L&d Fetal Monitoring
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LABOR AND DELIVERY FETAL MONITORING INTERPRETATION Student Name: Allie Jones Type of deceleration
Cause
Early deceleration
Treatment
As the fetal head is compressed an altered A transient decrease in fetal cerebral blood flow heart rate, dipping in decreasing the HR (vaso conjunction with & vagal reflex); contractions mirroring uterine then cause the fetal head to contraction; the shape will be subjected to stimuli of the be that of a U on the EFM vagus nerve. tracing – just like a contraction.
No nursing interventions are needed as the head is most likely just being compressed during the beginning of the contraction causing a decrease in HR; report this finding to MD and continue to observe the FHR.
Variable deceleration Initially due to vaginal stimulation resulting in Variable decelerations compression of the umbilical which fluctuate in intensity, cord, but repetitive variable duration and relation to decelerations may be due to uterine contraction; they significant fetal hypoxia appear V or U shaped. and/or acidosis.
If the variable decelerations occur prior to the second stage of labor, the treatment can include saline amnioinfusion. The nurse will also want to alleviate cord compression by having the woman get into a lateral, knee-chest or supine position to release the cord. With recurrent decelerations during the second stage, pushing should be modified to fetal response, and possibly only every other, or every third contraction to increase blood flow to fetal and allow it to recover between contractions.
Late deceleration
Uteroplacental insufficiency is a compromise of the blood Repetitive, persistent, flow to the fetus. This causes smooth, symmetric decrease the amount of oxygen in HR occurring at or after received by the fetus to be the peak of uterine inadequate, and the stress of contraction; decelerations labor may not be able to be are down to 90 bpm. A endured. return to baseline only occurs after the end of the contraction, and recovery can be slow.
Nursing interventions should include placing the patient on her side, providing 02 by NRB mask, discontinuation of Oxytocin and correction of any hypotension. If the decelerations are associated with uterine tachysystole, the MD may order Terbutaline SC, betasympathomimetics IV, or magnesium sulfate IV. If decelerations continue despite all treatment efforts, emergency delivery may be necessary.
Variability: Fetal HR variability is fluctuations, and normal irregular changes seen as an irregular HR seen on the fetal heart tracing, instead of a smooth line; the baseline rate should
vary between 10 – 15 beats over one minute. The variation in beats causes a jagged tracing, but is positive due to its indication of maturity of the fetal neurologic system, and the additional suggestion of fetal reserve. Variability is the most important indicator of an adequately oxygenated fetus. Types of variability: •
Absent: less than 2 bpm; this is a possible indication of fetal hypoxia especially if it is associated with late or severe variable decelerations.
•
Minimal: less than 5 bpm; a normal variant may possibly be related to sleep cycles, drugs or prematurity. It is uncommon, but possible, for it to be related to hypoxia.
•
Moderate: highly correlated with the absence of significant metabolic acidosis, and is an indication that the fetus is maintaining tolerance to the changes in blood flow occurring during labor; fluctuation in the FHR baseline of as little as 6 bpm to as much as 25 bpm.
•
Marked: is the presence of more than 25 bpm of fluctuation in the FHR, usually seen only in intrapartum.
Cause
Early deceleration
Treatment
As the fetal head is compressed an altered A transient decrease in fetal cerebral blood flow heart rate, dipping in decreasing the HR (vaso conjunction with & vagal reflex); contractions mirroring uterine then cause the fetal head to contraction; the shape will be subjected to stimuli of the be that of a U on the EFM vagus nerve. tracing – just like a contraction.
No nursing interventions are needed as the head is most likely just being compressed during the beginning of the contraction causing a decrease in HR; report this finding to MD and continue to observe the FHR.
Variable deceleration Initially due to vaginal stimulation resulting in Variable decelerations compression of the umbilical which fluctuate in intensity, cord, but repetitive variable duration and relation to decelerations may be due to uterine contraction; they significant fetal hypoxia appear V or U shaped. and/or acidosis.
If the variable decelerations occur prior to the second stage of labor, the treatment can include saline amnioinfusion. The nurse will also want to alleviate cord compression by having the woman get into a lateral, knee-chest or supine position to release the cord. With recurrent decelerations during the second stage, pushing should be modified to fetal response, and possibly only every other, or every third contraction to increase blood flow to fetal and allow it to recover between contractions.
Late deceleration
Uteroplacental insufficiency is a compromise of the blood Repetitive, persistent, flow to the fetus. This causes smooth, symmetric decrease the amount of oxygen in HR occurring at or after received by the fetus to be the peak of uterine inadequate, and the stress of contraction; decelerations labor may not be able to be are down to 90 bpm. A endured. return to baseline only occurs after the end of the contraction, and recovery can be slow.
Nursing interventions should include placing the patient on her side, providing 02 by NRB mask, discontinuation of Oxytocin and correction of any hypotension. If the decelerations are associated with uterine tachysystole, the MD may order Terbutaline SC, betasympathomimetics IV, or magnesium sulfate IV. If decelerations continue despite all treatment efforts, emergency delivery may be necessary.
Variability: Fetal HR variability is fluctuations, and normal irregular changes seen as an irregular HR seen on the fetal heart tracing, instead of a smooth line; the baseline rate should
vary between 10 – 15 beats over one minute. The variation in beats causes a jagged tracing, but is positive due to its indication of maturity of the fetal neurologic system, and the additional suggestion of fetal reserve. Variability is the most important indicator of an adequately oxygenated fetus. Types of variability: •
Absent: less than 2 bpm; this is a possible indication of fetal hypoxia especially if it is associated with late or severe variable decelerations.
•
Minimal: less than 5 bpm; a normal variant may possibly be related to sleep cycles, drugs or prematurity. It is uncommon, but possible, for it to be related to hypoxia.
•
Moderate: highly correlated with the absence of significant metabolic acidosis, and is an indication that the fetus is maintaining tolerance to the changes in blood flow occurring during labor; fluctuation in the FHR baseline of as little as 6 bpm to as much as 25 bpm.
•
Marked: is the presence of more than 25 bpm of fluctuation in the FHR, usually seen only in intrapartum.
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