Fetal Monitoring
2013
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
Maternal blood flow
 Fetal blood flow
 Gas/substance Exchange

– Contraction’s affect
Placental Physiology
Regulation of FHR
Autonomic nervous system
 Baroreceptors
 Chemoreceptors
 Adrenal gland
 Central nervous system

Fetal Heart Rate Monitoring
Devices

Hand held dopple

Fetoscope
Electronic Fetal Monitor
Methods of Fetal Monitoring
Intermittent auscultation
 Continuous external
 Continuous internal

Methods of Fetal Monitoring

External
– Ultrasound transducer
– Tocotransducer

Internal
– Fetal scalp electrode (FSE)
– Intrauterine pressure catheter (IUPC)
Internal Monitoring
Criteria for Internal Monitoring:
 Amniotic membranes must be ruptured
 Cervix dilated 2 cm.
 Presenting part down against the
cervix
Spiral Electrode is placed on the fetal
occiput which allows for more accurate
continuous data then external monitoring.
Also is not affected by mom or fetal
movement as with external monitoring.
Internal Monitoring
The spiral electrode is
attached to the
fetal scalp
Internal uterine pressure
catheter (IUPC) is placed
between fetus and the
uterine wall.
Nursing Responsibilities
Electronic Fetal Monitoring




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Placement of equipment
Teaching the woman about use
Notation of events on the strip
Evaluation of data
Intervention as indicated by data
Electronic Fetal Monitor Paper
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, betaadrenergic blocking drugs
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.
Causes of Decreased Variability
Hypoxia and acidosis
Medications
Sleep cycle
Preterm status
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.

Early Decelerations

Related to Head Compression

Intervention
– No intervention necessary. Just
continue to watch for any changes.
Early Deceleration
Variable Decelerations

Related to cord compression

Intervention
– Reposition
– Amnioinfusion
Variable Deceleration
Late Decelerations

Related to decreased uteroplacental
perfusion
Nursing Care for
FHR Decelerations

Stop the Pitocin

Reposition - Turn woman to a side-lying or
knee-chest position. Avoid supine position

Increase rate of the mainline IV

Administer oxygen by mask at 10 L/min.

Give Terbutaline sub-q.

Notify the primary care provider

If late decelerations do not improve,
prepare for immediate delivery
Late Deceleration
VEAL
CHOP
Variable
Early
Acceleration
Late
Cord
Head
Okay
Placenta
Prolong Deceleration

Fetal heart rate deceleration that
lasts greater than 2 minutes.
Sinusoidal Pattern (Undulating)

Fetal heart rate repeating cycle of
upward increase in the heart rate
followed by a decrease in the rate.
Prolonged Deceleration
Sinusoidal Pattern
Interpreting FHR as…..

Reassuring (Category I)
– Accelerations
– Moderate variability

Non-reassuring (Category II or III)
–
–
–
–
–
Tachycardia
Bradycardia
Decreased or absent variability
Late decelerations
Variable decelerations (persistent)
Non-reassuring FHR Tracing

Interventions
–
–
–
–
–
Reposition
Oxygen therapy
IV fluid bolus
(Discontinue oxytocin infusion)
Other
Fetal Scalp Stimulation

Used to assess fetal well being.
– Procedure: examiner gently sweeps
fingers in a circular motion on the
fetal scalp
– FHR acceleration = well oxygenated
fetus and normal acid base balance.
Cord Blood Gases & pH

Analysis used to assess the infant’s
acid-base balance immediately
after birth.
Montevideo Units

Montevideo units is a measure of uterine
contraction intensity during labor.

Units are calculated via internal pressure
monitor, measuring uterine contraction peak
pressure and subtracting the baseline resting
tone. This is done over a 10 minute interval.

Generally, above 200 MVUs is considered
necessary for adequate labor to bring about
dilation and effacement during the active
phase.
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The End