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Uterine contractions
Fetal heart rate (FHR)
Ways to Monitor
Uterine contractions
Fetal heart rate (FHR)
Features to Describe
Fetal heart rate (FHR)
– Top line on monitor strip
Uterine contractions
– Bottom line on
monitor strip
Features to Describe
Baseline
Variability
Accelerations
Decelerations
Trends over time
Interpret into 1 of 3 categories
Baseline
Prolonged accelerations
– Last 2 minutes to 10 minutes
Baseline change
– Acceleration lasting 10 mins or longer
>15 beats above baseline
15 seconds to 2 minutes in length
Features to Describe
Baseline
Variability
Accelerations
Decelerations
Trends over time
Interpret into 1 of 3 categories
Decelerations
Decrease in baseline
3 Types
– Early
– Variable
– Late
Deceleration
Decrease in FHR
Early Deceleration
Symmetrical to
contraction
Mirror image of
contraction
Gradual decrease in
FHR
– 30 secs or more from
onset to nadir
EARLY DECELERATION
Gradual FHR decrease
Onset to nadir 30 seconds or more
Nadir of deceleration occurs with peak of contraction
Mirror contraction
Late Decelerations
Pathophysiology
– umbilical cord
compression
Decelerations
Prolonged deceleration
– Decrease of 15 BPM
– Lasts 2-10 minutes
Baseline change
– Deceleration lasting at least 10 mins
Description
– Intermittent
Less than 50% of contractions in 20 minutes
– Recurrent
More than 50 % of contractions in 20 minutes
Sinusoidal Pattern
Normal baseline
– 110-160 BPM
FHR Variability
– moderate
Late or Variable decelerations
– none
Category II
Abnormal tracing
Predictive of abnormal fetal acid-base status
Requires prompt intervention
The ABCD’s of Fetal Monitoring
Examples of Tracings
Non-Stress Test
•Reactive
•2 or more accelerations in 20 mins
•Acceleration
•At least 15 beats above baseline
•Lasting for at least 15 seconds
•Non-reactive
Reactive NST
Biophysical Profile (BPP)
NST + ultrasound markers
Score linearly correlated with fetal pH
Risk of fetal death within one week of normal
BPP is 1:1300
Biophysical Profile
normal patient
– reviewed every 30 min in the first stage of labor
– every 15 minutes in the second stage
complicated patients
– every 15 minutes in first stage
– Every 5 mins in second stage