Fetal Monitoring

·       Types : intermittent vs continuous and external vs internal

·       Interpretation

v Normal FHR 110-160

v Normal variability- moderate ( 6-25 beats/min)

v Periodic vs episodic changes

v Best indicator of fetal well being

·       3 tier system

v Category 1

v Category 2

v Category 3

Three-Tier System

·       Category 1

Ø  Baseline FHR of 110-160/min

Ø  Baseline FHR variability: Moderate

Ø  Accelerations: present or absent

Ø  Early decelerations: present or absent

Ø  Variable or late decelerations: absent

·       Category 2

Ø  Baseline rate: Tachycardia, bradycardia not accompanied by absent baseline variability

Ø  Baseline FHR variability: minimal, absent, marked

Ø  Episodic or periodic decelerations

Ø  No accelerations

·       Category 3

Ø  Non-reassuring

Ø  Sinusoidal pattern, absent baseline FHR variability with variable decels or late decels or bradys

Ø  Each contraction has an increment, acme, or decrement

Ø  None reassuring FHR patter with fetal hypoxia

Fetal Monitoring

u  Patterns

u  Accelerations (variable increase above baseline)

u  Fetal bradycardia

u  Fetal tachycardia

u  Decrease or loss of FHR variability (variability is beat to beat changes or fluctuations from baseline)

u  Decelerations (slow/decrease below baseline)

§  Early

§  Late   and    Variable

Early Decelerations

u  FHR deceleration mimics the contraction creating a mirror image

u  Slowing of FHR with the beginning of the uterine contraction and returning to baseline at the end

u  Results from head compression from contractions

u  No intervention; continue to monitor

Late Decelerations

u   Slowing of FHR after contraction has begun with  return of FHR to baseline well after contraction has ended

u   Uteroplacental insufficiency

u   Interventions:

·       Place in side-lying position

·       Decrease/stop oxytocin

·       Increase IVF rate

·       Administer oxygen

·       Notify provider

·       Prepare for birth

Variable decelerations

u  Abrupt slowing of FHR 15/min or more below baseline for at least 15 seconds; variable in duration, timing, and in relation to contractions

u  Indicates cord compression

u  Most often shaped like a “V” or a “W” with quick recovery

u  Interventions

·       Reposition side to side, knee to chest

·       Discontinue oxytocin

·       Administer oxygen

·       Perform/assist with vaginal exam

·       Assist with amnioinfusion if ordered

Prolapsed Cord

u   Displaced, preceding the presenting part of the fetus or protruding through the cervix

u   Nursing Interventions

·       Notify provider

·       Apply finger pressure to either side of the cord to the fetal presenting part to elevate it off the cord

·       Reposition patient

·       Apply warm, saline-soaked towel to the visible cord to prevent drying out and to maintain blood flow

·       Monitor FHR

·       Administer Oxygen and Prepare for delivery

Meconium-Stained Amniotic Fluid

u  Meconium passage in the amniotic fluid during the antepartum period

u  Increased risk factor with cord compression, increased gestational age, hypoxia

u  Interventions

·       Document color and consistency

·       Notify neonatal team

·       Follow suction protocol for meconium fluid

·       Assess for fetal distress

Dystocia

u  Abnormal labor related to the 5 P’s of labor

·       1. passenger

·       2. Passageway

·       3. Powers

·       4. Position

·       5. psychologic response

u  Atypical uterine contraction pattern delays labor and progression

u  Administer oxytocin (Pitocin) per MD orders

Precipitous Labor

u  Labor that lasts 3 hours or less from onset of contractions to delivery

u  Nursing interventions

·       Prepare for delivery

·       Reassure patient

·       Side-lying position

·       Do not attempt to stop delivery

u  Assess for complications

·       Maternal: cervical, vaginal, or perineal lacerations, uterine rupture, amniotic fluid embolism, postpartum hemorrhage

·       Fetal: hypoxia due to hypertonic contractions or nuchal cord, intracranial hemorrhage due to head trauma from rapid birth

Uterine Rupture

u  Complete rupture: uterine wall, peritoneal cavity, and/or broad ligament

u  Incomplete rupture: dehiscence at site of prior scar (c/s or surgical intervention), watch for internal bleeding

u  RARE BUT LIFE THREATENING

Anaphylactoid Syndrome of Pregnancy (amniotic fluid embolism)

u  Rupture in amniotic sac or maternal uterine veins with high intrauterine pressure>>> Causes amniotic fluid into maternal circulation>>> Travels to pulmonary vessels>>>respiratory distress and circulatory collapse

u  Occurs during labor, birth, or within 30 minutes following birth

u  Watch for respiratory distress, coagulation failure, and circulatory collapse

u  Nursing interventions

·       Administer oxygen

·       Administer CPR if necessary

·       IVF

·       Administer blood products if coagulation failure

·       Urinary catheter to monitor output

·       Monitor maternal and fetal status