Fetal Heart Monitoring
Fetal Heart Monitoring - ANS-an electronic method of continually assessing the fetal
heart rate and obtaining information about the client's uterine activity. This information is
recorded on graph paper and allows fetal well-being to be assessed.
Why Fetal Heart monitoring is used - ANS-1. Errors can be made when auscultating the
fetal heart rate using a fetoscope
2 Two listeners auscultating the same fetal heart rate (FHR) may get different rates
3. If the FHR is more than 160 betas per minute, it is very difficult to count
4. It is hard to hear the fetal heart rate during a contraction just at the time when you
want to know how the fetus is withstanding the stress of labor
5. Currently, EFM is used to identify FHR characteristics indicating fetal well-being as
well as those suggesting risks.
Antepartal risk factors for EFM - ANS-Hypertension, diabetes, sickle cell disease,
Chronic renal disease, Rh isoimmunization, Multiple gestations, grand multiparty,
anemia, preterm infants, postterm infants, intrauterine growth-restricted infants, poor
obstetrical history, age (under 15, over 35), congenital heart disease
Intrapartal risk factors for EFM - ANS-premature rupture of membranes, failure to
progress in labor, abnormal presentations, piton augmentation/induction, previous
cesarean section, meconium-stained amniotic fluid, possible cephalopelvic
disproportion
external fetal heart monitoring - ANS-the FHR is monitored with an ultrasound
transducer and the client's contractions are monitored with a tocodynamometer. Both of
these monitors are held in place by belts around the pregnant abdomen.
ultrasound transducer (doppler) - ANS-picks up movements with the fetal heart. This
movement is the opening and closing of valves in the heart
tocodynamometer - ANS-gives information about the client's contraction pattern by
detecting changes in the shape of her abdominal wall directly above her uterine fundus
Internal fetal monitoring - ANS-the FHR is monitored by the use of a spiral electrode
applied directly to the presenting part of the fetus (may be used with breech or vertex
presentation). The client's contraction pattern is monitored by the use of an intrauterine
pressure catheter which is inserted directly into the uterine cavity through the cervix.
, internal/external monitoring combo - ANS-the FHR may be monitored internally by the
use of the electrode, and the client's contraction pattern is monitored externally by the
use of the tocodynamometer
external EFM - ANS-the FHR is measured by use of a ultrasound transducer and the
mother's contraction pattern is monitored by use of a taco dynamometer
internal EFM - ANS-the FHR is measured by use of a spiral electrode and the mother's
contraction pattern is monitored by use of an intrauterine pressure catheter
determining baseline FHR - ANS-it is the approximate fetal heart rate (rounded to
increments of 5 ppm) during a 10 minute segment excluding accelerations,
decelerations, and marked variability. In any 10 minute window, the minimum baseline
duration must be at least 2 minutes.
normal baseline - ANS-110-160
during intrapartum period - ANS-the FHR is interpreted in relation to uterine activity. and
involves four components frequency, duration, intensity, and resting tone to assess
uterine activity.
frequency - ANS-Measured from the beginning of one contraction to the beginning of
the next and is described in minutes and is usually 2-5 minutes apart (shouldn't be more
frequent than 1 1/2-2 minutes)
Duration - ANS-The length of the contraction and is measured from the beginning of a
contraction to the end of the same contraction. It is described in seconds and should be
<90 seconds
Intensity - ANS-Refers to the strength of the contraction. It is described as mild,
moderate, or strong by palpation. It is described in millimeters of mercury if an IUPC is
used. Usually <80 mmHg, but increases with labor progress
Resting tone - ANS-it is assessed in the absence of contractions or between
contractions. By direct palpation, resting tone is described as soft or firm. If an IUPC is
in place the resting tone is measured in mmHg. Usually <20 mmHg. Hypertonicity is
cause for concern
Parasympathetic - ANS-attempts to decrease the heart rate
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