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Intermediate Fetal Monitoring: Understanding Fetal Heart Rate Patterns and Interventions, Exams of Nursing

Coastal Alabama Community CollegeNursing

A comprehensive overview of intermediate fetal monitoring, covering key physiological goals, fetal heart rate patterns, and interventions to optimize fetal well-being. It delves into the interpretation of various fetal heart rate parameters, such as baseline rate, variability, accelerations, and decelerations, as well as the assessment of fetal acid-base status. The document also discusses the extrinsic and intrinsic factors that influence fetal heart rate patterns, and the appropriate interventions to maintain appropriate uterine activity, maximize blood flow, oxygenation, and umbilical circulation. This information is crucial for healthcare professionals involved in the management of labor and delivery, as it enables them to make informed decisions and provide the best possible care for the mother and the fetus.

Typology: Exams

2024/2025

Available from 09/20/2024

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Intermediate Fetal Monitoring
5 Physiological Goals - ✔✔1. support maternal coping and labor progress
2. maximize uterine blood flow
3. maximize umbilical circulation
4. maximize oxygenation
5. maintain appropriate uterine activity
Absent variability - ✔✔amplitude range undetectable
Acceleration - ✔✔visually apparent abrupt (<30 sec to peak) increase in FHR above baseline for less than
2 minutes
-15bpmx15sec for 32 weeks and up
-10bpmx10sec for less than 32 weeks
Acid-base values - ✔✔-pH: <7.10 acidosis
-pCO2: >60 respiratory
-BD: >12 (BE <-12) metabolic
Adequate MVUs - ✔✔200-250
AFI and the Placenta - ✔✔amniotic fluid volume is an indirect indicator of placental function
Assessment of Fetal Acid-base Status - ✔✔-indirect: scalp stim, vibroacoustic stim
-direct: umbilical cord sampling
Baseline change - ✔✔a deceleration that lasts greater than or equal to 10 minutes
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Intermediate Fetal Monitoring

5 Physiological Goals - ✔✔1. support maternal coping and labor progress

  1. maximize uterine blood flow
  2. maximize umbilical circulation
  3. maximize oxygenation
  4. maintain appropriate uterine activity Absent variability - ✔✔amplitude range undetectable Acceleration - ✔✔visually apparent abrupt (<30 sec to peak) increase in FHR above baseline for less than 2 minutes
  • 15bpmx15sec for 32 weeks and up
  • 10bpmx10sec for less than 32 weeks Acid-base values - ✔✔-pH: <7.10 acidosis
  • pCO2: >60 respiratory
  • BD: >12 (BE <-12) metabolic Adequate MVUs - ✔✔ 200 - 250 AFI and the Placenta - ✔✔amniotic fluid volume is an indirect indicator of placental function Assessment of Fetal Acid-base Status - ✔✔-indirect: scalp stim, vibroacoustic stim
  • direct: umbilical cord sampling Baseline change - ✔✔a deceleration that lasts greater than or equal to 10 minutes

Baseline Rate - ✔✔-approximate mean FHR rounded to increments of 5bp during a 10 min segment

  • duration must be at least 2 min. or the baseline for that period is indeterminate Baseline variability - ✔✔fluctuations in baseline FHR that are irregular in amplitude and frequency Bradycardia - ✔✔baseline rate less than 110 bpm Category 1 - ✔✔-baseline 110- 160
  • moderate variability
  • no late or variable decels
  • present or absent early decels
  • present or absent accels Category 2 - ✔✔anything not in cat 1 or 3
  • baseline bradycardia (not with absent variability) or tachycardia
  • minimal, marked, or absent (not with recurrent decels) variability
  • absence of induced accels after fetal stimulation
  • recurrent variables with minimal or moderate variability
  • prolonged decel 2-10 minutes long
  • recurrent lates with moderate variability Category 3 - ✔✔either
  • sinusoidal
  • absent variability with: recurrent lates, recurrent variables, or bradycardia Doppler - ✔✔baseline, rhythm, accels, decels Early Deceleration - ✔✔A visually apparent usually symmetrical gradual (more than 30 sec) decrease in FHR and return to baseline associated with a contraction

Interventions to maximize blood flow - ✔✔-reduce anxiety/pain

  • maternal positioning (lateral)
  • hydration
  • medication to reduce uterine contractions (decrease pit or tocolytics) Interventions to maximize oxygenation - ✔✔-maternal breathing
  • supplemental oxygen (cautious use, not 1st line, not for prophylactic use) Interventions to maximize umbilical circulation - ✔✔-maternal position
  • amnioinfusion (closely monitor resting tone) Intrinsic Influences on FHR - ✔✔fetal homeostatic compensatory mechanisms
  • fetal circulation
  • ANS responses
  • baroreceptors
  • chemoreceptors
  • hormonal responses: redistribute blood flow Late Deceleration - ✔✔visually apparent, usually symmetrical gradual decrease in FHR and return to baseline associate with a contraction
  • delayed in timing with the nadir occurring after the peak of the contraction Marked variability - ✔✔amplitude range greater than 25 bpm Metabolic Acidosis - ✔✔-increased lactic acid levels (BD >12, BE <-12)
  • result from anaerobic metabolism
  • takes longer to develop
  • takes longer to correct

Minimal variability - ✔✔amplitude range > undetectable but <5/min Moderate variability - ✔✔amplitude ranges 6-25 bpm Periodic - ✔✔associated with contractions Physiologic Stress of Contractions - ✔✔-decrease in utero-placental blood flow

  • stasis in intervillous spaces fetus relies on reserves Prolonged Acceleration - ✔✔acceleration lasting longer than 2 minutes but less than 10 minutes. Prolonged Deceleration - ✔✔visually apparent decrease in FHR that is at least 15 bpm lasting greater than or equal to 2 minutes but less than 10 minutes from onset to return to baseline Recurrent - ✔✔occurring the greater than or equal to 50% of contractions in a 20 minute period Respiratory Acidosis - ✔✔-increased CO2 levels (>60)
  • occurs when fetal CO2 cant be easily diffused
  • can develop rapidly
  • can be corrected rapidly Signal ambiguity - ✔✔the fetal signal replaced by an alternate signal from the mother or another fetus Sinusoidal - ✔✔visually apparent undulating sine wave like pattern in FHR and cycle frequency of 3-5 per minute which persists for greater than or equal to 20 minutes Systematic Assessment of Monitor Tracing - ✔✔-baseline