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INTRODUCTION http://www.youtube.com/watch?v=k NkOOuVYYdI&feature=relatedhttp:/ /www.youtube.com/watch?v=m3YjHIF Hcb8&feature=related

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INTRODUCTION. http://www.youtube.com/watch?v=kNkOOuVYYdI&feature=relatedhttp://www.youtube.com/watch?v=m3YjHIFHcb8&feature=related. INTRAPARTAL FETAL ASSESSMENT. Developed by D. Ann Currie, R.N., M.S.N. FETAL MONITORING. ANTEPARTUM ASSESSMENT-FETAL SURVEILLANCE AND DIAGNOSTICS. - PowerPoint PPT Presentation

TRANSCRIPT

Page 1: INTRODUCTION

INTRODUCTION http://www.youtube.com/watch?v=kNkOOu

VYYdI&feature=relatedhttp://www.youtube.com/watch?v=m3YjHIFHcb8&feature=related

http://www.youtube.com/watch?v=kNkOOuVYYdI&feature=relatedhttp://www.youtube.com/watch?v=m3YjHIFHcb8&feature=related
http://www.youtube.com/watch?v=kNkOOuVYYdI&feature=relatedhttp://www.youtube.com/watch?v=m3YjHIFHcb8&feature=related
http://www.youtube.com/watch?v=kNkOOuVYYdI&feature=relatedhttp://www.youtube.com/watch?v=m3YjHIFHcb8&feature=related
http://www.youtube.com/watch?v=kNkOOuVYYdI&feature=relatedhttp://www.youtube.com/watch?v=m3YjHIFHcb8&feature=related
Page 2: INTRODUCTION

INTRAPARTAL FETAL

ASSESSMENTDeveloped by

D. Ann Currie, R.N., M.S.N.

Page 3: INTRODUCTION
Page 4: INTRODUCTION
Page 5: INTRODUCTION

FETAL MONITORING ANTEPARTUM ASSESSMENT-FETAL

SURVEILLANCE AND DIAGNOSTICS. INTRAPARTUM ASSESSMENT-FETAL

SURVEILLANCE AND DIAGNOSTICS.

Page 6: INTRODUCTION

ANTEPARTUM ASSESSMENT OF FETAL HEART RATE AUSCULTATION-WITH FETOSCOPE OR

DOPPLER. ELECTRONICAL(EFM)- NST(NONSTRESS TEST) CST(CONTRACTION STRESS TEST) FAST(FETAL ACOUSTIC STIMULATION

TEST)

Page 7: INTRODUCTION

Auscultation of FHR with Doppler

Page 8: INTRODUCTION

Fetal Acoustic Stimulation Test-FAST

Page 9: INTRODUCTION

AUSCULTATION OF FHR FETOSCOPE- ADVANTAGES-CHEAP CAN BE DONE ANYWHERE NO ELECTRICITY

Page 10: INTRODUCTION

DISADVANTAGES NOT CONTINOUS NO HARD COPY OR PERMENANT

RECORD REQUIRES SKILL TO USE FETOSCOPE UNABLE TO DETERMINE PATTERNS OF

FHR UNABLE TO DETERMINE VARIABILITY.

Page 11: INTRODUCTION

ELECTRONICALFETALMONITORING(EFM)

Page 12: INTRODUCTION
Page 13: INTRODUCTION

EXTERNAL EFM 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.

Page 14: INTRODUCTION

DISADVANTAGES OF EXTERNAL EFM 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

Page 15: INTRODUCTION

Placement of External Monitor

Page 16: INTRODUCTION

INTERNAL FETAL MONITORING FETAL SCALP ELECTRODE ADVANTAGES- DIRECT FHR MORE ACCURATE FHR-CLEAR

BASELINE,VARIABLITY-STV&LTV MATERNAL COMFORT DISADVANTAGES-MUST HAVE ROM. INCREASE RISK OF INFECTIONS

Page 17: INTRODUCTION
Page 18: INTRODUCTION

INTERNAL EFM 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

Page 19: INTRODUCTION

INTERNAL EFM 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

Page 20: INTRODUCTION

FHR BASELINE

FHR BASELINE IS DETERMINED WHEN THERE IS NO CHANGES IN THE FHR- NO ACCELERATIONS OR DECELERATIONS.

FHR BASELINE RATE IS THE RANGE OF FHR-NORMAL IS 110-160.

FHR BASELINE VARIABILITY IS THE VARIABILITY ON BASELINE

Page 21: INTRODUCTION

Fetal Heart Rate Baseline

Page 22: INTRODUCTION

FHR BASELINE NORMAL -110-160 BRADYCARDIA-UNDER 110 FOR TEN

MINUTES TACHYCARDIA-OVER 160 FOR TEN

MINUTES

Page 23: INTRODUCTION

FHR BASELINE VARIABILITY SHORT TERM VARIABILITY(STV)-ALSO

CALLED BEAT TO BEAT. ONLY DETERMINED BY INTERNAL EFM IT IS PRESENT OR NOT. DOCUMENTING STV-PRESENT OR

ABSENT.

Page 24: INTRODUCTION

FHR BASELINE VARIABILITY 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.

.

Page 25: INTRODUCTION

Absent Variability

Page 26: INTRODUCTION

Minimal Variability

Page 27: INTRODUCTION

Average Variability

Page 28: INTRODUCTION

PERIODIC FHR CHANGES

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.

Page 29: INTRODUCTION

ACCELERATIONS TYPES- SHOULDERS-SEEN WITH

VARIABLE DECELERATIONS AND INDICATE WELLBEING

OVERSHOOTS- SEEN AFTER VARIABLE DECELERATIONS INDICATE DISTRESS.

ACCELERATIONS ARE UNDER TEN MINUTES.

Page 30: INTRODUCTION

Accelerations

Page 31: INTRODUCTION

Acelerations

Page 32: INTRODUCTION

EARLY DECELERATIONS REASSURING MECHANISM-FETAL HEAD

COMPRESSION.,VAGAL REFLEX. DOCUMENT THEIR PRESENTS TX: NONE.

Page 33: INTRODUCTION

Early Deceleration

Page 34: INTRODUCTION

LATE DECELERATIONS NONREASSURING MECHANISM: UTERINE PLACENTA

INSUFFICIENCY-FETAL HYPOXIA. CAUSES: UTERINE

HYPERACTIVITY,SUPINE HYPOTENSION, COMPLICATIONS-SLE,DM ETC.

TX:TURN TO SIDE FIRST LEFT IS BEST.

Page 35: INTRODUCTION

Late Decelerations

Page 36: INTRODUCTION

LATE DECELERATIONS 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

Page 37: INTRODUCTION

VARIABLE DECELERATIOS 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

Page 38: INTRODUCTION

Variable Decelerations

Page 39: INTRODUCTION

REASSURING FHR PATTERN 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

Page 40: INTRODUCTION

NONREASSURING FHR PATTERN BASELINE RATE BELOW 110 OR

ABOVE160 FOR 10 MINUTES. BASELINE VARIABILITY-

MINIMAL,ABSENT,OR INCREASED. DECELERATIONS-LATES, MOD-SEVERE

VARIABLES,PROLONGED. NO ACCELERATIONS WITH UC, FM OVERSHOOTS. SINUSIODAL PATTERN

Page 41: INTRODUCTION
Page 42: INTRODUCTION
Page 43: INTRODUCTION
Page 44: INTRODUCTION

Sinusiodal FHR Pattern

Page 45: INTRODUCTION

Evaluate this EFM strip/What do you think is happening?

Page 46: INTRODUCTION

What do you think of this EFM Strip?

Page 47: INTRODUCTION

MONITORING UTERINE ACTIVITY METHODS EXTERNAL UTERINE MONITORING INTERNAL UTERINE MONITORING

Page 48: INTRODUCTION
Page 49: INTRODUCTION
Page 50: INTRODUCTION

UTERINE CONTRACTIONS DEFINIONS OF TERMS FREQUENCY DURATION INTENSITY-1.BY PALPATION 2. IUPC-

mmHg.3.MONTEVIDEOUNITS(MVU) RESTING PERIOD RESTING TONE(TONUS)

-

Page 51: INTRODUCTION

Uterine Contractions

Page 52: INTRODUCTION

TYPES OF UTERINE ACTIVITY EFFECTIVE UTERINE CONTRACTIONS INEFFECTIVE UTERINE

CONTRACTIONS HYERSTIMULATION TETANIC CONTRACTIONS UTERINE IRRITABILITY HYPERTONUS

Page 53: INTRODUCTION
Page 54: INTRODUCTION

Questions? ;

Page 55: INTRODUCTION

QUESTIONS

Page 56: INTRODUCTION

THANK YOU http://www.youtube.com/watch?v=ysx9BVY

lUY4&feature=related

http://www.youtube.com/watch?v=ysx9BVYlUY4&feature=related
http://www.youtube.com/watch?v=ysx9BVYlUY4&feature=related

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