1. Fetal Assessment During Labor
Chapter 15
Fetal Assessment During Labor
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2. 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
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3. 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
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4. 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
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5. Basis for Monitoring (Cont.)
Normal uterine activity during labor
Frequency of contractions
Duration of contractions
Strength of contractions
Resting tone
Relaxation time
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6. 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
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7. 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
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8. 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
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10. Monitoring Techniques (Cont.)
Electronic Fetal Monitoring (EFM)
External monitoring
FHR: ultrasound transducer
UC: tocotransducer
Internal monitoring (invasive)
Spiral electrode
Montevideo units
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15. 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
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16. Fetal Heart Rate Patterns (Cont.)
Variability
Absent and minimal
Abnormal or indeterminate
Fetal hypoxemia or metabolic acidemia
Moderate
Normal
Marked
Unclear significance
Sinusoidal pattern
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22. 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
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25. 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
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31. 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
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35. 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
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37. Care Management (Cont.)
Categorizing FHR tracings
Category I
Normal
Category II
Indeterminate
Category III
Abnormal
Fetal monitoring standards of care
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38. 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
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39. 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
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42. 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
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