Fetal Monitoring and Fetal Assessment

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Fetal Monitoring and Fetal AssessmentA few new techniques and protocols!

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IA= Intermittent AuscultationAt the start of the 20th Century, IA of the FHR during labor was the predominant method of assessment. IA is the practice of using a device that allows one to listen to the fetal heart sounds over time. Examples would be placing the ear over the pregnant abdomen, using a fetoscope, or using a Doppler.

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EFM= Electronic Fetal MonitoringResearch in Randomized Clinical Trials on Low-risk pregnancies has demonstrated that (Anderson, 1994) “The use of EFM as compared with IA has not been shown to reduce neonatal morbidity or mortality rates but has been associated with increased rates of cesarean section and maternal infection” (p. 165).

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EFM= Electronic Fetal MonitoringThis research is a cause for concern as we look at research-based practice and the fact that we are doing “stuff” that has not been necessarily supported by research! Something to think about and ponder! The future practice of EFM may change if agencies choose to practice based on clinical research findings.

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Clinical Decision-making Based on Auscultation FindingsAuscultate FHRInterpretationReassuring FHR Pattern? Baseline rate 110-160 Regular rhythm Absence of decrease from baselineContinue Individualized Assessment and Care Assess with IA & palpation per pt/care provider preferences, guidelines, & availability (1:1 nurse to fetus ratio) Promote maternal comfort & continued fetal oxygenation(position change; anxiety reduction measures Notify midwife or MD when a problem exists or is resolvedYesNo

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Non-Reassuring FHR Pattern Baseline <110 pbm Baseline >160 bpm (unexplained persistent tachycardia for > 3 contractions or > 10-15 minutes Irregular rhythm FHR during & 30 seconds after contractions Gradual or abrupt change in FHR Intervention/Management  frequency of IA to clarify FHR charracteristics Assess potential cause of FHR characteristics Attempt to remove problem(s)/cause Intervene to promote 5 physiologic goals: Improve uterine blood flow Improve umbilical blood flow Improve oxygenation  uterine activity (e.g. position change, hydration)

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Problem Solved ??YES—Return to Continued Individualized Assessment & Care FHR Pattern Persists? Continue interventions Apply EFM to clarify pattern interpretation, assess variability, to further assess fetal status Notify midwife or MD Consider additional assessments (e.g. fetal scalp stimulation; fetal acoustic stimulation)No

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Goals of Physiologic Interventions

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Definitions of Fetal Heart Rate Patterns National Institute of Child Health and Human Development (NICHD)

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That’s it for now!!Have fun learning more about the Fetal Heart Monitor on the clinical unit! Technology is really going places in fetal surveillance, so who knows what will be next!!

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Last Updated: 8th March 2018

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