The patient received an epidural bolus approximately 10 minutes ago. 3. The patient's membranes ruptured 1 hour ago, and the fluid was clear. Turn the patient to the left side, stop the oxytocin infusion, and assess maternal vital signs. Electronic fetal heart rate monitoring is commonly used to assess fetal well-being during labor. Internal vs external. Fetal Heart Tracing: All You'll Ever Need to Know - Flo A new nurse is asking an experienced nurse about interpreting a Category III FHR tracing. A prolonged fetal heart rate deceleration lasts >2 minutes, but <10 minutes. The nurse understands that the primary intervention is to: The nurse notes that the fetal heart rate baseline is 120-130 with an increase in FHR to 145 bpm lasting 15 seconds. A more recent article on intrapartum fetal monitoring is available. Home. This web game uses NICHD terminology to identify tracing elements and categorize EFM tracings. b. apply a stressful stimulus to the fetus. Structured intermittent auscultation can be used for low-risk labor because it statistically decreases cesarean and operative vaginal delivery rates without increasing cerebral palsy or fetal death. Appendix A: Amnioinfusion Appendix B: Selected FHR Tracings and Cases: Interpretation and . Correlate accelerations and decelerations with uterine contractions and identify the pattern. Continuous electronic fetal monitoring, compared with structured intermittent auscultation, has been shown to increase the need for cesarean delivery (number needed to harm = 56; RR = 1.63; 95% CI, 1.29 to 2.07; n = 18,861) and operative vaginal delivery (number needed to harm = 41; RR = 1.15; 95% CI, 1.01 to 1.33; n = 18,615), with no statistical decrease in fetal death or cerebral palsy.1 Continuous electronic fetal monitoring has also led to a 50% reduction in the incidence of neonatal seizure vs. structured intermittent auscultation, but this has no effect on long-term outcomes.1, Several adjuncts have been studied to overcome the high false-positive rate of continuous electronic fetal monitoring. See permissionsforcopyrightquestions and/or permission requests. -Contractions started by: IV pitocin or Nipple stimulation Bradycardia of this degree is common in post-date gestations and in fetuses with occiput posterior or transverse presentations.16 Bradycardia less than 100 bpm occurs in fetuses with congenital heart abnormalities or myocardial conduction defects, such as those occurring in conjunction with maternal collagen vascular disease.16 Moderate bradycardia of 80 to 100 bpm is a nonreassuring pattern. 10. Structured intermittent auscultation is a technique that employs the systematic use of a Doppler assessment of fetal heart rate (FHR) during labor at defined timed intervals (Table 1).4 It is equivalent to continuous EFM in screening for fetal compromise in low-risk patients.2,3,5 Safety in using structured intermittent auscultation is based on a nurse-to-patient ratio of 1:1 and an established technique for intermittent auscultation for each institution.4 Continuous EFM should be used when there are abnormalities in structured intermittent auscultation or for high-risk patients (Table 2).4 An admission tracing of electronic FHR in low-risk pregnancy increases intervention without improved neonatal outcomes, and routine admission tracings should not be used to determine monitoring technique.6.
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