Direct auditory monitoring interpretations of FHR in utero Fetoscope or

Direct auditory monitoring interpretations of fhr in

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Direct auditory monitoring & interpretations of FHR in utero Fetoscope or ultrasound Doppler used to listen to & count FHR Listen for 30-60 seconds FHR heard most clearly at fetal back (Leopold’s maneuver) Listen before, during, & just after UC to detect FHR decelerations
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Slide 29 Frequency of Auscultation: Assessment & Documentation Low Risk Patients 1 st stage of labor: q. 30 min 2 nd stage of labor: q. 15 min High Risk Patients 1 st stage of labor: q. 15 min 2 nd stage of labor: q. 5 min
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Slide 30 Frequency of Auscultation: Assessment & Documentation Assess FHR before: Initiation of labor-enhancing procedures (i.e. AROM) Periods of ambulation Administration of medications Administration or initiation of analgesia/anesthesia
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Slide 31 Frequency of Auscultation: Assessment & Documentation Assess FHR following: Rupture of membranes Recognition of abnormal uterine activity Evaluation of oxytocin (maintenance, increase, or decrease of dosage) Administration of medications Expulsion of enema Urinary catheterization Vaginal examination Periods of ambulation Evaluation of analgesia and/or anesthesia (maintenance, increase or decrease of dosage)
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Slide 32 Electronic Fetal Monitoring External Monitoring: ultrasound transducer placed on maternal abdomen over fetal back Internal Monitoring: Fetal scalp electrode attached to fetal scalp Provides a direct ECG of the FHR & produces most direct FHR tracing Do not apply over fetal face, suture lines, fontanelles, cervix, or perineum Should be avoided in presence of maternal infections (i.e. HIV, hepatitis, group B strepococcus)
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Slide 33 Baseline Rate Baseline rate is the approximate mean FHR rounded to increments of 5 bpm during a 10 min. segment, excluding: Periodic or episodic changes Periodic patterns are those associated with UC Episodic patterns are those not associated with UC Periods of marked FHR variability Segments of the baseline that differ by > 25 bpm Baseline rate can be determined between UC
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Slide 34 Variability Amplitude of FHR Amplitude of FHR change change Baseline Variability Baseline Variability Description Description Undetectable from Undetectable from baseline baseline Absent Absent Visually detectable from Visually detectable from baseline, ≤ 5 bpm baseline, ≤ 5 bpm Minimal Minimal (possible causes: fetal sleep, (possible causes: fetal sleep, anomalies, hypoxia, meds) anomalies, hypoxia, meds) 5-25 bpm 5-25 bpm Moderate Moderate > 25 bpm > 25 bpm Marked Marked
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Slide 35
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Slide 36 Fetal Tachycardia FHR baseline > 160 bpm for at least a 10- minute period Possible causes: Maternal: fever, dehydration, anxiety, betasympathominmetic drugs (terbutaline, atropine), hyperthyriodism, supraventricular tachycardia Fetal: early fetal hypoxia, asphyxia, fetal anemia, infection, prematurity, prolonged fetal stimulation
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Slide 37 Fetal Bradycardia FHR baseline < 110 bpm for at least a 10- minute period Possible causes: stimulation of vagus
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