Fetal Well-being
and
Electronic Fetal
Monitoring
Fetal Tests
Fetal Heart Rate
Decelerations
Variability
Fetal Movement Counts
Ultrasound
• Confirmation of pregnancy and fetal
presentation
• Evaluation of fetal heartbeat and fetal
respiration
• Identification of more than one embryo/fetus
• For examination of anatomical fetal structures
• To estimate gestational age, fetal weight, and
growth
• Location of the placenta and amniotic fluid
volume
• Accompanying invasive procedures
Fetal Activity
• Vigorous fetal activity - provides
reassurance of fetal well-being
• Marked decrease or cessation in activity
– May indicate possible fetal compromise
– May require immediate follow-up
• Assessment of fetal activity (from week
28 to week 38) - noninvasive method of
monitoring the fetus
Fetal Movement Counts
• Daily record beginning at 27 weeks gestation
• Count at same time each day – 1 hour after
meals
• Lie in side-lying position
• Contact health care provider when:
– <10 movements in 3 hours using Cardiff card
– < 3 movements in 8 hours using daily movement
record
– No fetal movement in AM
– Fetal movements becoming slower
Electronic Fetal Monitoring
• Provides continuous data and is routine
for high-risk clients
– Also used for women experiencing an
induction of labor
– May be done externally or with an internal
monitor
Electronic Fetal Monitoring
• - Indications for:
– Previous history of stillborn
– Presence of complication
– Induction of labor, preterm labor
– Decreased fetal movement
– Non-reassuring fetal status
– Meconium staining of amniotic fluid
– Trial of labor following a C-section
Electronic Fetal Monitoring
• Fetal Heart Rate – 110 – 160 bpm
• Fetal Tachycardia
– Sustained rate of 161 bpm or above
– If rate is 180 bpm or above, is marked
tachycardia
• Causes
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Early fetal hypoxia
Maternal fever
Maternal dehydration
Chorioamnionitis
Maternal hyperthyroidism
Beta-sympathomimetic drugs
Fetal anemia
Fetal Tachycardia
• Ominous sign if tachycardia is
accompanied by
– Late decelerations
– Severe variable decelerations
– Decreased variability
Fetal Bradycardia
• Fetal Bradycardia
– less than 110 bpm during a 10-minute period or
longer
• Causes
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Profound hypoxia in fetus
Maternal hypotension
Prolonged umbilical cord compression
Fetal arrhythmias
Uterine hyperstimulation
Abruptio placentae
Uterine rupture
Vaginal stimulation in second stage of labor
Evaluate Fetal Monitoring
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Is baseline within normal limits?
Is there tachycardia or bradycardia?
Is variability present or absent?
If present, is variability Minimal (≤ 5
bpm)? Moderate (6-25 bpm)? Marked
(> 25 bpm)?
• Are there accelerations or decelerations
(early, late, variable, prolonged)
(prolonged = decrease ≥ 15 bpm for ≥ 2
min but < 10 min)?
EFM Categories
• Category 1 - Normal
– FHR 110 – 160
– No late or variable decelerations
– May see early decelerations
• Category 3 – Abnormal
– Absent variability and any of following:
– Recurrent and variable decelerations
– Bradycardia
– Sinusoidal pattern (cycle frequency 3 – 5
minutes for >= 20 minutes)
EFM Categories
• Category 2 – Indeterminate
– Any fetal heart rate pattern not in Category
1 or Category 2
Nursing Interventions for
Nonreassuring FHR
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Optimize maternal positioning – side-lying
Discontinue oxytocin if indicated
Give supplemental oxygen if indicated
Notify physician or midwife
Administer IV fluids as needed
Monitor maternal v/s for hypotension and
treat
• Elevate HOB 30 degrees
• Initiate continuous monitoring
Nursing Interventions for
Nonreassuring FHR
• Assist with internal monitors as appropriate
• Perform vaginal exam to assess for
prolapsed cord or labor progress
• Assist physician with fetal blood sampling
• Prepare for expeditious birth
• Provide client and family with explanation
• Administer tocolytic as ordered
Biophysical Profile
Non-Stress Test
• Used to assess fetal status using an
electronic fetal monitor
• Based on the knowledge
– Well-oxygenated fetus has adequate oxygenation
– Intact central nervous system
– Increase in fetal heart rate (FHR) with fetal
movement
• Reactive NST: Two accelerations of FHR
over 20 minutes
• Nonreactive: Less than 2 accelerations over
40 minutes
• Unsatisfactory: Cannot be interpreted
Non-Stress Test
Example of a reactive nonstress test (NST). Accelerations of 15 beats per
minute lasting 15 seconds with each fetal movement (FM).
Non-Stress Test
Example of a nonreactive NST. There are no accelerations of FHR with
FM.
Contraction Stress Test
Example of a positive contraction stress test (CST). Repetitive late
decelerations occur with each contraction. Note that there are no
accelerations of FHR with three fetal movements (FM).
Amniocentesis
• Nursing care: Assist the physician during
amniocentesis
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Support the woman undergoing the procedure
Obtain informed consent
Clarify the physician’s instructions or explanations
Obtain baseline vital signs
Obtain baseline fetal heart rate
After procedure, review reportable side effects
Assess vital signs and fetal heart rate
L/S Ratio
16–6
Lecithin / Sphingomyelin (L/S) Ratio and Phophatidylglycerol
(PG)
NCLEX Question
•
A biophysical profile result of 4 is
reported to the physician. Which
intervention should the nurse plan to
do?
A.
B.
C.
D.
Schedule a repeat BPP for later today.
Schedule a contraction stress test.
Instruct in fetal movement counts.
Prepare for delivery of fetus.