Fetal Monitoring During Labor- Maternal (OB) Nursing

A review for nursing students studying fetal monitoring during labor. This Maternal (OB) Nursing review will discuss the methods of fetal monitoring, fetal heart rate patterns, and nursing considerations during fetal monitoring.

Once you review the information in this post, be sure to download this PDF cheat sheet that includes all the important information.

Also, be sure to check out these other Maternal (OB) Nursing study guides (downloadable PDF cheat sheets also available):

• Changes in Pregnancy
• Stages of Labor
• Pain Management During Labor
• Nursing Care of the Postpartum Mother
• Pregnancy Complications
• Labor and Delivery Complications
• Postpartum Complications

During labor, both the mother and fetus will be monitored closely. The nurses typically rely on maternal vital signs and physical assessment of the mother to determine her status.

Since the fetus is inside the mother’s uterus, physical assessment is not a viable option. Therefore, healthcare staff focus on the fetal heart rate and fetal heart rate patterns to monitor the fetus during labor and obtain insight on the status of the fetus.

Obtaining the fetal heart rate can be done in a few different ways.

The following are 3 different methods of fetal monitoring:

• Intermittent auscultation and palpation
• External fetal monitoring
• Internal fetal monitoring

Let’s break down each of these methods.

Auscultation and palpation

Only appropriate in low-risk women Use of a fetoscope or Doppler ultrasound to auscultate fetal heart rate Requires 1-1 nursing care Mother is free to walk around and change positions as she wants Pressure from device is uncomfortable for some women

Electronic fetal monitoring

Supplies more data about the fetus than auscultation Provides a record that can be printed or stored electronically Easy to identify trends in fetal heart rate and uterine activity Allows for one nurse to observe two laboring women Main disadvantage is reduced mobility for the mother External: -Ultrasound transducer- secured on the mother’s abdomen with straps -Less accurate than internal devices but are noninvasive -Toco transducer- this device detects changes in uterine activity -Fetal size, abdominal fat thickness, maternal position, and location will all affect the reading obtained -Produces a tracing Internal: -Accuracy is the main advantage -Requires ruptured membranes and about 2 cm of cervical dilation -Slightly increased risk for infection -Fetal scalp electrode -detects electrical signals from the fetal heart –avoid fetal face, fontanels, and genitals -Intrauterine pressure catheter -measures uterine activity -solid catheter or a hollow, fluid-filled catheter

Now that we know how to monitor the fetal heart rate, let’s look into what this information will clue us into.

First things first, the basics:

Normal fetal heart rate: 110-160

Bradycardia <110

Tachycardia >160

The nurse should be mindful of the following mechanisms that influence heart rate:

• Maternal hypertension– could reduce flow to the placenta
• Hypertonic contractions– decrease placental blood flow
• Placental disruptions
• Compressed or prolapsed cord

Baseline Fetal Heart Rate Variability

Variability is the fluctuation of the baseline fetal heart rate.

It is important to monitor variability while monitoring fetal heart rate as it can indicate how the fetus is tolerating the birthing process.

Variability in the fetal heart rate can be affected by many factors.

A few factors to keep in mind:

• Narcotics, sedatives, alcohol, illicit drugs
• >28 weeks gestation
• Hypoxia

There are 4 different categories of variability:

• Absent- Undetectable
• Minimal: Undetectable to <5 bpm
• Moderate: 6-25 bpm
• Marked: >25 bpm

Fetal Heart Rate Patterns

Go check out this helpful guide on how to read basic fetal heart rate patterns. It provides pictures/strips for each fetal heart rate pattern as well as descriptions for each pattern. It’s also a good idea to reference your Maternal-Child Nursing textbook for more fetal heart rate strips.

Variable decelerations:

• Caused by reduced flow through the umbilical cord- cord compression
• Shape, duration, and degree of fall below baseline rate are variable- fall and rise in rate is abrupt
• Change position of mother, apply O2, discontinue oxytocin, assess mother’s VS

Early decelerations:

• Mirror images of contraction
• Return to baseline fetal heart rate by the end of the contraction
• Head compression during contractions- increases intracranial pressure
• Maternal position changes usually have no effect on pattern
• Not associated with fetal compromise

Accelerations:

• Temporary increases in fetal heart rate; periodic or nonperiodic
• Peaks at 15 bpm above the baseline for at least 15 seconds
• Associated with fetal movement
• Reassuring– baby is moving and is tolerating it
• No intervention needed-Nurse should continue supporting optimal oxygenation

Late decelerations:

• Begins after contraction begins (often near peak)
• Reflect possible impaired placental exchange; nonreassuring
• Requires nursing intervention to improve blood flow and fetal oxygen supply

VEAL CHOP

In nursing, the acronym VEAL CHOP can be used to remember the types of fetal heart rate patterns and the causative factors associated with them. It also gives you a clue as to what the correlating nursing interventions should be for each pattern.

Variable declerations —– Cord compression

Early decelerations ——–Head compression

Accelerations —————Ok

Late decelerations———-Placental insufficiency

Fetal heart rate patterns can be categorized into three different categories.

Category I: Normal- associated with fetal well-being; accelerations

Category II: Indeterminate- ambiguous data- describes patterns or elements of reassuring characteristics but also data that may be nonreassuring; not an emergency but important to continue monitoring

• Tachycardia

• Bradycardia w/ variability

• Minimal or marked baseline variability

• Absent variability

• Absence of accelerations after fetal stimulation

• Periodic or episodic variations

• Variable decelerations w/ other characteristics

Category III: abnormal- nonreassuring- favorable signs are absent

• Absent variability

• Recurrent late decelerations

• Bradycardia

• Sinusoidal pattern- rare

Main takeaway:

Category I= GOOD

Category II= Continue monitoring

Category II= NOT GOOD= nursing intervention required

General nursing interventions while monitoring fetal heart rate patterns:

• Identify the cause of the pattern
• Increase placental perfusion- turn mother to left side, administer oxygen, infuse Lactated Ringers
• Tocolytic drug, such as terbutaline, may need to be administered to lessen uterine activity
• Reduce cord compression
• Prepare for c-section if fetal compromise is suggested
• Update and educate the mother and partner
• Communicate nonreassuring signs with the healthcare provider

I hope this was helpful for the nursing students out there currently studying for their Maternal (OB) Nursing rotation. Fetal monitoring is a large part of the labor process that labor and delivery nurses must be knowledgeable about.

If you have any questions, please let me know. Feel free to contact me with questions about the material or if you simply want to chat.

Happy Nursing!