Fetal Adaptation to
Labor
Physiologic
Fetal
Monitoring Techniques
Intermittent auscultation
Pinard stethoscope
Doppler ultrasound
Ultrasound stethoscope
Monitoring Techniques
Electronic Fetal Monitoring
Electronic Fetal
Monitoring
+
Assessment of Uterine
Contractions
Palpation
External
IUPC
tocotransducer
Systematic Evaluation of
Fetal Heart Rate Tracing
Fetal Status
Baseline FHR
Between Contractions
5-10 minute segment
Document as range
Normal is 110-160
VARIABILITY
Variability
undetectable
6-25 bpm
0-5 bpm
>25 bpm
In response to contractions
Episodic
Acceleration
Etiology of Accelerations
Fetal
movement
Uterine contractions
Vaginal exam
ISE application
Fetal scalp stimulation
Partial cord compression
Breech presentation
ALWAYS
REASSURRING!
Accelerations
Etiology of Decelerations
Early
Head Compression
Late
Uteroplacental
Insufficiency
Variable
Cord Compression
Early deceleration
Late deceleration
Variable deceleration
Normal
NO ACTION REQUIRED
Not predictive of
abnormal fetal acid base
status but cant
categorize
I or III intraRe-evaluation,
Category II
Category I
Normal
NO ACTION REQUIRED
Category II
Not
predictive
of
abnormal
fetal acid
base
status but
cant
categorize
I or III
Category III
Abnormal
fetal acidbase status
Sinusoidal pattern
ACTION REQUIRED
Relax
Remove Pitocin
Rehydrate
Report to MD
+
Nursing Care for Active Labor
+
Nursing Care for Active Labor
Leopolds Maneuvers
Maternal
Open-glottis
pushing( Encourage
women to push as they feel like
pushing which is instinctive,
spontaneous pushing)
Amnioinfusion
Amniotomy
Nipple Stimulation
Prostaglandins
Oxytocin
Forceps
Vacuum
assisted
Cesarean Birth
Planned,
Surgical
unplanned, or elective
technique
Complications
Anesthesia
VBAC
Approximately
Vaginal
MD immediately available
Anesthesia available
Obstetric Emergencies
Shoulder dystocia
Uterine Rupture