Intrapartum fetal monitoring allows assessment of fetal well-being during labor and delivery. Methods include intermittent auscultation of the fetal heart rate, electronic fetal monitoring of the heart rate and uterine contractions, and fetal scalp blood sampling. Patterns in the fetal heart rate tracing like decelerations, variability, and accelerations provide information about fetal oxygenation. Category I tracings are reassuring, Category II tracings are indeterminate, and Category III tracings are nonreassuring and indicate fetal acidosis requiring preparations for delivery to prevent hypoxic injury. Interpretation of fetal monitoring guides management to ensure timely intervention if the fetus is not tolerating labor well.

2. INTRAPARTUM
FETAL WELLBEING
BY
ALOMONI SINGH
1ST YEAR M.SC NURSING STUDENT
GOVT. COLLEGE OF NURSING ID & BG

3. INTRAPARTUM FETAL WELLBEING
What is Intrapatum?
The intrapartum period refers to the time
of pregnancy from the onset of labor to
delivery of the newborn and the placenta.
What is the Meaning of fetal wellbing?
Assessment of fetal wellbing is designed
to identify foetuses at risk for in utero
death or asphyxia-mediated damage and
affect expeditious and safe delivery.

4. AIM OF INTRAPARTUM FETAL MONITORING
 Identify fetal well-being.
Identify the Fotus who may be having hypoxic
stress.
Timely detection and effective intervension.
Prevention of brain injury.
To detect potential fetal harm due to decreased
oxygenation during labour.
Decreased in perinatal / neonatal morbidity and
mortality.

5. Two major factors affect fetal oxygenation in labour:
1. Placental blood flow.
2. Blood flow through the umbilical cord.

6. Uterine
contraction
Decreased utero-
placental blood
flow
Intermittently decreased
fetal oxygenation
Term well-oxygenated
fetus
Prolonged insult Growth
restricted fetus Preterm
fetus
Insult tolerated
Insult not tolerated
No hypoxia
Fetal hypoxia
Possible brain injury

7. Cause of intrapartum hypoxia

8. Types of hypoxic injuries
•Hypoxic ischemic encephalopathy (HIE)
•Neonatal encephalopathy
•Cerebral palsy (CP)

9. Methods of intrapartum fetal Monitoring
CLINICAL METHODS
BIOPHYSICAL METHODS
BIOCHEMICAL/OTHERS METHODS

10. CLINICAL METHODS
•Intermittent Auscultation (IA)
- Pinard fetoscope
- Stethoscope
-Handheld Doppler device

11. BIOPHYSICAL METHODS
•Ultrasound
•Cardiotocography (CTG) or
electronic fetal monitoring (EFM)

12. BIOCHEMICAL AND OTHERS METHOD
•Fetal scalp blood sampling
- Scalp pH
-Fetal lactate concentration
•Fetal electrocardiography
•Pulse oximetry

13. Intermittent Auscultation (IA)
Frequency of auscultation for fetal heart rate
in labor
•First stage of labour (till complete cervical dilation):
• Every 15 minutes during the active phase
of first stage of labor.
• Before the start of the contraction to
after the contractions is over.
•oxygenation of the fetus decreased
during construction.
•Any abnormal changes, it will alert the
obstetrician

14. Intermittent Auscultation (IA)
Frequency of auscultation for fetal heart rate
in labor
2. Second stage of labour (from complete cervical
dilation to delivery of the fetus)
•Every 5 minutes during the second stage of labor.
•After every contraction during the pushing phase
of labor.

15. Interpretation of fetal heart rate by auscultation
BaselineFatalheartrate
Initial counting for 60 seconds.
Between contractions.
Follow-up assessment for 30-60 seconds.
Normal baseline fatal heart rate 110-160 bpm
Baseline fetal heart rate
Normal: 110-160 bpm

16. Fetal heart ratechanges
It is easy to identify changes from the baseline by
auscultation.
Accelerations
- Abrupt rise
- >15 bpm above baseline
- Lasting 15-60 seconds
- Reassuring sign
Decelerations
- Abrupt drop below baseline
- Lasting 15-60 seconds
-Cannot diagnose etiology
Tachycardia
- Fetal heart rate above 160 bpm for >10 minute
Bradycardia
- Fetal heart rate below 110 bpm for >10
minute

17. Electronic fetal monitoring
Indications for electronic fetal monitoring
•Maternal
-Hypertension
-Pregestational diabetes
-Previous cesarean section
-Induced or augmented labor
- Chorioamnionitis.
•Fetal
- Meconium-stained amniotic fluid.
- Fetal grouth restriction.
-Multiple pregnancy.
- Prematurity
- Postterm.
-Previous intrapartum asphyxia/death.

18. Equipment for electronic fetal monitoring
• External electronic monitoring-From the maternal
abdomen wall-(Non invasive)
• Internal electronic monitoring-Directly from the
fetus-(Invasive)

19. The external electronic monitoring equipment consists
 Ultrasound transducer that detects the fetal heart
rate.
The external tocotransducer-uterine contractions
and uterine pressure are recorded simultaneously
by tocodynamometer
Graphic tracing: permanent record of the fetal
heart rate and uterine contractions

20. The internal electronic
monitoring equipment consists
Internal fetal heart rate monitor-a spiral
electrode that is fixed to the fetal scalp.
Counts every R-R interval of the fetal ECG

21. Advantages of internal fetal heart
rate monitoring
•Used in active labor
• Maternal movements difficult to use
an external monitor.
• Used in obese women.
•More accurate.

22. FETAL HEART RATE PATTERN ON
ELECTRONIC FETAL MONITORING
•Baseline fetal heart rate
• Baseline variability
• Periodic changes
- Accelerations
-Decelerations

23. Baseline fetal heart rate
• Normal baseline fetal heart rate is
110-160 bpm.
•Fetal heart rate exceeds 160 bpm for
10 minutes or more, it is called
tachycardia.
•Fetal heart rate is below 110 bpm for
10 minutes or more, it is called
bradycardia.

24. The causes for fetal Tachycardia and Bradycardia
Tachycardia
Maternal fever
Chorioamnionitis
Fetal compromise
Bradycardia
Fetal Head compression
compromise

25. Baseline variability:
•Amplitude range of 6-25 bpm.
•Mnimal when it is <5 bpm,
•Moderate or normal 5-25
•Marked when it is >25 bpm.
 Fluctuations in the baseline fetal heart
rate that are irregular in amplitude and
frequency.
 Decrease variability is an important sign
of fetal hypoxia.

26. Causeof decreased or absent base-
line s variability
• Maternal administration of
-analgesics
-sedatives
-magnesium sulfate
•Fetal hypoxia

27. Periodic changes of Acceleration and
Decelerations
Accelerations
• Increases basal heart rate by 15 bpm
• lasting at least 15 seconds .
• reassuring sign
• presence of accelerations rules out fetal
hypoxia

28. Decelerations
Differentiate types based on their
relationship to uterine contractions.
• If it decreases >15 bpm below
baseline
• lasts for >15 seconds,
• and is repetitive..

29. Visually apparent gradual decrease and
return of the fetal heart rate associated
with a uterine contraction.

30. •Gradual decrease in the fetal heart
rate typically following the uterine
contraction.
•Nadir of the deceleration occurs after the peak of
the contraction. They are caused by placental
insufficiency .

31. •Characteristi- cally variable in
duration, intensity, and timing.
•persitsten, deep, and recurrent variable
decelerations are indicative of fetal acidosis. vary in
onset, depth, and duration.

32. Patterns suggestive of fetal
hypoxia
•Decelerations to <70 bpm.
•Loss of variability.
•Persistent baseline breadycardia/trahycardia

33. • Deceleration lasts >2 minutes but <10 minutes.
• Indicative of prolonged cord compression,
hypotension, or severe, acute placental insufficiency.

34. Sinusoidal pattern:
•Baseline fetal heart rate is 120-160 bpm.
•Variability is markedly decreased or absent. The oscillations are
5-15 bpm,
•Cycle frequency is 3-5 times/min.
• persists for 20 minutes or more
•smooth, sine wave- like undulating pattern

35. THREE TIERED FETAL HEART RATE
INTERPRETATION SYSTEM
Reassuring (Category I
Indeterminate (Category II)
•Nonreassuring (Category III

36. THREE TIERED FETAL HEART RATE
INTERPRETATION SYSTEM
Category I or reassuring
tracings
•A baseline fetal heart rate of 110-160 bpm
• Absence of late or variable fetal heart rate
decelerations
• Moderate fetal heart rate variability (6-25 bpm)
• Fetal heart rate accelerations-present or absent
•Early decelerations-present or absent

37. Category II tracings Indeterminate
•Tachycardia
•Bradycardia without absent variability
• Minimal or marked variability
•Absent variability without recurrent decel erations
•Prolonged decelerations >2 minutes but <10minutes
THREE TIERED FETAL HEART RATE
INTERPRETATION SYSTEM

38. THREE TIERED FETAL HEART RATE INTERPRETATION SYSTEM
Nonreassuring (Category III)
Absent baseline fetal heart rate
variability
-Recurrent late deceleration
Recurrent variable deceleration
Bradycardia
 Sinusoidal pattern

39. Interpretation of an electronic
fetal monitoring graph
•Baseline fetal heart rate (in bpm)
•Baseline variability (normal, decreased, absent)
•Presence of decelerations (duration, decrease
below baseline, and relation to contraction)
-Early
-Late
-Variable
•Presence of accelerations (duration and
elevation above baseline)

40. Further evaluation of Category II and
Category III tracings
•Assess the degree of fetal acidemia.
•Fetal scalp stimulation test
•Fetal scalp blood sampling

41. Management of Category I, Category II,
and Category III tracings Category I
•Denote a normal fetus
•Every 30 minutes in the first stage and
labor.
•No intervention is
require
•Every 15 minutes in the second stage of
labor.

42. Category II tracings are suspicious
•managed before acidemia
Category III tracings indicate fetal acidemia
preparations for delivery
•If membranes are not ruptured artificial rupture of
membranes (ARM)
•Help assess the amniotic fluid.

43. Interventions in Category II and Category III
tracings
 Decrease uterine activity.
Improve uterine blood flow
 Improve umbilical artery blood flow
 Improve maternal/fetal oxygenation
 Perform vaginal examination
 Prepare for delivery

44. Other methods (Bio-Chemical method)
oFetal scalp blood sampling
pH values
 >7.25: Normal,
 7.25-7.2: Borderline, repeat
test in 20-30 minutes
 <7.2: Acidemia, immediate
delivery indicated

45. Other methods (Bio-Chemical method)
 Fetal electrocardiography
 Fetal pulse oximetry

46. The fetus faces stress during labor. Fetal survilance
during labor helps to recognizing the fetus that is not
tolerating labor well and is hypoxic/academic.
Recognition of fetal compropise guideds decisions
about appropriate intervention so that short- and long
term neurological damage may be avoided.
CONCLUTION:

47. Bibliography:
1.Essential of Obstetrics,Lakshmi Seshadri,First Edition,
Wolters Kluwer,page no 239 to 250.
2.Textbook of Obstetrics by Hiralal Konar, 8th edition.
Jaypee The Health science publisher, New Delhi.
3. www. http://academic.oup.com>article