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Fetal Monitoring and Fetal Assessment

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Fetal Monitoring and Fetal Assessment A few new techniques and protocols! IA= Intermittent Auscultation At the start of the 20th Century, IA of the FHR during labor ... – PowerPoint PPT presentation

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Title: Fetal Monitoring and Fetal Assessment


1
Fetal Monitoring and Fetal Assessment
  • A few new techniques and protocols!

2
IA Intermittent Auscultation
  • At the start of the 20th Century, IA of the FHR
    during labor was the predominant method of
    assessment.
  • IA is the practice of using a device that allows
    one to listen to the fetal heart sounds over
    time.
  • Examples would be placing the ear over the
    pregnant abdomen, using a fetoscope, or using a
    Doppler.

3
EFM Electronic Fetal Monitoring
  • Research in Randomized Clinical Trials on
    Low-risk pregnancies has demonstrated that
    (Anderson, 1994)
  • The use of EFM as compared with IA has not been
    shown to reduce neonatal morbidity or mortality
    rates but has been associated with increased
    rates of cesarean section and maternal infection
    (p. 165).

4
EFM Electronic Fetal Monitoring
  • This research is a cause for concern as we look
    at research-based practice and the fact that we
    are doing stuff that has not been necessarily
    supported by research!
  • Something to think about and ponder!
  • The future practice of EFM may change if agencies
    choose to practice based on clinical research
    findings.

5
Clinical Decision-making Based on Auscultation
Findings
  • Continue Individualized
  • Assessment and Care
  • Assess with IA palpation per pt/care
    provider preferences, guidelines,
    availability (11 nurse to fetus ratio)
  • Promote maternal comfort continued fetal
    oxygenation(position change anxiety
    reduction measures
  • Notify midwife or MD when a problem exists
    or is resolved

Auscultate FHR
Interpretation
Yes
  • Reassuring FHR Pattern?
  • Baseline rate 110-160
  • Regular rhythm
  • Absence of decrease from baseline

No
6
  • Non-Reassuring FHR
    Pattern
  • Baseline lt110 pbm
  • Baseline gt160 bpm (unexplained persistent
    tachycardia for gt 3 contractions or gt 10-15
    minutes
  • Irregular rhythm
  • ?FHR during 30 seconds after contractions
  • Gradual or abrupt change in FHR
  • Intervention/Management
  • ? frequency of IA to clarify FHR charracteristics
  • Assess potential cause of FHR characteristics
  • Attempt to remove problem(s)/cause
  • Intervene to promote 5 physiologic goals
  • Improve uterine blood flow
  • Improve umbilical blood flow
  • Improve oxygenation
  • ? uterine activity (e.g. position change,
    hydration)

7
Problem Solved??
YESReturn to Continued Individualized
Assessment Care
No
  • FHR Pattern Persists?
  • Continue interventions
  • Apply EFM to clarify pattern interpretation,
    assess variability, to further assess fetal
    status
  • Notify midwife or MD
  • Consider additional assessments (e.g. fetal
    scalp stimulation fetal acoustic stimulation)

8
Goals of Physiologic Interventions
Improve Uterine Blood Flow Maternal position change Hydration Anxiety reduction Medication Improve Oxygenation Maternal position change Maternal oxygen Maternal breathing techniques
Improve Umbilical Circulation Maternal position change Vaginal manipulation Amnioinfusion Reduce Uterine Activity Maternal position change Hydration Modified pushing Medication (e.g. discontinue or ? rate of labor-stimulating drug infusion
9
Definitions of Fetal Heart Rate Patterns
National Institute of Child Health and Human
Development (NICHD)
PATTERN DEFINITION
Baseline The mean FHR rounded to increments of 5 bpm during a 10 min. segment, excluding - Periodic or episodic changes - Segments of baseline that differ by more than 25 bpm The baseline must be for a minimum of 2 min. in any 10 min. segment
10
PATTERN DEFINITION
Baseline Variability Fluctuations in the FHR of two cycles per min or greater Variability is visually quantitated as the amplitude of peak-to-trough in bpm- -Absentamplitude range undetectable- -Minimalamplitude range detectable but 5 bpm or fewer- -Moderate (normal)amplitude range 6-25 bpm- -Markedamplitude range greater than 25 bpm
11
PATTERN DEFINITION
Acceleration A visually apparent increase (onset to peak less than 30 sec.) in the FHR from the most recently calculated baseline The duration of an acceleration is defined as the time from the initial change in FHR from baseline to the return of the FHR to baseline At 32 weeks of gestation and beyond, an acceleration has an acme of 15 bpm or more above baseline, with a duration of 15 sec. or more but less than 2 min. Before 32 weeks gestation an acceleration has an acme of 10 bpm or more above baseline, with a duration of 10 sec. or more but less than 2 min. If an acceleration lasts 10 min. or longer it is a baseline change
12
PATTERN DEFINITION
Bradycardia Early deceleration Baseline FHR less than 110 bpm In association with a uterine contraction, a visually apparent, gradual (onset to nadir 30 sec. or more) decrease in FHR with return to baselineNadir of the deceleration occurs at the same time as the peak of the contraction
13
PATTERN DEFINITION
Late deceleration Tachycardia In association with a uterine contraction, a visually apparent, gradual (onset to nadir 30 sec. or more) decrease in FHR with return to baseline Onset, nadir, and recovery of the deceleration occur after the beginning, peak, and end of the contraction, respectively Baseline gt 160 bpm
14
PATTERN DEFINITION
Variable Deceleration Prolonged Deceleration An abrupt (onset to nadir less than 30 sec), visually apparent decrease in the FHR below the baseline The decrease in FHR is 15 bpm or more, with a duration of 15 seconds or more, but lt 2 minutes Visually apparent decrease in FHR below the baseline Deceleration is 15 bpm or more, lasting 2 minutes or more but less than 10 minutes from onset to return to baseline.
15
Thats it for now!!
  • Have fun learning more about the Fetal Heart
    Monitor on the clinical unit!
  • Technology is really going places in fetal
    surveillance, so who knows what will be next!!
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