Transcript UTERINE CONTRACTIONS - El Paso Community College

INTRAPARTAL
FETAL
ASSESSMENT
Developed by
D. Ann Currie, R.N., M.S.N.
FETAL MONITORING
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ANTEPARTUM ASSESSMENT-FETAL
SURVEILLANCE AND DIAGNOSTICS.
INTRAPARTUM ASSESSMENT-FETAL
SURVEILLANCE AND DIAGNOSTICS.
ANTEPARTUM ASSESSMENT
OF
FETAL HEART RATE
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AUSCULTATION-WITH FETOSCOPE OR
DOPPLER.
ELECTRONICAL(EFM)NST(NONSTRESS TEST)
CST(CONTRACTION STRESS TEST)
FAST(FETAL ACOUSTIC STIMULATION
TEST)
Auscultation of FHR with Doppler
Fetal Acoustic Stimulation TestFAST
AUSCULTATION OF FHR
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FETOSCOPEADVANTAGES-CHEAP
CAN BE DONE ANYWHERE
NO ELECTRICITY
DISADVANTAGES
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NOT CONTINOUS
NO HARD COPY OR PERMENANT
RECORD
REQUIRES SKILL TO USE FETOSCOPE
UNABLE TO DETERMINE PATTERNS OF
FHR
UNABLE TO DETERMINE VARIABILITY.
ELECTRONICAL
FETAL
MONITORING
(EFM)
EXTERNAL EFM
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NONINVASIVE METHOD OF ASSESSING
FHR
PERMENANT RECORD OF FHR
CAN BE USED IN THE OUTPATIENT
AREAS AND IN THE HOSPITALS.
MOST EQUIPMENT(EFM) IN EL PASO
ARE ULTRASOUND TRANSDUCERS.
DISADVANTAGES OF
EXTERNAL EFM
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NOT AS ACCURRATE AS INTERNAL
EFM
CAN ONLY DETERMINE LTV(LONG
TERM VARIABILITY)
IF FETUS OR MOTHER MOVES IT MAY
INTERUPT EFM STRIP…READJUST
FREQ.
RESTRICTION OF CLIENT’S MOVEMENT
Placement of External Monitor
INTERNAL FETAL
MONITORING
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FETAL SCALP ELECTRODE
ADVANTAGES- DIRECT FHR
MORE ACCURATE FHR-CLEAR
BASELINE,VARIABLITY-STV&LTV
MATERNAL COMFORT
DISADVANTAGES-MUST HAVE ROM.
INCREASE RISK OF INFECTIONS
INTERNAL EFM
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CONT.
CAN ONLY BE PLACED IF
PRESENTATION IS KNOWN
NO FACE PRESENTATIONS,NO
EYES,NOT OVER FONTANELLES,OR ON
GENITALS.
CAN NOT BE PLACED WITH MATERNAL
HX OF STI’S OR INFECTIONS
INTERNAL EFM
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CONT.
CAN NOT BE USED IF PLACENTA
LOCATION IS NOT KNOWN OR WITH
PLACENTA PREVIA.
PERSONNEL NEEDS TO BE TRAINED
TO PLACE INTERNAL SCALP
ELECTRODE
STERILE PROCEDURE
FHR BASELINE
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FHR BASELINE IS DETERMINED WHEN
THERE IS NO CHANGES IN THE FHRNO ACCELERATIONS OR
DECELERATIONS.
FHR BASELINE RATE IS THE RANGE OF
FHR-NORMAL IS 110-160.
FHR BASELINE VARIABILITY IS THE
VARIABILITY ON BASELINE
Fetal Heart Rate Baseline
FHR BASELINE
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NORMAL -110-160
BRADYCARDIA-UNDER 110 FOR TEN
MINUTES
TACHYCARDIA-OVER 160 FOR TEN
MINUTES
FHR BASELINE VARIABILITY
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SHORT TERM VARIABILITY(STV)-ALSO
CALLED BEAT TO BEAT.
ONLY DETERMINED BY INTERNAL EFM
IT IS PRESENT OR NOT.
DOCUMENTING STV-PRESENT OR
ABSENT.
FHR BASELINE VARIABILITY
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LONG TERM VARIABILITY(LTV)RHYTHMIC CYCLES -3-5 CYCLES LONG
TERM VARIABILITY(LTV)RHYTHMIC CYCLES -3-5 CYCLES PER
MINUTE
DESCRIBED AS ABSENT 0-2 BPM
,MINIMAL 3-5BPM, AVE. 6-25
BPM,INCREASED/MARKED OVER
25BPM.
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Absent Variability
Minimal Variability
Average Variability
PERIODIC FHR CHANGES
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ACCELERATIONS- NOTE IN THIS
COURSE JUST NOTE THAT THEY ARE
PRESENT OR ABSENT.
ACCELERATIONS OF FHR SHOULD GO
UP 15-20 BEAT ABOVE BASELINE FOR
15-20 SECONDS.
ACCCELERATIONS INDICATE FETAL
WELL-BEING.
ACCELERATIONS
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TYPES- SHOULDERS-SEEN WITH
VARIABLE DECELERATIONS AND
INDICATE WELLBEING
OVERSHOOTS- SEEN AFTER VARIABLE
DECELERATIONS INDICATE DISTRESS.
ACCELERATIONS ARE UNDER TEN
MINUTES.
Accelerations
Acelerations
EARLY DECELERATIONS
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REASSURING
MECHANISM-FETAL HEAD
COMPRESSION.,VAGAL REFLEX.
DOCUMENT THEIR PRESENTS
TX: NONE.
Early Deceleration
LATE DECELERATIONS
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NONREASSURING
MECHANISM: UTERINE PLACENTA
INSUFFICIENCY-FETAL HYPOXIA.
CAUSES: UTERINE
HYPERACTIVITY,SUPINE
HYPOTENSION, COMPLICATIONSSLE,DM ETC.
TX:TURN TO SIDE FIRST LEFT IS BEST.
Late Decelerations
LATE DECELERATIONS
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TX: TURN TO SIDE, INCREASE FLUID IF
OK WITH CLIENT’S CONDITION,
OXYGEN,IF PITOCIN RUNNING STOP,
NOTIFY DR. IF LATE CONT. BE
PREPARED FOR DELIVERY OR
C/SECTION, NOTIFY ICN.
DOCUMENT
VARIABLE DECELERATIOS
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ABURPT DROP IN FHR AND RETURNS
TO BASELINE ABURPTLY
MOST COMMON OR FREQUENT SEEN
TYPE OF DECELERATION
MECHANISM: UMBILICAL
COMPRESSION.
TX: TURN CLIENT OFF CORD-EITHER
TO SIDE OR OTHER POSITIONS
Variable Decelerations
REASSURING FHR PATTERN
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BASELINE RATE-110-160
BASELINE VARIABILITY-AVERAGE
ACCELERATIONS WITH FM OR UC OR
STIMULATION.
EARLY DECELERATIONS
NO LATE DECELERATIONS
NO MODERATE OR SEVERE VARIABLE
DECELERATIONS
NONREASSURING FHR
PATTERN
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BASELINE RATE BELOW 110 OR
ABOVE160 FOR 10 MINUTES.
BASELINE VARIABILITYMINIMAL,ABSENT,OR INCREASED.
DECELERATIONS-LATES, MOD-SEVERE
VARIABLES,PROLONGED.
NO ACCELERATIONS WITH UC, FM
OVERSHOOTS.
SINUSIODAL PATTERN
Sinusiodal FHR Pattern
Evaluate this EFM strip/What do
you think is happening?
What do you think of this EFM
Strip?
MONITORING UTERINE
ACTIVITY METHODS
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EXTERNAL UTERINE MONITORING
INTERNAL UTERINE MONITORING
UTERINE CONTRACTIONS
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DEFINIONS OF TERMS
FREQUENCY
DURATION
INTENSITY-1.BY PALPATION 2. IUPCmmHg.3.MONTEVIDEOUNITS(MVU)
RESTING PERIOD
RESTING TONE(TONUS)
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Uterine Contractions
TYPES OF UTERINE ACTIVITY
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EFFECTIVE UTERINE CONTRACTIONS
INEFFECTIVE UTERINE
CONTRACTIONS
HYERSTIMULATION
TETANIC CONTRACTIONS
UTERINE IRRITABILITY
HYPERTONUS