The FHR normally exhibits variability, with an average change of 6 to 25 bpm of the baseline rate, and is linked to the fetal central nervous system. Presence of moderate fetal heart rate variability and accelerations with absence of recurrent pathologic decelerations provides reassurance that acidosis is not present. Continuous electronic fetal monitoring has been shown to reduce the incidence of neonatal seizures, but there has been no beneficial effect in decreasing cerebral palsy or neonatal mortality. Prolonged FHR decelerations from baseline (more than two minutes but less than 10 minutes) may represent rapid cervical change and/or fetal descent, maternal hypotension, placental abruption, umbilical cord prolapse, or uterine rupture2,5,26 (Figure 77). The nurse's action after turning the patient to her left side should be:, The nurse is assessing a fetal monitor tracing and notes that the FHR baseline is 140-150 bpm with decreases to 120 bpm noted beginning . External monitoring is performed using a hand-held Doppler ultrasound probe to auscultate and count the FHR during a uterine contraction and for 30 seconds thereafter to identify fetal response. When you've finished these first five, here are five more. Issues such as hypoxia, however, might slow their heart rate. https://www.ncbi.nlm.nih.gov/pubmed/19546798 Ordinarily, your babys heart beats at a faster rate in the late stage of pregnancy, when theyre especially active. T(t)=50+50cos(6t). Any tracing not meeting the criteria of Category I or III, with any of the following findings: 5 contractions in 10-minute period averaged over 30 minutes, Tachysystole: > 5 contractions in 10-minute period averaged over 30 minutes, No response to intrauterine resuscitative measures; stopping/reducing uterotonic agents or tocolytics with persistent Category II/III tracing, 110 to 160 bpm; determine by 2-minute segment in 10-minute period, Fluctuations from baseline over 10-minute period, with 6 to 25 bpm: moderate, 15 bpm above baseline rate, onset to peak < 30 seconds, lasts for at least 15 seconds, Early: onset to nadir 30 seconds, nadir occurs with peak of contraction, Variable: onset to nadir < 30 seconds, decrease in fetal heart rate 15 bpm with duration 15 seconds to < 2 minutes, Recurrent late or prolonged decelerations for > 30 minutes or for > 20 minutes if reduced variability, No hypoxia/acidosis; no intervention necessary, Low probability of hypoxia/acidosis; take action to correct reversible causes and monitor closely, High probability of hypoxia/acidosis; take immediate action to correct reversible causes and expedite delivery. If one of the following is detected during structured intermittent auscultation for a low-risk patient, switch to continuous electronic fetal monitoring to assess the National Institute of Child Health and Human Development category and to determine necessary clinical management: Fetal tachycardia (> 160 beats per minute for > 10 minutes), Fetal bradycardia (< 110 beats per minute for > 10 minutes), Recurrent decelerations following contractions (> 50% of contractions) or prolonged deceleration (> 2 minutes but < 10 minutes). VEAL CHOP Nursing Mnemonic: Complete Guide - Nurseslabs Late. Initiate scalp stimulation to provoke fetal heart rate acceleration, which is a sign that the fetus is not acidotic. If you want to see how you are doing overall, try the comprehensive assessment: Describe the variability. Correct. Accelerations last from 15 seconds to 10 minutes, and the majority occur in conjunction with fetal movements. The Value of EFM Certification (One Team One Language), showcases the national PSA campaign Your Baby Communicates along with peer-to-peer video discussions on the value of EFM Board Certification. What is the most appropriate nursing response? This content is owned by the AAFP. The practitioner has ordered continuous electronic monitoring, but the patient requests IA for the early part of labor. These require attachment of fetal head electrodes; a recent randomized controlled trial and meta-analysis showed no improvement in neonatal outcomes or rates of operative or cesarean delivery.24,25, The National Institute of Child Health and Human Development terminology (revised in 2008) classifies continuous electronic fetal monitoring tracings using a three-tiered system and is the accepted national standard for continuous electronic fetal monitoring interpretation.5 Labor management depends on the continuous electronic fetal monitoring category and overall clinical scenario (Table 3).4,5,7, Interpretation of continuous electronic fetal monitoring tracings must include comments on uterine contractions, baseline FHR, variability (fluctuations in the FHR around the determined baseline during a 10-minute segment), presence of accelerations and/or decelerations, and trends of continuous electronic fetal monitoring patterns over time.2,5. The effect of continuous EFM monitoring on malpractice liability has not been well established. Fetal heart tracing is also useful for eliminating unnecessary treatments. Predictive of abnormal fetal-acid base status at the time of observation. Try your hand at the following quizzes. Remember , the baseline is the average heart rate rounded to the nearest five bpm . Patient information: See related handout on intrapartum fetal monitoring, written by the authors of this article. Fetal Assessment Flashcards | Quizlet Fetal heart rate patterns are classified as reassuring, nonreassuring or ominous. Category III tracings are highly concerning for fetal acidosis, and delivery should be expedited if immediate interventions do not improve the tracing. A nurse is teaching a woman how to do "kick counts." https://www.acog.org/~/media/For%20Patients/faq015.pdf, Current version ( Health care professionals play the game to hone and test their EFM knowledge and skills. See permissionsforcopyrightquestions and/or permission requests. y=4105xy=4 \times 10^{5 x}y=4105x, -Fetoscope: horn or stethoscope-like instrument, -Fetal movement decreases with low oxygen intake, -Test for fetal well-being after 28 weeks, -Any maternal or fetal condition that increases risk of "fetal demise", Reactive (Normal): If you have any feedback on our "Countdown to Intern Year" series, please reach out to Samhita Nelamangala at d4medstudrep@gmail.com. You have to lie down or sit in a reclined position for the test, which lasts about 20 minutes. Tachycardia greater than 200 bpm is usually due to fetal tachyarrhythmia (Figure 4) or congenital anomalies rather than hypoxia alone.16 Causes of fetal tachycardia are listed in Table 5. DR C BRAVADO incorporates maternal and fetal risk factors (DR = determine risk), contractions (C), the fetal monitor strip (BRA = baseline rate, V = variability, A = accelerations, and D = decelerations), and interpretation (O = overall assessment).
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