Presentation is loading. Please wait.

Presentation is loading. Please wait.

Fetal Health Surveillance (FHS): Part 1 - Introduction Maternal Newborn Orientation Learning Module Reproductive Care Program of Nova Scotia Revised July,

Similar presentations


Presentation on theme: "Fetal Health Surveillance (FHS): Part 1 - Introduction Maternal Newborn Orientation Learning Module Reproductive Care Program of Nova Scotia Revised July,"— Presentation transcript:

1

2 Fetal Health Surveillance (FHS): Part 1 - Introduction Maternal Newborn Orientation Learning Module Reproductive Care Program of Nova Scotia Revised July, 2013

3 Objectives Review physiology influencing the fetal heart rate Describe tools for fetal surveillance –Doppler –The electronic fetal monitor (EFM) Review Intermittent Auscultation (IA) of the FHR

4 References:

5 Physiology related to the FHR Intrinsic and extrinsic factors Homeostatic mechanisms

6 Intrinsic Factors Internal mechanisms of FHR control Central Nervous System  Medulla oblongata – controls HR, BP  Mid-brain to cortex – controls FHR and changes that occur in response to fetal states and activity Autonomic Nervous System  Sympathetic -  FHR, strength of cardiac contractions  Parasympathetic -  FHR via vagus nerve

7 Intrinsic factors Hormones - catecholamines  Epinephrine  HR, BP, stroke volume and cardiac output  Norepinephrine  blood flow to vital organs during hypoxemia  Angiotensin, aldosterone potent vasoconstrictors acting in response to hemorrhage or hypoxemia

8 Intrinsic factors Baroreceptors  ‘pressure receptors’ located in aortic arch and carotid  respond to changes in BP to  or  the FHR Chemoreceptors  located in aortic arch, carotid, and medulla oblongata  respond to changes in pO 2 and pCO 2 to  or  the FHR

9 Intrinsic factors Fetal behavioral states and development Quiet/active sleep, awake Advancing gestation Used with permission, 2013 NCAST University of Washington

10 Extrinsic factors Factors in the fetal environment that affect oxygen availability, fetal well-being, and the FHR Maternal health Placenta Umbilical cord

11 Extrinsic factors Maternal influences: pO 2 – respiratory status, smoking O 2 carrying capacity – Hgb, blood volume Uterine blood flow – circulation, venous return Uterine contractions – normal, tachysystole, hypertonus

12 Extrinsic factors - placenta Maternal arterioles

13 Extrinsic factors Normal placentaCalcified placenta

14 Extrinsic factors

15 Umbilical Cord Abnormalities Nuchal cordTrue knot

16 Extrinsic factors Umbilical cord influences

17 Homeostatic Mechanisms Regulating mechanisms that allow the fetus to adapt to the stresses of labour and birth Reflex responses  Normal responses Compensatory responses  Protect fetal integrity  Dependent on fetal reserve Decompensation

18 Methods and tools for FHS William’s Obstetrics

19 Leopold’s Maneuver - an essential skill William’s Obstetrics

20 Fetal Health Surveillance - Principles SOGC advises: (2007) ‘The normal, healthy fetus is well-equipped to withstand the repeated, transient hypoxia associated with labour contractions.’ ‘Intermittent auscultation (IA) is the preferred method of fetal surveillance for healthy women without risk factors for adverse outcomes’.

21 Decisions around methods of FHS Always consider a woman’s choice Use of EFM supported for pregnancies with complications Hypertension Postmaturity >42 weeks IUGR Prematurity Multiple pregnancies Continuous EFM for augmentation / ‘mostly continuous’ for induction

22 Auscultation Auscultate the FHR q 15 minutes in active labour, q 5 minutes during second stage once active pushing has begun

23 Auscultation procedure 60-second count ‘results in greatest accuracy’ Baseline rate is assessed between contractions. Check maternal pulse to confirm FHR Record rate, rhythm (regular or irregular), and accelerations (abrupt increases) and/or decelerations (gradual or abrupt)

24 Ausculation classification Normal FHR: FHR 110 to 160 Regular rhythm Accelerations Abnormal FHR: Outside normal range Decelerations

25 Documentation – NS Partogram (RCP)

26 If the FHR is abnormal on auscultation…. ‘Auscultate the FHR after the next contraction to confirm the characteristics’ (SOGC) Assess potential causes – attempt to eliminate or reduce the effect Recheck maternal pulse, V/S Initiate EFM

27 Part 2… Analysis and interpretation of EFM tracings Interventions recommended in the event of atypical or abnormal tracings

28 Thank you! We welcome your feedback. Please take a few moments to complete a short evaluation: If you have any questions, please contact the RCP office at or


Download ppt "Fetal Health Surveillance (FHS): Part 1 - Introduction Maternal Newborn Orientation Learning Module Reproductive Care Program of Nova Scotia Revised July,"

Similar presentations


Ads by Google