Electronic Fetal Monitoring

Front 1

Periodic patterns in the FHR

Back 1

1.Fetal bradycardia and tachycardia
a. Bradycardia: the FHR is less than 120 beats per minute for 10 minutes or more
b. Tachycardia: the FHR is greater than 160 beats per minute for 10 minutes or more
c. Change position of the mother and administer oxygen
d. Notify the physician

Front 2

Periodic patterns in the FHR

Back 2

2. Variability
a. Fluctuations in the baseline FHR may include irregular fluctuations of 2 cycles per minute or greater
b. Decreased variability can result from fetal hypoxemia, acidosis, or certain medications.
c. A temporary decrease in variability can occur when the fetus is in a sleep state (sleep states do not usually last longer than 30 minutes)

Front 3

Periodic patterns in the FHR

Back 3

3. Accelerations
a. Accelerations are brief, temporary increases in the FHR of at least 15 beats greater than the baseline and lasting at least 15 seconds.
b. Accelerations usually are a reassuring sign, reflecting a responsive, nonacidotic fetus.
c. Accelerations usually occur with fetal movement.
d. Accelerations may be nonperiodic (having no relation to contractions) or periodic
e. Accelerations may occur with uterine contractions, vaginal examinations, or mild cord compression, or when fetus is in a breech presentation.

Front 4

Periodic patterns in the FHR

Back 4

4. Early decelerations
a. Early decelerations are decreases in the FHR below baseline; the rate at the lowest point of the deceleration usually remains greater than 100 beats per minute.
b. Early decelerations occur during contractions as the fetal head is pressed against the woman's pelvis or soft tissues, such as the cervix, and return to baseline FHR by the end of the contraction
c. Tracing shows a uniform shape and mirror image of uterine contractions.
d. Early decelerations are not associated with fetal compromise and require no intervention.

Front 5

Periodic patterns in the FHR

Back 5

5. Late Decelerations
a. Later decelerations are nonreassuring patterns that reflect impaired placental exchange or uteroplacental insufficiency.
b. The patterns look similar to early decelerations but begin well after the contraction begins and return to baseline after the contraction ends.
c. the degree of fall in the heart rate from baseline is not related to the amount or uteroplacental insufficiency.
d. Interventions include improving placental blood flow and fetal oxygenation.

Front 6

Periodic patterns in the FHR

Back 6

6. Variable decelerations
a. Variable decelerations are caused by conditions that restrict flow through the umbilical cord.
b. Variable decelerations do not have the uniform appearance of early and late decelerations.
c. Their shape, duration, and degree of fall below baseline heart rate are variable; they fall and rise abruptly with the onset and relief of cord compression.
d. Variable decelerations also may be nonperiodic, occurring at times unrelated to contractions.
e. One considers baseline rate and variability when evaluating variable decelerations.
f. Variable decelerations are significant when the FHR repeatedly decreases to less than 70 beats per minute and persists at that level for at least 60 seconds before returning to the baseline.

Front 7

Periodic patterns in the FHR

Back 7

7. Hypertonic uterine activity
a. assessment of uterine activity includes frequency, duration, intensity of the contractions, and uterine resting tone.
b. The uterus should relax between contractions for 60 seconds or longer.
c. Uterine contraction intensity is about 50 to 75 mm Hg (with the intrauterine uterine catheter) during labor and may reach 110 mm Hg with pushing during the second stage.
d. the average resting tone is 5 to 15 mm Hg.
e. In hypertonic uterine activity the uterine resting tone between contractions is high, reducing uterine blood flow and decreasing fetal oxygen supply.

Front 8

Nonreassuring Patterns

Back 8

Tachycardia
Bradycardia
Decreased or absent variability
Late decelerations
Variable decelerations falling to less than 70 beats per minute for longer than 60 seconds.
Prolonged decelerations
Hypertonic uterine activity

Front 9

Interventions for Nonreassuring Patterns

Back 9

a. Identify the cause (assess for cord prolapse)
b. Discontinue oxytocin (Pitocin) if infusing as prescribed.
c. Change the mother's position (avoid the supine position for patterns associated with cord compression).
d. Administer oxygen by face mask at 8 to 10 L per minute.
e. Increase IV Fluids as prescribed.
f. Notify the physician or nurse midwife as soon as possible.
g. Prepare to initiate continuous electronic fetal monitoring with internal devices if not contraindicated.
h. Prepare to obtain a fetal scalp pH monitor to determine blood pH value.
i. Prepare for cesarean delivery if necessary.