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NUR 231 M. Johnston, RN-BC, M.Ed. Cindy Irwin, RNC, MN

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Types of Monitoring Auscultation- listen to fetal heart rate (FHR) Electronic Fetal Monitoring use of instruments to record FHR and uterine contractions(U/Cs)

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Auscultation Doppler - ultrasound converts sounds waves to signals of fetal heart Fetoscope - Like stethoscope, open end pressed on abdomen, used less frequently

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Electronic Fetal Monitoring Measures response of FHR to uterine contractions (U/Cs) Intermittent or Continuous External Ultrasound transducer Tocotransducer Internal Fetal Scalp Electrode Intrauterine Pressure Catheter

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Fetal Monitoring Setup

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Fetal Heart Rate Characteristics Evaluate to determine fetal status NICHD terminology Baseline Rate Baseline Variability Accelerations (present or absent) Decelerations (present or absent) Changes or trends over time

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Baseline (BL) Normal range 110-160 bpm Measure between U/Cs for at least 2 min. period during 10 minute segment Tachycardia - >160 bpm for >10 minutes Bradycardia - 10 minutes

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Baseline

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Classifications of FHR Variability Fluctuations in FHR, irregular in frequency and amplitude Absent 0-2 bpm Minimal >2 25 bpm

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Absent Variabilty

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Minimal Variability

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Moderate Variability

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Marked Variability

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Periodic/Episodic Changes Periodic with uterine contractions Episodic without uterine contractions

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Accelerations Abrupt increase in FHR above BL Present or Absent < 32 wks gestation Peak 10 bpm above BL for at least 10 sec. >32 wks gestation Peak 15 bpm above BL for at least 15 sec. Accel 10 min. is defined as BL change

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Accelerations Abrupt increase in FHR above BL Peak 15 bpm above BL for at least 15 sec.

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Recognition Criteria for Fetal Heart Rate Accelerations Transient increase in the Fetal Heart Rate > 32 weeks acceleration stays 15 beats above the baseline for at least 15 seconds < 32 weeks acceleration stays 10 beats above the baseline for at least 10 seconds

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Types of Decelerations Early Gradual decrease and return to BL, mirrors the U/C Variable Abrupt (