Fetal Assessment During Labor

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Presentation transcript:

Fetal Assessment During Labor Chapter 15 Fetal Assessment During Labor All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Fetal Assessment During Labor Electronic fetal monitoring is a useful tool for visualizing fetal heart rate (FHR) patterns on a monitor screen or printed tracing First used in 1970s Anticipated effect was a decrease in cerebral palsy; however, the rate has not declined Primary mode of intrapartum assessment in the United States All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Basis for Monitoring Fetal response Labor is a period of physiologic stress for fetus Frequent monitoring of fetal status is part of nursing care during labor Fetal oxygen supply must be maintained during labor to prevent fetal compromise All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Basis for Monitoring (Cont.) Fetal oxygen supply can decrease due to: Reduction of blood flow through maternal vessels as result of hypertension and hypotension Reduction of oxygen content in maternal blood as result of hemorrhage or severe anemia Alterations in fetal circulation with compression of umbilical cord Reduction in blood flow to intervillous space in placenta All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Basis for Monitoring (Cont.) Normal uterine activity during labor Frequency of contractions Duration of contractions Strength of contractions Resting tone Relaxation time All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Basis for Monitoring (Cont.) Fetal well-being during labor measured by response of FHR to uterine contractions (UCs) Reassuring FHR patterns are: Baseline FHR in normal range of 110 to 160 beats/min, with no periodic changes and a moderate baseline variability In the preterm infant, baseline FHR may be higher All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Basis for Monitoring (Cont.) Fetal compromise Goals of intrapartum FHR monitoring are to identify nonreassuring patterns indicative of fetal compromise Nonreassuring FHR patterns are associated with fetal hypoxemia If uncorrected can progress to fetal hypoxia All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Monitoring Techniques Intermittent auscultation (IA) Listening to fetal heart sounds at periodic intervals to assess FHR IA can be performed with: DeLee-Hillis fetoscope Pinard stethoscope Doppler ultrasound device All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Monitoring Techniques (Cont.) Electronic Fetal Monitoring (EFM) External monitoring FHR: ultrasound transducer UC: tocotransducer Internal monitoring (invasive) Spiral electrode Montevideo units All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Fetal Heart Rate Patterns Baseline FHR Baseline rate is average during 10-minute segment, excluding: Periodic or episodic changes Periods of marked variability Segments of the baseline that differ by more than 25 beats per minute All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Fetal Heart Rate Patterns (Cont.) Variability Absent and minimal Abnormal or indeterminate Fetal hypoxemia or metabolic acidemia Moderate Normal Marked Unclear significance Sinusoidal pattern All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Fetal Heart Rate Patterns (Cont.) Baseline FHR Tachycardia: baseline more than 160 beats/min for duration of 10 minutes or longer Bradycardia: baseline less than 110 beats/min for duration of 10 minutes or longer All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Fetal Heart Rate Patterns (Cont.) Changes in FHR Periodic changes occur with UCs Episodic (nonperiodic) not associated with UCs Accelerations Decelerations Early decelerations: response to fetal head compression Late decelerations caused by uteroplacental insufficiency All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Fetal Heart Rate Patterns (Cont.) Periodic and episodic changes to FHR Variable decelerations Visually abrupt Caused by compression of the cord Prolonged decelerations Visually apparent decrease Interruption to fetal oxygen supply All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Care Management Evaluation of EFM equipment EFM pattern recognition Central monitor displays Remote access EFM pattern recognition Must evaluate whether pattern is normal or abnormal Anticipate time interval until birth Determine if intervention is needed All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Care Management (Cont.) Categorizing FHR tracings Category I Normal Category II Indeterminate Category III Abnormal Fetal monitoring standards of care All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Care Management (Cont.) Additional methods of assessment and intervention FHR response to stimulation Fetal scalp stimulation Vibroacoustic stimulation Umbilical cord acid-base determination Fetal scalp blood sampling Amnioinfusion Tocolytic therapy All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Care Management (Cont.) Additional methods of assessment and intervention Patient and family teaching Maternal positioning Pain management techniques Documentation Computerized charting Institutional policy for strip notation All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Question Fetal tachycardia is most common during: maternal fever. umbilical cord prolapse. regional anesthesia. MgSO4 administration. ANS: A Feedback A Correct: Fetal tachycardia can be considered an early sign of fetal hypoxemia and can also result from maternal or fetal infection. B Incorrect: This situation most likely would result in fetal bradycardia, not tachycardia. C Incorrect: This situation most likely would result in fetal bradycardia, not tachycardia. D Incorrect: This situation most likely would result in fetal bradycardia, not tachycardia. DIF: Cognitive Level: Comprehension OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.