Chapter 17 Fetal Assessment during Labor

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Chapter 17: Fetal Assessment during Labor
Chapter 17
Fetal Assessment
during Labor
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Chapter 17: Fetal Assessment during Labor
Fetal Assessment during Labor

Electronic fetal monitoring (EFM) useful
tool for visualizing FHR patterns on
monitor screen or printed tracing
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Chapter 17: Fetal Assessment during Labor
Basis for Monitoring

Fetal response

Labor is a period of physiologic stress for
fetus

Frequent monitoring of fetal status is part of
nursing care during labor

Fetal oxygen supply must be maintained
during labor to prevent fetal compromise
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Chapter 17: Fetal Assessment during Labor
Basis for Monitoring

Fetal oxygen supply can decrease:

Reduction of blood flow through maternal
vessels as result of:
• Maternal hypertension: chronic hypertension or
pregnancy-induced hypertension
• Hypotension caused by supine maternal position,
hemorrhage, epidural analgesia or anesthesia
• Hypovolemia caused by hemorrhage
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Chapter 17: Fetal Assessment during Labor
Basis for Monitoring

Fetal oxygen supply can decrease:
(cont’d)

Reduction of oxygen content in maternal blood
as result of hemorrhage or severe anemia

Alterations in fetal circulation with
compression of umbilical cord

Reduction in blood flow to intervillous space
in placenta
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Chapter 17: Fetal Assessment during Labor
Basis for Monitoring

Fetal well-being during labor measured by
response of FHR to UCs

Reassuring FHR patterns are:

Baseline FHR in normal range of 110 to 160
beats/min, with no periodic changes and a
moderate baseline variability

Accelerations with fetal movement
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Chapter 17: Fetal Assessment during Labor
Basis for Monitoring

Fetal compromise

Goals of intrapartum FHR monitoring are to
identify nonreassuring patterns indicative of
fetal compromise

Nonreassuring FHR patterns associated with:
• Fetal hypoxemia, deficiency of oxygen in arterial
blood
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Chapter 17: Fetal Assessment during Labor
Basis for Monitoring

Fetal compromise (cont’d)

Hypoxemia can deteriorate to severe fetal
hypoxia
• Inadequate supply of oxygen at cellular level

Nurse’s role is to assess that FHR pattern
reflects adequate fetal oxygenation
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Chapter 17: Fetal Assessment during Labor
Basis for Monitoring

Fetal compromise (cont’d)

When pattern is nonreassuring, nurse must
discriminate between:
• Patterns indicating mild fetal hypoxemia
• Patterns indicating severe fetal hypoxia
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Chapter 17: Fetal Assessment during Labor
Monitoring Techniques

Intermittent auscultation (IA)

Listening to fetal heart sounds at periodic
intervals to assess FHR

IA can be performed with:
• Leff scope
• DeLee-Hillis fetoscope
• Ultrasound device
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Chapter 17: Fetal Assessment during Labor
Monitoring Techniques

Electronic fetal monitoring

External monitoring
• FHR—ultrasound transducer
• UCs—tocotransducer

Internal monitoring (invasive)
• Spiral electrode
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Chapter 17: Fetal Assessment during Labor
Fetal Heart Rate Patterns

Baseline fetal heart rate

Baseline rate is average during 10-minute
segment, excluding:
• Periodic or episodic changes
• Periods of marked variability
• Segments of baseline that differ by more than
25 beats/min
• Normal range at term 110 to 160 beats/min
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Chapter 17: Fetal Assessment during Labor
Display of Fetal Heart Rate and Uterine Activity on Monitor Paper
A. External mode with ultrasound and tocotransducer as signal source
B. Internal mode with spiral electrode and intrauterine catheter as
signal source. Frequency of contractions is measured from the
beginning of one contraction to the beginning of the next
B
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Chapter 17: Fetal Assessment during Labor
Fetal Heart Rate Variability
A. Absent or undetected
B. Minimal
C. Moderate
D. Marked
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Chapter 17: Fetal Assessment during Labor
Fetal Heart Rate Patterns

Baseline fetal heart rate (cont’d)

Variability

Tachycardia: baseline more than 160 beats/min
for duration of 10 minutes or longer

Bradycardia: baseline less than 110 beats/min
for duration of 10 minutes or longer
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Chapter 17: Fetal Assessment during Labor
Fetal Heart Rate Patterns

Changes in fetal heart rate

Periodic occur with UCs

Episodic (nonperiodic) not associated
with UCs

Accelerations

Decelerations
• Early decelerations: response to fetal head
compression
• Late decelerations due to uteroplacental
insufficiency
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Chapter 17: Fetal Assessment during Labor
A. Acceleration of fetal heart rate (FHR) with uterine contractions
B. Spontaneous (episodic) acceleration of FHR movement
A
B
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Chapter 17: Fetal Assessment during Labor
Deceleration Patterns
A. Early decelerations
caused by head
compression
B. Late decelerations caused
by uteroplacental
insufficiency
C. Variable decelerations
caused by cord compression
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Chapter 17: Fetal Assessment during Labor
Fetal Heart Rate Patterns

Changes in fetal heart rate (cont’d)

Variable decelerations: due to umbilical cord
compression

Prolonged decelerations
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Chapter 17: Fetal Assessment during Labor
Care Management

Assessment

Nursing diagnoses

Expected outcomes of care

Plan of care and implementation

Electronic fetal monitoring pattern recognition
• Nursing management of nonreassuring patterns
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Chapter 17: Fetal Assessment during Labor
Care Management

Additional methods of assessment and
intervention

Fetal heart rate response to stimulation

Fetal oxygen saturation monitoring
• Fetal pulse oximetry (FPO)

Fetal scalp blood sampling

Amnioinfusion

Tocolytic therapy

Umbilical cord acid-base determination
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Chapter 17: Fetal Assessment during Labor
Care Management

Additional methods of assessment and
intervention (cont’d)

Patient and family teaching
• Maternal positioning
• Discouraging the Valsalva maneuver

Documentation

Evaluation
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Chapter 17: Fetal Assessment during Labor
Key Points

Fetal well-being during labor is gauged by
response of FHR to UCs

FHR characteristics include baseline FHR
and periodic changes in FHR

Monitoring of fetal well-being includes:

FHR assessment

Watching for meconium-stained amniotic fluid

Assessment of maternal vital signs and uterine
activity
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Chapter 17: Fetal Assessment during Labor
Key Points

Responsibility of nurse to:

Assess FHR patterns

Implement independent nursing interventions

Report nonreassuring patterns to physician or
nurse-midwife
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