Fetal Monitoring Strip Information 1.

. UTERINE CONTRACTIONS Frequency the beginning of one contraction to the beginning of the next contraction Duration the beginning of a contraction to the end of that contraction Intensity Strength of contractions 2. FHR/FHT Baseline heart rate - (120-160) Variability beat to beat fluctuations Periodic changes decelerations and accelerations The fetus can be monitored via external fetal monitoring (EFM) or Internal fetal Monitoring (IFM) Baseline rate is the approximate mean FHR rounded to increments of 5 bpm during a 10 minute period. Normal range is 120-160 The range doesnt include any periodic or episodic changes or periods of marked FHR variability Accelerations Transient s in FHR Non-periodic changes are normally caused by fetal movement Periodic changes are ones that occur with contractions Decelerations Period s in FHR from the baseline Early due to pressure on the fetal head, mirrors the contraction Late- due to uteroplacental insufficiency and a result of d blood flow to the fetus and they are late in their onset and recovery Variable vary in onset, occurrence and waveform

Early Decelerations:

Late Decelerations:

Variable Deceleration:

Factors that reduce fetal oxygenation: Alterations in fetal circulation Reduction in maternal blood flow Reduction in oxygen content of maternal blood Reduction in placental blood flow Non-Stress Test : NST A method that obtains a tracing of the fetal rate. Reactive (2 or more episodes of acceleration {> 15 bpm} in 20 min, each lasting > 15 seconds and associated with fetal movement) Reactive Non-Stress Test is Right Really Good Non-reactive Non-stress is NO good! (Less than 2 episodes of accelerations) Reactive (good) Non-Stress Test:

Non (bad) reactive Stress test:

Contraction Stress Test: CST A method used to assess the fetal respiratory function, by stimulating contractions. Negative CST is Nice. NO problem! Positive CST is Poor! Problem!

Negative (nice) CST

Positive (poor) CST:

BIOPHYSICAL PROFILE Assessment of 5 fetal biophysical variables Nonstress test (Reactive fetal heart rate) Fetal breathing movements Gross fetal body movements Fetal tone Amniotic fluid volume

Nonstress Test (Fetal rate) Fetal Breathing Movements Fetal Movement Fetal tone

ABNORMAL Reactive Present (at least 1 episode in 30 sec. duration in a 30 min period) Present (At least 3 episodes in a 30 min period) Full Flexion (at least one episode of active extension with return to flexion) One or more > 1 cm pocket

NORMAL Nonreactive Absent or diminished Absent or less than 3 episodes Extremities in extension or no movement No pockets or < 1 cm pocket

Amniotic Fluid Volume (AFV) Nursing Diagnosis Possible:

Knowledge Deficit Fear Anxiety Grief over the loss of a perfect child RF Injury to fetus and * RF Fetal Distress