Fetal Monitoring and
Fetal Assessment
Mr. Bart De Peralta RN MAN
Clinical Instructor
UNP College of Nursing
IA= Intermittent Auscultation
• At 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 stethoscope, or
using a Doppler.
EFM= Electronic Fetal Monitoring
• Research 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).
EFM= Electronic Fetal Monitoring
• This 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.
Clinical Decision-making Based on
Auscultation Findings
Continue Individualized
Auscultate FHR Assessment and Care
• Assess with IA & palpation per
Interpretation pt/care provider preferences, guidelines,
& availability (1:1 nurse to fetus ratio)
Y • Promote maternal comfort & continued
fetal oxygenation(position change; anxiety
Reassuring FHR Pattern? e
reduction measures
•Baseline rate 110-160 s • Notify midwife or MD when a problem exists
•Regular rhythm or is resolved
•Absence of decrease from
baseline
No
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)
YES—Return to Continued Individualized
Assessment & Care
Problem Solved
??
No
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)
Goals of Physiologic Interventions
Improve Uterine Blood Flow Improve Oxygenation
Maternal position change Maternal position change
Hydration Maternal oxygen
Anxiety reduction Maternal breathing techniques
Medication
Improve Umbilical Circulation Reduce Uterine Activity
Maternal position change Maternal position change
Vaginal manipulation Hydration
Amnioinfusion Modified pushing
Medication (e.g. discontinue or
rate of labor-stimulating drug infusion
Definitions of Fetal Heart Rate Patterns
PATTERN DEFINITION
Baseline •The mean FHR rounded to increments of 5
bpm during a 10 min. segment, excluding:
- Periodic or episodic changes
- Segments of baseline that differ by more
than 25 bpm
•The baseline must be for a minimum of 2 min.
in any 10 min. segment
PATTERN DEFINITION
Baseline •Fluctuations in the FHR of two cycles per
Variability min or greater
•Variability is visually quantitated as the
amplitude of peak-to-through in bpm-
-Absent—amplitude range undetectable-
-Minimal—amplitude range detectable
but 5 bpm or fewer-
-Moderate (normal)—amplitude range
6-25 bpm-
-Marked—amplitude range greater than
25 bpm
PATTERN DEFINITION
Acceleration •A visually apparent increase (onset to peak less
than 30 sec.) in the FHR from the most recently
calculated baseline
•The duration of an acceleration is defined as the
time from the initial change in FHR from baseline
to the return of the FHR to baseline
•At 32 weeks of gestation and beyond, an
acceleration has an acme of 15 bpm or more
above baseline, with a duration of 15 sec. or more
but less than 2 min.
•Before 32 weeks gestation an acceleration has an
acme of 10 bpm or more above baseline, with a
duration of 10 sec. or more but less than 2 min.
•If an acceleration lasts 10 min. or longer it is a
baseline change
PATTERN DEFINITION
Bradycardia •Baseline FHR less than 110 bpm
Early •In association with a uterine contraction,
deceleration a visually apparent, gradual (onset to
nadir 30 sec. or more) decrease in FHR
with return to baseline*Nadir of the
deceleration occurs at the same time as
the peak of the contraction
PATTERN DEFINITION
Late deceleration •In association with a uterine contraction,
a visually apparent, gradual (onset to
nadir 30 sec. or more) decrease in FHR
with return to baseline
•Onset, nadir, and recovery of the
deceleration occur after the beginning,
peak, and end of the contraction,
respectively
Tachycardia
•Baseline > 160 bpm
PATTERN DEFINITION
Variable •An abrupt (onset to nadir less than 30
Deceleration sec), visually apparent decrease in the
FHR below the baseline
•The decrease in FHR is 15 bpm or more,
with a duration of 15 seconds or more,
but < 2 minutes
Prolonged •Visually apparent decrease in FHR
Deceleration below the baseline
•Deceleration is 15 bpm or more, lasting 2
minutes or more but less than 10 minutes
from onset to return to baseline.
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!!
