Fetal Monitoring
Ann Hearn RNC, MSN
Fall 2009
Electronic Fetal Monitoring
Standard of Care
 “Nurses who care for women during the childbirth process are legally
responsible for correctly interpreting FHR patterns, initiating
appropriate nursing interventions based on the pattern seen, and
documenting the outcome of those interventions.”
Placental Physiology
Fetal Heart Rate Monitoring Devices
Electronic Fetal Monitor
Methods of Fetal Monitoring
Patterns of Fetal Heart Rate Monitoring
Fetal Heart Rate
 Baseline FHR = 110 – 160 bpm
– Average rate over 10 minutes
 Tachycardia – baseline above 160 BPM
– RT= maternal fever, fetal hypoxia, intrauterine infection,
drugs
 Bradycardia – baseline below 110 BPM
– RT = profound hypoxia, anesthesia, beta-adrenergic
blocking drugs
Electronic Fetal Monitor Paper
Fetal Heart Rate Variability
 Normal irregularity of the cardiac rhythm.
 Absence of variability, or a smooth flat baseline is a sign of fetal
compromise.
 A determinant of fetal wellbeing.
Fetal Heart Rate Variability
Periodic Changes of FHR
 Acceleration
 Deceleration
Acceleration
 Increase in the fetal heart rate from baseline by 15 bpm lasting 15
seconds or more.
A
determinant of fetal wellbeing
Reassuring Fetal Heart Rate Pattern
Deceleration
 Decreases in the fetal heart rate from the normal baseline.
–
–
–
–
Variable
Early
Late
Prolong
Deceleration
 Variable – related to cord compression. Interventions vary.
 Late – related to utero-placental insufficiency. Immediate
intervention.
 Early – related to head compressions. Interventions not necessary.
 Prolong – lasts > 2 minutes. Interventions necessary.
Nursing Care for FHR Decelerations
 Reposition: Turn woman to a side-lying position, or knee- chest
position. Avoid supine position
 Hydrate: Increase rate of mainline IV
 Decrease uterine activity:
– Stop Pitocin infusion
– Give Terbutaline sub-q.
 Oxygenate: Provide oxygen by mask at 10 L/min.
VEAL
CHOP
Variable
Early
Acceleration
Late
Cord
Head
Okay
Placenta
The End