Exam 2--Module 4: Basic Fetal Monitoring
pwrpt
A method of fetal assessment used prior to labor for antepartal evaluation and/or during
labor for intrapartum evaluation.
Intermittent or continuous electronic recording of fetal heart rate and uterine
contractions. - ANS-fetal monitoring
what are components of external monitoring? - ANS-Tocotransducer: placed over
fundus
Ultrasound transducer: placed over fetal back
-The FHR is determined noninvasively using a Doppler ultrasound device belted to the
maternal abdomen throughout labor.
-The device is connected to the monitor, which continuously plots the FHR on a paper
strip, while a pressure transducer simultaneously monitors the frequency, timing, and
duration of uterine contractions.
-This process is called continuous cardiotocography or continuous electronic FHR
monitoring. - ANS-electronic fetal monitor
How do external monitors work? - ANS-The ultrasound transducer (ultrasound) is
attached to the abdomen with straps and transmits the fetal heartbeat to a recorder. Gel
on the mother's abdomen acts as a medium to help conduction of the ultrasound
transducer
what are advantages of EFM? - ANS-Identifies a well oxygenated fetus
Identifies fetal intolerance
Advantages for nursing staff:
--Decreased time required for assessment
--Increased time for teaching and labor support
Provides written record of fetus during labor
Advantages for patients
, Fewer interruptions
what are limitations of EFM? - ANS-Requires subjective judgements
Requires competent staff to be reliable
Inaccurate interpretations due to inexperience
No proof of effects on perinatal morbidity/mortality in low risk population
Higher rate of intervention
May incorrectly identify infants already damaged prior to labor as having intrapartum
complications
Disadvantages for patient:
-Medicalizes labor
-Decreased mobility/comfort
-Increased anxiety/fear
How do external monitors work? - ANS-A tocodynamometer or tocotransducer (toco) is
a monitoring device that is placid over the top of the uterus with a belt
As the patient's abdomen tightens during a contraction, it presses against a sensor on
the back of the toco. This registers as an upward deflection on the monitor paper. As the
patient's abdomen relaxes, the pressure against the sensor decreases, which registers
as a downward deflection on the paper.
Determining where the monitors go? - ANS-To determine where the monitors should be
applied, you need to determine which way the baby is facing and whether the baby is
head down (cephalic or vertex) or head up (breech).
Among its other purposes, Leopold Maneuver is a multi step process to obtain
information about the fetus's position. Knowing this information will help you know
where to place the monitors and belts.
how do you place the toco? - ANS-Place the monitor belt around the patient's abdomen
Place the toco transducers on the patient's abdomen over the upper uterine segment,
approximately 2 cm from the top of the fundus
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