Fetal Heart Monitoring
What is electronic fetal monitoring used for? - ANS-- used to assess fetal O2 during
labour to be able to recognize if the fetus is in a hypoxic state so we can do
interventions to prevent harm and injury to the fetus
What is the reason for EFM? - ANS-- going to determine our plan of care for the birth
When is EFM done? - ANS-- pregnancy, labour, birth
Is EFM used for all patients in labor? - ANS-- No, not for low risk patients
What is uteral placenta insufficiency? - ANS-- a problem with O2 transfer
Does the surface area of the placenta matter? - ANS-- Yes, the more surface area, the
better amount of surface area for oxygen transfer to the umbilical cord
O2 delivery to the fetus is via the uterine arteries to the uterus, from the uterus through
the placenta, and from the placenta to the fetus via the umbilical cord - ANS-Uterine and
placenta blood flow are decreased with each contraction, uterine relaxation return
uterine perfusion and placental O2 exchange resumes
What system is in charge of regulation of the FHR? - ANS-- autonomic nervous system
and extrinsic factors
Variability: changes fetal oxygenation will correspond and be reflected in a variation of
the FHR and its characteristics - ANS-
What are the 2 parts of the EFM and what are they? - ANS-- FHR
- Tocodynamometer (Toco): uterine contractions
What do you need to know in order to appropriately interpret and respond to with fetal
monitoring tracing? - ANS-- Evaluate the recording: is it continuous and adequate for
interpretation?
- Identify the type of monitor used - external versus internal.
- Identify the baseline fetal heart rate and presence of variability.
- Evaluate uterine contraction patterns.
- Determine the presence of accelerations from baseline.
- Determine the presence of any decelerations from baseline.
, - Identify changes or trends in FHR patterns over time - Classify the tracing.
- Respond appropriately (nursing action).
What is FHR rounded to? - ANS-- 5 bpm increments
How many minutes must the baseline change be in order to have a change in the
baseline? - ANS-- 10 minutes or longer
How do we know what is considered our baseline? - ANS-- must be a minimum of 2
mins in any 10 minute segment of the tracing
What are some causes of FHR tachycardia? - ANS-- drugs (cocaine), maternal
hypothyroidism
- maternal or fetal anemia
- fetal cardiac abnormalities or heart failure
- acute or chronic fetal hypoxemia
- maternal or fetal infections
- stress
What is FHR bradycardia usually associated with? - ANS-- hypoxemia
What are some causes of FHR bradycardia? - ANS-- drugs
- maternal hypotension
- maternal hypothermia
- maternal hypoglycemia
- umbilical cord compression
- amniotic fluid embolism
- hypoxemia
What is maternal heart rate artifact? What must you do? - ANS-- Irregular variation or
intermittent pick-up of the FHR
- not an accurate rating, going to request to get an internal HR monitor to be inserted
How do you determine variability? - ANS-- Look at one minute period
- Visually estimate peak to trough in bpm
- Variability is irregular in amplitude and frequency
What is the single most important indicator for FHR and if the fetus is getting enough
O2? - ANS-- variability
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