Assessment of Fetal Health

Assessment of Fetal Health

Prenatal Fetal Assessment
•Why do antepartum testing?

To see if the fetus is okay.


Prenatal Fetal Assessment – table 6-1
• Diagnostic techniques and nursing considerations
§ Diagnostic (obstetric) ultrasound
§ Doppler ultrasound blood flow
§ Chorionic villi sampling
§ Amniocentesis
§ Percutaneous cord blood sampling
§ Nonstress test (NST)
§ Contraction stress test (CST)
§ Biophysical profile (BPP)
§ Vibroacoustic stimulation test
• Psychologic reactions to diagnostic testing – may produce fear & anxiety; allow time for questions & discussion

Fetal Assessment During Labor
• Fetal monitoring during labor is used to identify the healthy fetus vs the fetus showing signs of compromise; measures the response of the FHR to uterine contractions
• Intermittent FHR monitoring
Ø used for low risk pregnancies/labors see box 6-2
Ø uses a doppler or fetal monitor
Ø advantages: places fewer restrictions on maternal activity
Ø some health care providers feel legally vulnerable doing intermittent auscultation; there is a tendency to monitor FHR continuously

•Continuous electronic fetal monitoring
Ø can detect changes & problems immediately & intervene; there is a higher incidence of C-sections due to problems found
Ø data is transcribed on a continuous strip of graph paper or recorded in the computer-fig 6-5
•The nurse’s role
Ø reassuring heart rate pattern reflects adequate oxygenation
Ø nonreassuring heart rate pattern indicate presence of fetal distress,& appropriate nursing measures should be taken – fast focus 6-2
Ø documentation of interventions done on the strip as well as the medical record



Fetal Assessment During Labor
•Types of electronic monitoring
§External – skill 6-2, fast focus 6-3, fig 6-8
§Internal – fig 6-9, fast focus 6-4
•Relation of FHR to uterine contractions during labor: periodic changes – fig 6-10
Ø accelerations
Ø decelerations ( early & late)
Ø variable decelerations

Reassuring and Nonreassuring FHR Patterns – table 6-2

• Normal pattern /reassuring pattern– heart rate of 110-160 beats/min; beat to beat variability is between 6 – 25 beats/min, no decelerations
• Accelerations – brief, temporary increases in FHR of at least 15 beats/min above the baseline; sign of fetal well being
• Decelerations – transitory decreases in FHR from the baseline; labeled in relation to uterine contractions
§ Early
§ Late
§ Variable

EARLY DECELERATIONS
•Fig 6-10, A
•Slowing of FHR when contraction begins; returns to normal at the end of contraction
•Mirrors contraction
•Caused by head compression during contraction; vaginal exam; or fundal pressure
•No intervention required

Late Deceleration
•Fig 6-10, C
•Slowing of FHR after the contraction begins, when uterine blood flow is at a minimum; recover to normal is delayed, until uterine blood flow has resumed
•Causes: utero-placental insufficiency; inadequate fetal oxygenation; maternal HTN
•Interventions: change to side lying position, start O2 10L/min by MASK; correct hypotension if possible; discontinue oxytocin infusion; notify MD
Variable Decelerations
•Fig 6-10, B
•An abrupt, transient drop in FHR before, during, or after uterine contraction related to brief compression of the umbilical cord
•Causes: cord compression, short cord, prolapsed cord, cord around neck, oligohydramnios
•Intervention: Change maternal position, apply 02 if FHR does not respond, correct hypotension if possible, notify MD if measures do not work, amnioinfusioin

FETAL PULSE OXIMETRY
•A transcervical catheter placed against the fetal cheek; level should be between 40 – 70%
•Anything less than 30% may indicate fetal acidosis & require rapid delivery of fetus
•Amniotic membranes must be ruptured & cervix dilated to at least 2 cm

Amnioinfusion

• Intrauterine infusion of warm normal saline or Ringer’s lactate after ROM
• To decrease cord compression; increase fluid if oligohydramnios present; dilute intrauterine meconium; lessen risk of meconium aspiration
• Contraindicated with prolapsed cord, vaginal bleeding, severe fetal distress
• Must use an infusion pump for accurate administration
• Underpads used to absorb extra drainage