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Fetal Well-being and Electronic Fetal Monitoring Fetal Tests Fetal Heart Rate Decelerations Variability Fetal Movement Counts Ultrasound • Confirmation of pregnancy and fetal presentation • Evaluation of fetal heartbeat and fetal respiration • Identification of more than one embryo/fetus • For examination of anatomical fetal structures • To estimate gestational age, fetal weight, and growth • Location of the placenta and amniotic fluid volume • Accompanying invasive procedures Fetal Activity • Vigorous fetal activity - provides reassurance of fetal well-being • Marked decrease or cessation in activity – May indicate possible fetal compromise – May require immediate follow-up • Assessment of fetal activity (from week 28 to week 38) - noninvasive method of monitoring the fetus Fetal Movement Counts • Daily record beginning at 27 weeks gestation • Count at same time each day – 1 hour after meals • Lie in side-lying position • Contact health care provider when: – <10 movements in 3 hours using Cardiff card – < 3 movements in 8 hours using daily movement record – No fetal movement in AM – Fetal movements becoming slower Electronic Fetal Monitoring • Provides continuous data and is routine for high-risk clients – Also used for women experiencing an induction of labor – May be done externally or with an internal monitor Electronic Fetal Monitoring • - Indications for: – Previous history of stillborn – Presence of complication – Induction of labor, preterm labor – Decreased fetal movement – Non-reassuring fetal status – Meconium staining of amniotic fluid – Trial of labor following a C-section Electronic Fetal Monitoring • Fetal Heart Rate – 110 – 160 bpm • Fetal Tachycardia – Sustained rate of 161 bpm or above – If rate is 180 bpm or above, is marked tachycardia • Causes – – – – – – – Early fetal hypoxia Maternal fever Maternal dehydration Chorioamnionitis Maternal hyperthyroidism Beta-sympathomimetic drugs Fetal anemia Fetal Tachycardia • Ominous sign if tachycardia is accompanied by – Late decelerations – Severe variable decelerations – Decreased variability Fetal Bradycardia • Fetal Bradycardia – less than 110 bpm during a 10-minute period or longer • Causes – – – – – – – – Profound hypoxia in fetus Maternal hypotension Prolonged umbilical cord compression Fetal arrhythmias Uterine hyperstimulation Abruptio placentae Uterine rupture Vaginal stimulation in second stage of labor Evaluate Fetal Monitoring • • • • Is baseline within normal limits? Is there tachycardia or bradycardia? Is variability present or absent? If present, is variability Minimal (≤ 5 bpm)? Moderate (6-25 bpm)? Marked (> 25 bpm)? • Are there accelerations or decelerations (early, late, variable, prolonged) (prolonged = decrease ≥ 15 bpm for ≥ 2 min but < 10 min)? EFM Categories • Category 1 - Normal – FHR 110 – 160 – No late or variable decelerations – May see early decelerations • Category 3 – Abnormal – Absent variability and any of following: – Recurrent and variable decelerations – Bradycardia – Sinusoidal pattern (cycle frequency 3 – 5 minutes for >= 20 minutes) EFM Categories • Category 2 – Indeterminate – Any fetal heart rate pattern not in Category 1 or Category 2 Nursing Interventions for Nonreassuring FHR • • • • • • Optimize maternal positioning – side-lying Discontinue oxytocin if indicated Give supplemental oxygen if indicated Notify physician or midwife Administer IV fluids as needed Monitor maternal v/s for hypotension and treat • Elevate HOB 30 degrees • Initiate continuous monitoring Nursing Interventions for Nonreassuring FHR • Assist with internal monitors as appropriate • Perform vaginal exam to assess for prolapsed cord or labor progress • Assist physician with fetal blood sampling • Prepare for expeditious birth • Provide client and family with explanation • Administer tocolytic as ordered Biophysical Profile Non-Stress Test • Used to assess fetal status using an electronic fetal monitor • Based on the knowledge – Well-oxygenated fetus has adequate oxygenation – Intact central nervous system – Increase in fetal heart rate (FHR) with fetal movement • Reactive NST: Two accelerations of FHR over 20 minutes • Nonreactive: Less than 2 accelerations over 40 minutes • Unsatisfactory: Cannot be interpreted Non-Stress Test Example of a reactive nonstress test (NST). Accelerations of 15 beats per minute lasting 15 seconds with each fetal movement (FM). Non-Stress Test Example of a nonreactive NST. There are no accelerations of FHR with FM. Contraction Stress Test Example of a positive contraction stress test (CST). Repetitive late decelerations occur with each contraction. Note that there are no accelerations of FHR with three fetal movements (FM). Amniocentesis • Nursing care: Assist the physician during amniocentesis – – – – – – – Support the woman undergoing the procedure Obtain informed consent Clarify the physician’s instructions or explanations Obtain baseline vital signs Obtain baseline fetal heart rate After procedure, review reportable side effects Assess vital signs and fetal heart rate L/S Ratio 16–6 Lecithin / Sphingomyelin (L/S) Ratio and Phophatidylglycerol (PG) NCLEX Question • A biophysical profile result of 4 is reported to the physician. Which intervention should the nurse plan to do? A. B. C. D. Schedule a repeat BPP for later today. Schedule a contraction stress test. Instruct in fetal movement counts. Prepare for delivery of fetus.