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EFM - OB
Electronic Fetal Monitoring
| Question | Answer |
|---|---|
| What does Electronic Fetal Monitoring use to detect fetal heart rate | ultrasound transducer bounces off the beating fetal heart and picks up the closure of the heart valves |
| For external monitoring what is the best placement of the transducer | when placed over the fetal back |
| Internal monitoring requires....and provides... | spiral electrode placed on fetal scalp or buttock and provides a clearer more accurate picture |
| Indications of Fetal Monitoring (can be continuous or intermittent); mom can be up moving around if stable but back onto monitor every hr for 10-15min of tracing | presence of pregnancy complications, induction of labor(if on pitocin continuous monitoring), preterm labor(<37 wks), decreased fetal movement, fetal distress, meconium staining, previous stillborn |
| Interpretation; start with, then, | contraction pattern, frequency, duration and intensity; uterine resting tone; baseline FHR; variability; periodic changes (contraction) |
| Frequency of contractions | measured in minutes, time between the beginning of one contraction to the beginning of the next |
| Duration of contractions | measured in seconds; is the beginning of one contraction to its end |
| Intensity of contractions | strength of the contraction at its highest point |
| resting tone of uterus | is when the uterus is at rest |
| avoid placing the internal spiral electrode on | the fontanels or the face |
| baseline FHR; average, normal, don't count | avg is observed in 10 minute period, normal 110-160, accelerations & decelerations; look at pattern over time |
| Tachycardia sustained, causes | FHR > 160 for >10 min, hypoxia, maternal fever or dehydration, drugs that stimulate beta receptors (terbutaline or cocaine), maternal hyperthyroidism, fetal anemia/prematurity |
| Role of placenta | provides fetal oxygen, essential nutrients and hormones, and excretion of fetal waste; maintains metabolic balance; acts as barrier between mom/fetus blood |
| Bradycardia sustained, causes | FHR <110 for >10 min, often due to uteroplacental malfunction, maternal hypotension (epidural/supine position), prolonged cord compression, congential prob fetal heart block |
| Terminal Bradycardia | late hypoxia- deficiency of o2 reaching the tissue of the mom and therefore fetus, cord prolapse, abruptio placenta, uterine rupture |
| Two types of variability | short term long term |
| Short Term variability | "grass" beat to beat changes, can only be measure with internal monitor |
| long term variability | "waves" rhythmic fluctuations that occur 3-5 times per minute to indicate the range of the heartbeat |
| When is variability decreased | during periods of fetal sleep, after administration of certain drugs(pain, mag sulf,antihistimines), fetal tachycardia, fetuses less than 28 weeks gestation |
| Worrisome decreased variability | with maternal hypoxia, acidosis, or fetal congenital anomalies |
| Decreased variability that is not associated with drugs, sleep, or prematurity should be considered.... | an ominous sign |
| Short term variability is recorded as | absent or present |
| long term variability is recorded as | absent, minimal, moderate, and marked |
| moderate or marked variability is... | good sign that the fetus is not suffering cerebral asphyxia |
| Minimal Variability ranges | ranges less than or equal to 5 bpm |
| Moderate Variability ranges (most common) | ranges from 6-25 bpm |
| Marked Variability ranges | ranges over 25 bpm |
| Absent Variability ranges | undetectable |
| Sinusoidal Pattern & causes | waveform evenly distributed on STV or accelerations or decelerations; bleed from mom from MVA or RH+/- crossover, fetal hypoxia from fetal anemia |
| Accelerations | transient increases in FHR associated with fetal movement, thought to be a positive sign, reassuring |
| Decelerations | generally not reassuringl periodic decreases in FHR from baseline |
| Early Decelerations - causes | caused by fetal head compression - vagal response |
| Late Decelerations - causes | b uteroplacental insufficiency from decreased blood flow and oxygen to fetus - must take action notify provider - worst |
| Variable decelerations | caused by cord compression, decreased blood flow to the fetus and slowing of fetal heart rate - v-shaped |
| Early Decelerations | consistent and uniform, mirrors contraction inversely, onset just prior to or early in contraction, lowerst point at or before mid contraction, FHR stays 110-160, cause head compression which decreases cerebral bld flow/vagal cont to monitor/chart |
| late decelerations | uniform in shape and reflects contraction, onset is late in the contraction, lowest point consistently after mid contraction, FHR stays 110-130, causes placenta insufficiency ominous sign - take action |
| late deceleration nursing actions | turn to left side, o2 mask 7-10 liters, discontinue pitocin, increase IV fluids/give bolus, continue to monitor FHR/vaginal exam to check progress of labor, notify MD/CNM |
| Variable deceleration | doesn't have to be r/t contraction, shape variable has sharp drop and returns (v,u,w), onset is variable and abrupt, lowest point is variable, FHR not usually within normal limits (<110), cause umbilical cord compression, requires nsg action |
| Variable deceleration nsg action | change mom position to get best FHR, just get pressue off cord, also check for prolapsed cord, assess bladder empty is necessary, physician may order amnioinfusion |
| Amnioinfusion | warmed LR or NS infused into uterus to try and relive cord compression, need a IUPC |
| Prolonged Deceleration | Last longer than 90 seconds, profound changes in fetal environment, |
| Causes of prolonged deceleration/changes in environment | abruption, uterine rupture, hypertonous uterus, cord accidents, maternal seizures, maternal death |
| Causes of prolonged deceleration/hypotension | due to epidural or spinal, vagal stimulation(vaginal exam) with SVE or pushing, valsalva maneuver (holding breath while pushing) |
| Other causes of prolonged deceleration | rapid fetal decent, cord impingment (short cord, true knot, cord thrombosis) |
| Prolonged Deceleration - nursing actions | may need to use tocolytic drugs mag sulf, terbutaline, yutopar/ritodrine, prepare for C-section |
| Method of assessment stimulation of fetus | scalp (SVE), vibroacoustic stimulation; should see FHR accelerate in response |
| Method of assessment fetal o2 sat | should be 30% or greater |
| Method of assessment fetal scalp sampling | nicks scalp blood in capillary tube checks blood gas |
| method of assessment umbilical cord sample | pH should be 7.25-7.35 |
| Nonstress Test | noninvasive, measure fetal well-being, client placed on EFM to check for reassuring pattern of accelerations and acceptable variability in response to fetal movement, |
| Reactive Test | if there are at least 2 accelerations of at least 15 bpm lasting at least 15 seconds in a 20 minute tracing on a fetus at 32 weeks gestation or greater |
| Reassuring EFM tracing | FHR 110-160, short term variability prsent, long term variability moderate or marked with accelerations, early decelerations may be present, no late decelerations, if variable not deep and repetitive |
| Nonreassuring EFM tracing - any one can make it non-reassuring | severe variable decelerations (deep/repetitive), late decelerations, absence of variability, prolonged decelerations, severe bradycardia |
Created by:
angela.garrison511