Fetal Monitoring
Course
Disclosure
The Instructors of this course report
either conflicts of interests or relevant
financial relationships, or lack thereof.
The nurse planners for this course
report no conflicts of interests.
Disclosure
The Instructors will be discussing an
off-label use of the medication
terbutaline but will not be discussing
the off-label use of any medical
devices.
Course Objectives
1. Describe physiologic principles of maternal and fetal
oxygen transfer and acid-base balance.
2. Identify physiologic principles underlying fetal heart
monitoring.
3. Describe concepts in antenatal testing including
analysis and interpretation of biophysical profiles
and complex antenatal fetal heart monitoring
tracings.
4. Relate physiologic principles to the goals and
interventions of antenatal testing.
5. Evaluate interventions for patients undergoing
antenatal testing.
Fetal Oxygenation
Maternal circulation
Uterine circulation
Placental circulation
Umbilical circulation
Fetus
Four Components of
Oxygen Transport
Oxygen content
Oxygen affinity
Oxygen delivery
Oxygen consumption
Maternal Oxygen
Transport
Maternal oxygen content:
The total amount of oxygen in the
maternal arterial blood
Amount of oxygen dissolved in plasma
(PaCo2)
Percent of oxygen carried on the
hemoglobin (SaO2)
Maternal Oxygen
Transport (cont.)
PaO2 helps bind oxygen molecules to
hemoglobin.
Saturated hemoglobin molecule
carries four molecules of oxygen.
SaO2 is a more precise measure of
oxygen content than PaO2
Maternal Oxygen
Transport (cont.)
Oxygen affinity:
Gain and release of oxygen
molecules from hemoglobin
Can change with variations in pH,
CO2 or maternal temperature
Reflected on oxyhemoglobin
dissociation curve
Maternal Oxyhemoglobin
Dissociation Curve
Maternal Oxygen
Transport (cont.)
Oxygen delivery:
Amount of oxygen delivered to the
tissues each minute
Two components are:
Oxygen content
Cardiac output
Maternal Oxygen
Transport (cont.)
Oxygen consumption:
Amount of oxygen consumed by the
body and tissues each minute
Interventions to Decrease
Maternal Oxygen Consumption
Fetal Circulation
Change in variability
Change in reactivity
Fetal Response to
Decreased Oxygen
Redistribution of blood to vital organs
Oxygen consumption decreases:
Myocardium uses less oxygen
Changes in FHR
Absence of Metabolic
Acidemia
Systematic Assessment
of FHR Tracings
Baseline rate
Variability
Periodic/episodic changes
Uterine activity
Pattern evolution
Accompanying clinical characteristics
urgency
Category I
Indeterminate:
Compensatory
Response
Examples:
Moderate variability with
recurrent late or variable
decels
Minimal variability with
recurrent variable decels
Absent variability without
recurrent decels
Bradycardia with moderate
variability
Prolonged decels and
Tachycardia
Category II
Category III
Managing Strategies
Tracing may evolve between categories
Category I:
Followed in routine manner
Category II:
Requires evolution, continued surveillance and
interventions guided by the clinical picture
Category III:
Requires prompt evaluation
Use interventions
Systematic Decision
Making
Includes:
Intrapartum goals
Ongoing assessment
Physiologic interventions
Clinical evaluation
Effects of Ephedrine
Maternal:
Cardiac output
Heart rate
Blood pressure
Fetal:
Tachycardia
FHR variability
Accelerations