • Administer maternal Oxygen

    • Stop oxytocin (Pitocin) infusion

    • Treat maternal hypertension or hypotension

    • Consider cesarean section

Page 5: External Monitoring Equipment

  • Equipment Used:

    • Monitoring belts and ultrasound gel

    • Toco Transducer:

      • Detects contractions, placed on the upper one-third of the uterus

    • Ultrasound Transducer:

      • Detects fetal heartbeat, placed at the baby’s back

  • Wireless External Monitoring:

    • Advantages yet to be fully described.

Page 6: Internal Monitoring

  • Methods:

    • Fetal Scalp Electrode (FSE):

      • Assesses fetal heart rate (FHR)

      • Monitors changes in fetal heart rate

    • Intrauterine Pressure Catheter (IUPC):

      • Assesses uterine activity (duration and frequency)

      • Only method to measure intensity/strength of uterine contractions (mmHg)

  • High-Risk Pregnancies:

    • Defined by maternal age (over 35 years old is advanced maternal age, AMA) or existing conditions:

      • Chronic Hypertension (CHTN), Diabetes Mellitus (DM), HIV, heart disease

    • Developing issues such as Gestational Diabetes Mellitus (GDM), Gestational Hypertension (GHTN), Preeclampsia, and Placenta Previa

Page 7: Antepartum Non-Stress Test (NST)

  • Procedure:

    • Utilizes electronic fetal monitoring

    • Looks for accelerations in the fetal heart rate, indicating fetal movement and adequate oxygenation

      • Confirms healthy neural pathways due to stimuli-response

  • Goal:

    • Two accelerations in a 20-minute window are considered reactive

  • Nonreactive NST Options:

    • Extend testing to 40 minutes

    • Use fetal acoustic stimulator (FAS) to provoke movement

    • Consider Biophysical Profile (BPP) or Contraction Stress Test (CST)

Page 8: Contraction Stress Test (CST)

  • Overview:

    • Uses electronic fetal monitoring in cases where NST is nonreactive

    • Nipple stimulation may induce temporary contractions, minimizing the use of oxytocin

  • Goal:

    • Ensure a uterine contraction does not cause a late deceleration in the fetal heart rate. Late decelerations indicate uteroplacental insufficiency.

  • Maternal Assessment of Fetal Movements (Kick Counts):

    • Fetal movements are indicators of well-being and are self-monitored by mothers

    • General recommendations:

      • 5-10 movements/hour

      • 10 fetal movements in a 12-hour period

      • Observe for changes in normal movement

    • Pros:

      • Noninvasive and inexpensive

    • Cons:

      • Variables may affect results (e.g., fetal sleep patterns, medication influence, individual perception)

  • Contact Information:

    • For questions, contact via email anytime.