Fetal Assessment During Labor/FHR Pattern and Uterine Contraction Monitoring Flashcards
Intermittent Auscultation of the FHR
Intermittent auscultation of the FHR is a low-technology method that can
be performed during labor using a hand-held Doppler ultrasound device, an ultrasound stethoscope, or fetoscope to assess FHR. In conjunction, palpation of contractions at the fundus for frequency, duration, and intensity is used
to evaluate fetal well-being. During labor, uterine contractions compress the uteroplacental arteries, temporarily stopping maternal blood flow into the uterus and intervillous spaces of the placenta, decreasing fetal circulation and oxygenation. Circulation to the uterus and placenta resumes during uterine relaxation between contractions. For low-risk labor and delivery, this procedure allows the woman freedom of movement and can be done at home or a birthing center.
Guidelines for intermittent auscultation or continuous electronic fetal monitoring
■ Guidelines for intermittent auscultation or continuous electronic fetal monitoring
☐ Low-risk women
X During latent phase, every 60 min
X During active phase, every 30 min
X During second stage, every 15 min
☐ High-risk women
X During latent phase, every 30 min
X During active phase, every 15 min
X During second stage, every 5 min
Guidelines for intermittent auscultation or continuous electronic fetal monitoring
INDICATIONS (2)
Indications
◯ Potential diagnoses
■ Rule out labor
■ Active labor
Guidelines for intermittent auscultation following routine procedures (8)
Guidelines for intermittent auscultation following routine procedures
■ Rupture of membranes, either spontaneously or artificially
■ Preceding and subsequent to ambulation
■ Prior to and following administration of or a change in medication anesthesia
■ At peak action of anesthesia
■ Following vaginal examination
■ Following expulsion of an enema
■ After urinary catheterization
■ In the event of abnormal or excessive uterine contractions
Interpretation of Findings
-A normal, reassuring FHR is
Interpretation of Findings
◯ A normal, reassuring FHR is 110 to 160/min with increases and decreases from baseline.
Interpretation of Findings: NURSING ACTIONS Preparation Ongoing Care Interventions
●● Nursing●Actions
PREPARATION OF CLIENT
■● Perform●Leopold●maneuvers●to●determine●point●of●maximum●impulse●(PMI).
■● Auscultate●at●PMI●using●listening●device.
■● Palpate●the●client’s●abdomen●at●uterine●fundus●to●assess●uterine●activity.
■● Count●FHR●for●30●to●60●seconds●to●determine●baseline●rate.
Auscultate●FHR●during●a●contraction●and●for●30●seconds●following●the●completion● of●the●contraction.
ONGOING CARE
■● Identify●any●nonreassuring●FHR●patterns●and●notify●the●primary●care●provider.
INTERVENTIONS
■● It●is●the●responsibility●of●the●nurse●to●assess●FHR●patterns,●implement●nursing●
interventions,●and●report●nonreassuring●patterns●to●the●primary●care●provider.
■● The●emotional,●educational,●and●comfort●needs●of●the●mother●and●the●family● must●be●incorporated●into●the●plan●of●care●while●continuing●to●assess●the●FHR● pattern’s●response●to●the●labor●process.
◯●
The●method●and●frequency●of●fetal●surveillance●during●labor●will●vary●and●depend● on●maternal-fetal●risk●factors●as●well●as●the●preference●of●the●facility,●primary●care● provider,●and●client.●
DESCRIPTION OF PROCEDURE
Continuous electronic fetal monitoring
ADVANTAGES (5)
DISADVANTAGES (3)
●● Description●of●Procedure
◯● Continuous●electronic●fetal●monitoring
■● Continuous●external●fetal●monitoring●is●accomplished●by●securing●an●ultrasound● transducer●over●the●client’s●abdomen●to●determine●PMI,●which●records●the● FHR●pattern,●and●a●tocotransducer●on●the●fundus●that●records●the●uterine● contractions.
■● ADVANTAGES●of●external●fetal●monitoring
☐● Noninvasive●and●reduces●risk●for●infection
☐● Membranes●do●not●have●to●be●ruptured
☐● Cervix●does●not●have●to●be●dilated
☐● Placement●of●transducers●can●be●performed●by●the●nurse
☐● Records●permanent●record●of●FHR●tracing
■● DISADVANTAGES●of●external●fetal●monitoring
☐● Contraction●intensity●is●not●measurable
☐● Movement●of●the●client●requires●frequent●repositioning●of●transducers
☐● Quality●of●recording●is●affected●by●client●obesity●and●fetal●position
Continuous electronic fetal monitoring
INDICATIONS FOR MONITORING
POTENTIAL DIAGNOSES (12)
● Indications for Monitoring ◯ Potential diagnoses ■ Multiple gestations; oxytocin (Pitocin) infusion (augmentation or induction of labor) ■ Placenta previa ■ Fetal bradycardia ■ Maternal complications (diabetes mellitus, pregnancy-induced hypertension, renal disease) ■ Intrauterine growth restriction ■ Post dates ■ Active labor ■ Meconium-stained amniotic fluid ■ Abruption placenta – suspected or actual ■ Abnormal nonstress test or contraction stress test ■ Abnormal uterine contractions ■ Fetal distress
Continuous electronic fetal monitoring
INTERPRETATION OF FINDINGS
A normal FHR baseline at term is? excluding (3) ? within a ? min window. At least ? min of baseline segments in a ? min window should be ?. A single number should be documented instead of a base line range
Interpretation of findings
A normal FHR baseline at term is 110 to 160/ min
excluding accelerations, decelerations and periods of marked variability
within a 10 min window.
At least 2 min of baseline segments
in a 10 min window should be present.
A single number should be documented instead of a base line range
Reassuring FHR patterns consist of a heart rate of 110 to
160/min with beat-to-beat variability of 15/min, lasting at least
15 seconds, with a return to baseline in less than 2 min with no decelerations.
Fetal HR baseline variability described as fluctuations in the FHR baseline that are irregular in frequency and amplitude. Classification:
Variability 4 kinds Absent Minimal Moderate Marked
Absent variability (considered nonreassuring) Minimal variability ( 25/min)
Reassuring FHR patterns consist of a heart rate of?
Reassuring FHR patterns consist of a heart rate of 110 to
160/min with beat-to-beat variability of 15/min, lasting at least 15 seconds, with a return to baseline in less than 2 min with no decelerations.
Each uterine contraction is comprised of:
Each uterine contraction is comprised of:
☐ Increment – the beginning of the contraction as intensity is increasing.
☐ Acme – the peak intensity of the contraction.
☐ Decrement – the decline of the contraction intensity as the contraction is ending.
Nonreassuring FHR patterns are associated with fetal hypoxia and include: (5)
Nonreassuring FHR patterns are associated with fetal hypoxia and include:
Fetal bradycardia. Fetal tachycardia. Absence of FHR variability. Late decelerations. Variable decelerations.
FHR Pattern:
Accelerations (variable transitory increase in the FHR above baseline)
Cause/Complications (4) Nursing Intervention (3)
Accelerations (variable transitory increase in the FHR above baseline)
Cause/Complications • Healthy fetal/placental exchange • intact fetal central nervous system (CNs) response to fetal movement • vaginal exam • Fundal pressure
Nursing Intervention
Reassuring
• No interventions required
• indicate reactive nonstress test
FHR Pattern: Fetal bradycardia (FHR <110/min for 10 min or more)
Cause/Complications (6) Nursing Intervention (7)
Fetal bradycardia (FHR <110/min for 10 min or more)
Cause/Complications • uteroplacental insufficiency • umbilical cord prolapse • maternal hypotension • Prolonged umbilical cord compression • Fetal congenital heart block • anesthetic medications
Nursing Interventions
• discontinue oxytocin (Pitocin) if it is being infused.
• Help the client into a side-lying position.
• administer oxygen
(8 to 10 l/min by mask).
• start an iv line if one is not in place.
• administer a tocolytic medication as prescribed.
• stimulate the fetal scalp.
• Notify the primary care provider.
