Fetal Heart Rate Assessment

 Fetal Heart Rate Assessment

• Late Decelerations: Indicate potential uteroplacental insufficiency, often resolved by maternal repositioning to relieve vena cava pressure.
• Early Decelerations: Reflect fetal head compression, not ominous; they respond to the fetal descent during labor.
• Accelerations: Signify fetal well-being and do not require intensive monitoring; occur with fetal movement.
• Variable Decelerations: Caused primarily by umbilical cord compression; can happen intermittently during contractions.
• Nursing Priorities for Decelerations: If late decelerations occur, priorities include repositioning the mother, increasing IV fluids, and providing oxygen. If unresolved, a care provider should be notified.

Maternal Factors Influencing Fetal Heart Rate

• Maternal Hypotension: Reduces placental blood flow, leading to fetal hypoxemia; does not cause early decelerations.
• Position Changes: Encouraged to improve maternal cardiac output and alleviate venous pressure during labor.
• Amnioinfusion: Utilized for variable decelerations due to cord compression; not effective for late decelerations or bradycardia.

Fetal Heart Rate Variability and Monitoring

• Normal FHR Range: 110-160 beats/min; averages of 135 beats/min are considered within normal limits.
• Decreased Variability: Often linked to fetal sleep cycles; temporary decreases persist for less than 30 minutes.
• Non-reassuring FHR Patterns: Tachycardia, bradycardia, late decelerations, or reduced variability can indicate fetal hypoxemia.

Monitoring Techniques and Guidelines

• Electronic Fetal Monitoring (EFM): Provides continuous assessment during labor; necessary to clarify with patients about FHR readings.
• Intermittent Auscultation (IA): Utilized with a nurse-to-patient ratio of one to one; requires documentation in clearly defined terms, not subjective.
• Assessing Uterine Activity: Done through palpation to monitor frequency, duration, and intensity.

Legal and Clinical Responsibilities

• Accountability: Includes interpretation of FHR patterns, initiating interventions, and proper documentation.

Key Interventions during Labor

• Intrauterine Resuscitation Protocol: Should begin with maternal repositioning, followed by IV fluid increase and oxygen administration.
• Documentation: Vital for ongoing assessment of labor progress and fetal well-being.

Additional Considerations

• Common Medications Impacting FHR: Methamphetamines increase FHR variability, while narcotics and tranquilizers may decrease it.
• Fetal Condition Assessment: Regular monitoring of FHR and uterine contractions is essential to detect any distress or abnormal patterns.

Summary of FHR Findings

• Early Decelerations: Non-threatening, associated with head compression.
• Late Decelerations: Concerning, linked with uteroplacental insufficiency.
• Variable Decelerations: Caused by umbilical cord issues.
• Bradycardia and Tachycardia: Indicative of potential complications, requiring immediate attention.### Fetal Heart Rate Decelerations
• Types of Decelerations:
  • Early Decelerations: Typically associated with head compression; do not require maternal position change.
  • Late Decelerations: Indicative of uteroplacental inefficiency; necessitate a lateral position change.
  • Variable Decelerations: Caused by umbilical cord compression; require maternal position change to side-to-side.
  • Prolonged Decelerations: Have various causes, may be benign or critical.

Maternal Positioning

• Recommended Positions: Side-lying positions are preferred; semi-Fowler with a lateral tilt is optimal.
• Avoiding Supine Position: Encouraged to prevent pressure on major blood vessels and improve fetal oxygenation.
• Pushing Technique: Should avoid the Valsalva maneuver; encourage open mouth and glottis to allow air escape.

Internal Monitoring

• Contraindications: Internal monitoring devices require ruptured membranes; unruptured membranes are a contraindication.
• Cervical Dilation: 4 cm dilation permits the use of fetal scalp electrodes and intrauterine catheters.
• External Monitor Use: Can be discontinued once internal monitors are applied.

Fetal Monitoring

• Toco-transducer Placement: Should be positioned over the uterine fundus to accurately monitor uterine contractions.
• Categories of Fetal Heart Rate (FHR) Tracings:
  • Category I: Normal FHR pattern, no intervention needed.
  • Category II: Indeterminate patterns requiring further evaluation.
  • Category III: Abnormal tracings necessitating immediate intervention.

Physiological Alterations and Late Decelerations

• Causes of Late Decelerations: Primarily linked to uteroplacental insufficiency, which can result from:
  • Maternal hypotension (e.g., supine hypotension).
  • Uterine tachysystole.
  • Conditions like placental abruption.
• Effects of Other Factors:
  • Spontaneous fetal movement and head compression typically result in accelerations or early decelerations.
  • Variable decelerations often occur due to umbilical cord entanglement or compression.