INTRAPARTAL FETAL ASSESSMENT
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Transcript of INTRAPARTAL FETAL ASSESSMENT
INTRAPARTAL FETAL
ASSESSMENT
Developed by
D. Ann Currie, R.N., M.S.N.
FETAL MONITORING ANTEPARTUM ASSESSMENT-FETAL
SURVEILLANCE AND DIAGNOSTICS. INTRAPARTUM ASSESSMENT-FETAL
SURVEILLANCE AND DIAGNOSTICS.
ANTEPARTUM ASSESSMENT OF FETAL HEART RATE AUSCULTATION-WITH FETOSCOPE OR
DOPPLER. ELECTRONICAL(EFM)- NST(NONSTRESS TEST) CST(CONTRACTION STRESS TEST) FAST(FETAL ACOUSTIC STIMULATION
TEST)
Auscultation of FHR with Doppler
Fetal Acoustic Stimulation Test-FAST
AUSCULTATION OF FHR FETOSCOPE- ADVANTAGES-CHEAP CAN BE DONE ANYWHERE NO ELECTRICITY
DISADVANTAGES NOT CONTINOUS NO HARD COPY OR PERMENANT
RECORD REQUIRES SKILL TO USE FETOSCOPE UNABLE TO DETERMINE PATTERNS OF
FHR UNABLE TO DETERMINE VARIABILITY.
ELECTRONICALFETALMONITORING(EFM)
EXTERNAL EFM NONINVASIVE METHOD OF ASSESSING
FHR PERMENANT RECORD OF FHR CAN BE USED IN THE OUTPATIENT
AREAS AND IN THE HOSPITALS. MOST EQUIPMENT(EFM) IN EL PASO
ARE ULTRASOUND TRANSDUCERS.
DISADVANTAGES OF EXTERNAL EFM NOT AS ACCURRATE AS INTERNAL EFM CAN ONLY DETERMINE LTV(LONG TERM VARIABILITY) IF FETUS OR MOTHER MOVES IT MAY
INTERUPT EFM STRIP…READJUST FREQ.
RESTRICTION OF CLIENT’S MOVEMENT
Placement of External Monitor
INTERNAL FETAL MONITORING FETAL SCALP ELECTRODE ADVANTAGES- DIRECT FHR MORE ACCURATE FHR-CLEAR
BASELINE,VARIABLITY-STV<V MATERNAL COMFORT DISADVANTAGES-MUST HAVE ROM. INCREASE RISK OF INFECTIONS
INTERNAL EFM CONT. CAN ONLY BE PLACED IF
PRESENTATION IS KNOWN NO FACE PRESENTATIONS,NO
EYES,NOT OVER FONTANELLES,OR ON GENITALS.
CAN NOT BE PLACED WITH MATERNAL HX OF STI’S OR INFECTIONS
INTERNAL EFM CONT. CAN NOT BE USED IF PLACENTA
LOCATION IS NOT KNOWN OR WITH PLACENTA PREVIA.
PERSONNEL NEEDS TO BE TRAINED TO PLACE INTERNAL SCALP ELECTRODE
STERILE PROCEDURE
FHR BASELINE
FHR BASELINE IS DETERMINED WHEN THERE IS NO CHANGES IN THE FHR- NO ACCELERATIONS OR DECELERATIONS.
FHR BASELINE RATE IS THE RANGE OF FHR-NORMAL IS 110-160.
FHR BASELINE VARIABILITY IS THE VARIABILITY ON BASELINE
Fetal Heart Rate Baseline
FHR BASELINE NORMAL -110-160 BRADYCARDIA-UNDER 110 FOR TEN
MINUTES TACHYCARDIA-OVER 160 FOR TEN
MINUTES
FHR BASELINE VARIABILITY SHORT TERM VARIABILITY(STV)-ALSO
CALLED BEAT TO BEAT. ONLY DETERMINED BY INTERNAL EFM IT IS PRESENT OR NOT. DOCUMENTING STV-PRESENT OR
ABSENT.
FHR BASELINE VARIABILITY LONG TERM VARIABILITY(LTV)- RHYTHMIC CYCLES -3-5 CYCLES LONG TERM
VARIABILITY(LTV)- RHYTHMIC CYCLES -3-5 CYCLES PER
MINUTE DESCRIBED AS ABSENT 0-2 BPM ,MINIMAL 3-
5BPM, AVE. 6-25 BPM,INCREASED/MARKED OVER 25BPM.
.
Absent Variability
Minimal Variability
Average Variability
PERIODIC FHR CHANGES
ACCELERATIONS- NOTE IN THIS COURSE JUST NOTE THAT THEY ARE PRESENT OR ABSENT.
ACCELERATIONS OF FHR SHOULD GO UP 15-20 BEAT ABOVE BASELINE FOR 15-20 SECONDS.
ACCCELERATIONS INDICATE FETAL WELL-BEING.
ACCELERATIONS TYPES- SHOULDERS-SEEN WITH
VARIABLE DECELERATIONS AND INDICATE WELLBEING
OVERSHOOTS- SEEN AFTER VARIABLE DECELERATIONS INDICATE DISTRESS.
ACCELERATIONS ARE UNDER TEN MINUTES.
Accelerations
Acelerations
EARLY DECELERATIONS REASSURING MECHANISM-FETAL HEAD
COMPRESSION.,VAGAL REFLEX. DOCUMENT THEIR PRESENTS TX: NONE.
Early Deceleration
LATE DECELERATIONS NONREASSURING MECHANISM: UTERINE PLACENTA
INSUFFICIENCY-FETAL HYPOXIA. CAUSES: UTERINE
HYPERACTIVITY,SUPINE HYPOTENSION, COMPLICATIONS-SLE,DM ETC.
TX:TURN TO SIDE FIRST LEFT IS BEST.
Late Decelerations
LATE DECELERATIONS TX: TURN TO SIDE, INCREASE FLUID IF
OK WITH CLIENT’S CONDITION, OXYGEN,IF PITOCIN RUNNING STOP, NOTIFY DR. IF LATE CONT. BE PREPARED FOR DELIVERY OR C/SECTION, NOTIFY ICN.
DOCUMENT
VARIABLE DECELERATIOS ABURPT DROP IN FHR AND RETURNS
TO BASELINE ABURPTLY MOST COMMON OR FREQUENT SEEN
TYPE OF DECELERATION MECHANISM: UMBILICAL
COMPRESSION. TX: TURN CLIENT OFF CORD-EITHER
TO SIDE OR OTHER POSITIONS
Variable Decelerations
REASSURING FHR PATTERN BASELINE RATE-110-160 BASELINE VARIABILITY-AVERAGE ACCELERATIONS WITH FM OR UC OR
STIMULATION. EARLY DECELERATIONS NO LATE DECELERATIONS NO MODERATE OR SEVERE VARIABLE
DECELERATIONS
NONREASSURING FHR PATTERN BASELINE RATE BELOW 110 OR
ABOVE160 FOR 10 MINUTES. BASELINE VARIABILITY-
MINIMAL,ABSENT,OR INCREASED. DECELERATIONS-LATES, MOD-SEVERE
VARIABLES,PROLONGED. NO ACCELERATIONS WITH UC, FM OVERSHOOTS. SINUSIODAL PATTERN
Sinusiodal FHR Pattern
Evaluate this EFM strip/What do you think is happening?
What do you think of this EFM Strip?
MONITORING UTERINE ACTIVITY METHODS EXTERNAL UTERINE MONITORING INTERNAL UTERINE MONITORING
UTERINE CONTRACTIONS DEFINIONS OF TERMS FREQUENCY DURATION INTENSITY-1.BY PALPATION 2. IUPC-
mmHg.3.MONTEVIDEOUNITS(MVU) RESTING PERIOD RESTING TONE(TONUS)
-
Uterine Contractions
TYPES OF UTERINE ACTIVITY EFFECTIVE UTERINE CONTRACTIONS INEFFECTIVE UTERINE
CONTRACTIONS HYERSTIMULATION TETANIC CONTRACTIONS UTERINE IRRITABILITY HYPERTONUS