3Placental PhysiologyMaternal blood flows through the uterine arteries into the intervillous spaces then return through uterine veins to maternal circulationFetal blood flows through the umbilical arteries into the villous capillaries and returns through the umbilical vein to fetal circulation.Exchange of blood gases depends on an unobstructed blood flow through the placenta.Explain the process of uteroplacental exchange.
4Uteroplacental exchange As the myometrium contracts, the flow of oxygenated blood through the uterine artery may be decreased.Therefore, the fetus may have less oxygen available.
6Regulation of Fetal Heart Rate Autonomic nervous systemBaroreceptorsChemoreceptorsAdrenal GlandCentral Nervous System
7Electronic Fetal Monitoring Standard of Care “Nurses who care for women during the childbirth process are legally responsible for correctly interpreting FHR patterns, initiating appropriate nursing interventions based on the pattern seen, and documenting the outcome of those interventions.”
9Indications for Electronic Fetal Monitoring Previous history of stillbirthComplications of pregnancyInduction of LaborPreterm laborNonreassuring fetal status; fetal movementMeconium staining of amniotic fluidWho is candidate for electronic monitoring?
11Advantages of EFMConstant sound of FHR is reassuring and comforting to the familySupplies more data about the fetus and gradual trends in FHR are more apparentCoach uses strip pattern tracing to assist with support
12Disadvantages of EFM Reduces patient’s mobility Requires repositioning of equipment with fetal or maternal movementCan impart a technical air to the birth process
13Methods of Fetal Monitoring Intermittent ausculation by dopplerContinuous external monitoringContinuous internal monitoring
14Auscultation by Doppler Intermittent auscultation can be done with aFetascopeorDopplerfor FHT’s
15External MonitoringThe tocodynamometer (“toco”) is placed over the uterine fundus. The toco provides information that can be used to monitor uterine contractions.The ultrasound device is placed over the area of the fetal back. This device transmits information about the FHR.Information from both the toco and the ultrasound device is transmitted to the electronic fetal monitor.The FHR is displayed in a digital display (as a blinking light), on the special monitor paper, and audibly (by adjusting a button on the monitor). The uterine contractions are displayed on the special monitor paper as well.
16Internal Monitoring Criteria for Internal Monitoring: Amniotic membranes must be rupturedCervix dilated 2 cm.Presenting part down against thecervixSpiral Electrode is placed on the fetal occiput which allows for more accurate continuous data then external monitoring.Also is not affected by mom or fetal movement as with external monitoring.
17The spiral electrode is attached to the Internal MonitoringThe spiral electrode is attached to thefetal scalpWires that extend from attached spiral electrode are attached to a leg plate and then attached to electronic fetal monitor.
18Nursing Responsibilities Electronic Fetal Monitoring Placement of equipmentTeaching the woman about useNotation of events on the stripEvaluation of dataIntervention as indicated by data
28Periodic changes in the FHR Decelerations Early – related to head compressions. Interventions not necessaryVariable – related to cord compression. Interventions vary, but focus on position changes.Late – related to uteroplacental insufficiency. Most ominous and need immediate attention.
29Early DecelerationThe onset and return of the deceleration coincide with the start and end of the contraction.Fetal Heart RateContractions
30Early Decelerations Related to Head Compression Intervention No intervention necessary. Just continue to watch for any changes.
31Variable Deceleration Variable decelerations are variable in duration, intensity, and timing
32Variable Decelerations Related to cord compressionInterventionRepositionAmnioinfusion
33Late DecelerationThe fetal heart tones return to the baseline AFTER end of contraction
34Late DecelerationsRelated to decreased uteroplacental perfusion
35Nursing Care for FHR Decelerations Stop the PitocinReposition - Turn woman to a side-lying position, or knee- chest position. Avoid supine positionIncrease rate of the mainline IVAdminister oxygen by mask at 10 L/min.Give Terbutaline sub-q.
36Nursing Care Notify the primary care provider If condition does not improve, then prepare for immediate delivery
37Fetal Scalp Stimulation Gently stroke or massage fetal scalp for 15 sec. during a vaginal examinationAssess fetal tracing for signs of accelerations of 15 bpm for 15 sec.This is a sign of fetal well-beingHow is fetal scalp stimulation performed and what is the expected outcome?
38Fetal Scalp Blood Sampling Requires rupture ofmembranesAcidosis is present ifthe pH is lessthan 7.20
39Cord Blood Analysis Criteria Significant abnormal FHRMeconium stained amniotic fluidInfant is depressed at birthSmall amount of blood obtained from umbilical cord and tested for acidosisNormal fetal blood pH should be >7.25Lower level indicate acidosis and hypoxiaWhen is cord blood analysis performed and what does the test indicate?
40Montevideo UnitsMontevideo units is a measure of uterine contraction intensity during labor.Units are calculated via internal pressure monitor, measuring uterine contraction peak pressure and subtracting the baseline resting tone. This is done over a 10 minute interval.Generally, above 200 MVUs is considered necessary for adequate labor to bring about dilation and effacement during the active phase.