Hehi Fetal Heart Rate Monitoring

Front 1

Forms of auscultation

Back 1

- Doppler
- Ultrasound transducer
- Fetascope

Front 2

Rules for Auscultation

Back 2

- Auscultate full 60 seconds
- Counted in beats per minute
- Before, during and after uterine contraction: labor
- If contraction lasts longer than a minute will need to monitor/auscultate for longer than a minute.

Front 3

Forms of electronic fetal monitoring

Back 3

* External
- ultrasound
- Tocodynamometer
* Internal
- fetal scalp electrode
- intrauterine pressure catheter (IUPC)

Front 4

Ultrasound measures:

Back 4

- baseline rate
- variability
- periodic patterns

Front 5

Tocodynamometer measures:

Back 5

- frequency of contractions
- duration of contractions
- pressure changes over the uterus
- should be performed with palpation

Front 6

Fetal Scalp Electrode measures:

Back 6

- continuous tracing

Front 7

Intrauterine pressure catheter (IUPC) measures:

Back 7

- Frequency of contraction
- Duration of contraction
- Intensity of contractions
- Resting tone of uterus: impt when concerned about FHR
- pressure changes in the uterus

Front 8

Resting Tone

Back 8

- impt if concerned about the FHR
- impt when afraid if contractions are too strong for the fetus
- impt when pt is not making progress during labor and the strength of contractions is needed information

Front 9

Baseline

Back 9

* The approximate mean FHR raounded to increments of 5 beats/min during a 10 minute segment, excluding
- periodic or episodic changes
- periods of market FHR variability
- segments of baseline that differ by > 25 beats/min
- It's an average
- Looking at approximate mean over a 10 minute period
- normal baseline is 110-160 beats/min

Front 10

Bradycardia - maternal causes

Back 10

* Maternal
- position
- hypotension
- drug response
- connective tissue disease (SLE)
- prolonged maternal hypoglycemia

Front 11

Bradycardia

Back 11

- If FHR 10 minute average is less than 110 bpm
- No such things as prolonged bradycardia
- Need to know what's causing it in order to fix it

Front 12

Bradycardia - fetal causes

Back 12

* Fetal
- Mature parasympathetic nervous system
- Umbilical cord occlusion (prolapsed cord) (vagal response)
- Decompensated fetus (metabolic acidocis)
- Hypothermia
- Cardiac conduction defect (dysrhythmias or heart block)
- Vagal stimulation causes HR to decrease

Front 13

Tachycardia

Back 13

- If FHR 10 minute average is greater than 160 bpm

Front 14

Tachycardia - maternal causes

Back 14

* Maternal
- Fever
- Infection
- Dehydration
- Hyperthyroidism
- Endogenous adrenaline/anxiety
- Medications/drugs
- Anemia: if mother is anemic there is decreased perfusion to the baby

Front 15

Tachycardia - fetal causes

Back 15

* Fetal
- Infection
- Prolonged fetal activity or stimulation
- Compensatory effect following hypoxia
- Chronic hypoxia
- Cardiac abnormalities, heart failure
- Fetal dysrhythmia
- Prematurity: HR will be higher
- Congenital anomalies