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Electronic fetal monitoring is

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a useful tool for visualizing fetal heart rate (FHR) patterns on a monitor screen or printed tracing

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EFM is

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Primary mode of intrapartum assessment in the United States

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FHR monitoring made its debut for clinical use

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in the early 1970s

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The anticipation of FHR monitoring was that its

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use would result in less intrapartum asphyxia and thus fewer cases of cerebral palsy

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Fetal oxygen supply must be maintained during labor to

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prevent fetal compromise

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Fetal Oxygen may decrease by Reduction of

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blood flow through maternal vessels as result of hypertension and hypotension

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Reduction of oxygen content in maternal blood as result of

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hemorrhage or severe anemia

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Fetal Oxygen may decrease by alterations in

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fetal circulation with compression of umbilical cord

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Fetal Oxygen may decrease by reduction in blood flow to

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intervillous space in placenta

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Category I fetal heart rate (FHR) tracings include

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BHR: 110-160, BFHR Variability: Moderate, Late or variable decelerations: Absent, Early decelerations: Either present or absent, Accelerations: Either present or absent

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Category II FHR tracings include all FHR tracings not categorized as

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category I or category III

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Category III FHR tracings include either

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Absent baseline variability and any of the following: Recurrent late decelerations, Recurrent variable decelerations, Bradycardia, Sinusoidal pattern

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Abnormal FHR patterns are

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those associated with fetal hypoxemia

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Fetal hypoxemia is

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a deficiency of oxygen in the arterial blood

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Hypoxemia can deteriorate to

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severe fetal hypoxia

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Fetal hypoxia

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an inadequate supply of oxygen at the cellular level that can cause metabolic acidosis

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asphyxia is used when

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fetal hypoxia results in metabolic acidosis

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Frequency

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Contraction frequency overall generally ranges from two to five per 10 minutes during labor

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Duration

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Contraction duration remains fairly stable throughout first and second stages, ranging from 45-80 seconds (not greater than 90 seconds)

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Strength

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Uterine contractions generally range from peaking at 40-70 mm Hg in first stage of labor to over 80 mm Hg in second stage

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Resting tone

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Average resting tone during labor is 10 mm Hg

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Relaxing tone

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commonly 60 seconds or more in first stage and 45 seconds or more in second stage

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Intermittent auscultation

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Listening to fetal heart sounds at periodic intervals to assess FHR

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Intermittent Auscultation can be performed with

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DeLee-Hillis fetoscope, Pinard stethoscope, Doppler ultrasound device

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External monitoring FHR

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ultrasound transducer

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External monitoring UC

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tocotransducer

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Internal monitoring devices

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Spiral electrode and Montevideo units

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The contraction intensity is

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usually described as mild, moderate, or strong.

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The contraction duration is measured in

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seconds, from the beginning to the end of the contraction.

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The frequency of contractions is measured in

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minutes, from the beginning of one contraction to the beginning of the next

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Ultrasound transducer

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High-frequency sound waves reflect mechanical action of fetal heart

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Spiral electrode

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Converts fetal ECG as obtained from presenting part to FHR via cardiotachometer

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Tocotransducer

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Monitors frequency and duration of contractions by means of pressure-sensing device applied to maternal abdomen

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Intrauterine pressure catheter (IUPC)

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monitors frequency, duration, and intensity of contractions

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The standard paper speed used in the United States is

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3 cm/min

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Montevideo units (MVUs) are calculated by

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subtracting the baseline uterine pressure from the peak contraction pressure for each contraction that occurs in a 10-minute window and then adding together the pressures generated by each contraction that occurs during that period of time

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Spontaneous labor usually begins when MVUs are between

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80 and 120

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The baseline FHR is the average rate during

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a 10-minute segment that excludes periodic or episodic changes, periods of marked variability, and segments of the baseline that differ by more than 25 beats/min

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There must be at least

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2 minutes of interpretable baseline data in a 10-minute segment of tracing to determine the baseline FHR

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Variability of the FHR can be described as

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irregular waves or fluctuations in the baseline FHR of two cycles per minute or greater

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Moderate variability indicates that FHR regulation is

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not affected significantly by fetal sleep cycles, tachycardia, prematurity, congenital anomalies, pre-existing neurologic injury, or CNS depressant medications

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A sinusoidal pattern

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is not included in the definition of FHR variability

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Tachycardia is a baseline FHR greater

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than 160 beats/min for 10 minutes or longer

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Bradycardia is a baseline FHR less than

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110 beats/min for 10 minutes or longer

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Acceleration of the FHR is defined as

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a visually apparent, abrupt (onset to peak less than 30 seconds) increase in FHR above the baseline rate

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Early deceleration of the FHR is a

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visually apparent, gradual (onset to lowest point ≥30 seconds) decrease and return to baseline FHR associated with UC's

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Nursing interventions for Accelerations

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Nothing required

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Acceleration with fetal movement signifies

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fetal well-being representing fetal alertness or arousal states

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Late deceleration of the FHR is a

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visually apparent, gradual (onset to lowest point ≥30 seconds) decrease in and return to baseline FHR associated with UCs

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Nursing interventions on late deceleration

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none required

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Variable deceleration of the FHR is defined as a

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visually abrupt (onset to lowest point <30 seconds) and apparent decrease in FHR below the baseline

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Variable decelerations have a U, V, or W shape, characterized by a

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rapid descent and ascent to and from the nadir (lowest point) of the deceleration

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Clinical significance of late decelerations

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Abnormal pattern associated with fetal hypoxemia, acidemia, and low Apgar scores; considered ominous if persistent and uncorrected, especially when associated with absent or minimal baseline variability

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Nursing interventions for Late deceleration

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Change maternal position (lateral), correct maternal hypotension by elevating legs, Increase rate of maintenance intravenous solution, Palpate uterus to assess for tachysystole, Discontinue oxytocin if infusing, Administer oxygen at 8 to 10 L/min by nonrebreather face mask, Notify physician or nurse-midwife, Consider internal monitoring for more accurate fetal and uterine assessment, Assist with birth (cesarean or vaginal assisted) if pattern cannot be corrected

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A prolonged deceleration is a

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visually apparent decrease (may be either gradual or abrupt) in FHR of at least 15 beats/min below the baseline and lasting more than 2 minutes but less than 10 minutes

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FHR tracing be evaluated

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every 30 minutes during the first stage of labor and every 15 minutes during the second stage of labor in low risk women

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If risk factors are present, the FHR tracing should be evaluated

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every 15 minutes in the first stage of labor and every 5 minutes in the second stage of labor

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Intrauterine resuscitation is sometimes used to

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refer to specific interventions initiated when an abnormal FHR pattern is noted

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Amnioinfusion is

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infusion of room-temperature isotonic fluid (usually normal saline or lactated Ringer's solution) into the uterine cavity if the volume of amniotic fluid is low

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Tocolysis

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relaxation of the uterus

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Absent and minimal variability is

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Abnormal or indeterminate, Fetal hypoxemia or metabolic acidemia

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Moderate variability is

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normal

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Marked variability is

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Unclear significance, Sinusoidal pattern

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Early decelerations response to

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fetal head compression

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Late decelerations caused by

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uteroplacental insufficiency

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VEAL

answer

Variable, Early, Accelerations, Late

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CHOP

answer

Cord Compression, Head Compression, Ok , Placenta Insufficiency

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Prolonged decelerations

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Visually apparent decrease, Interruption to fetal oxygen supply

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