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Electronic Fetal Monitoring Debra Hastee, RNC-OB, BSN Kaplan University
Unit Objectives <ul><li>The objectives for this class are: </li></ul><ul><li>Learners will be able to explain fetal heart ...
Learning Objectives <ul><li>By the end of this class, the learners will be able to: </li></ul><ul><li>1. Define and recogn...
Overview <ul><li>NICHD definitions </li></ul><ul><li>Method for fetal heart tracing interpretation using NICHD terminology...
FHR tracing evaluation <ul><li>Qualitative & quantitative description of: </li></ul><ul><ul><li>Baseline rate </li></ul></...
Baseline FHR <ul><li>Approximate mean FHR rounded to increments of 5 beats/min </li></ul><ul><li>Read over 10 minutes (2 m...
Baseline FHR Variability <ul><li>Fluctuations in baseline FHR that are irregular in amplitude and frequency </li></ul><ul>...
Qualification of Waveform <ul><li>Abrupt - Onset to nadir (or peak) is < 30 seconds </li></ul><ul><li>Gradual - Onset to n...
Accelerations <ul><li>At 32 weeks and beyond, an acceleration is defined as an abrupt increase above the baseline with an ...
Late Decelerations <ul><li>Defined as a gradual decrease and return to baseline associated with a contraction </li></ul><u...
Variable Decelerations <ul><li>Defined as an abrupt decrease in FHR below the baseline of  >  15 beats/min lasting  >  15 ...
Prolonged Decelerations <ul><li>Defined as a decrease of  >  15 beats/min from baseline that has a duration of  >  2 minut...
FHR tracing practicum <ul><li>Interpret the following monitor strips using the standardized terminology for documentation ...
FHR Practicum # 1 Baseline rate: closest to 180 beats/min Baseline variability: Minimal ( <  5beats/min)
FHR Practicum # 2 Baseline rate: closest to 135 beats/min Baseline variability: Moderate (6-25 beats/min) Variable deceler...
FHR Practicum # 3 Baseline: closest to 135 beats/min Baseline variability: Moderate (6-25 beats/min) Prolonged deceleratio...
FHR Practicum # 4 Baseline: 180 beats/min Baseline variability: Absent (undetectable) Late decelerations: Gradual (30 seco...
Emergency Response <ul><li>Video by Michael Fox presented by Kaiser Permanente </li></ul><ul><li>http://www.youtube.com/wa...
Questions? <ul><li>Thank you </li></ul><ul><li>Upcoming modules will include physiology, fetal oxygenation, nursing interv...
References <ul><li>ACOG (2009). Intrapartum fetal heart rate monitoring: nomenclature, interpretation, and general managem...
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Electronic fetal monitoring. ppt

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NICHD terminology and definitions

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Electronic fetal monitoring. ppt

  1. 1. Electronic Fetal Monitoring Debra Hastee, RNC-OB, BSN Kaplan University
  2. 2. Unit Objectives <ul><li>The objectives for this class are: </li></ul><ul><li>Learners will be able to explain fetal heart rate patterns using NICHD terminology </li></ul><ul><li>Learners will be able to identify baseline FHR, variable, and late decelerations </li></ul><ul><li>Learners will be able to evaluate fetal heart tracings using a specified method of qualitative and quantitative description </li></ul>
  3. 3. Learning Objectives <ul><li>By the end of this class, the learners will be able to: </li></ul><ul><li>1. Define and recognize all elements of the EFM tracing including: FHR baseline, variability, accelerations, decelerations, and uterine contraction characteristics using the standard NICHD nomenclature. </li></ul><ul><li>2. Identify abnormal FHR tracings from normal </li></ul><ul><li>3. Demonstrate the correct method of interpretation of the FHR tracing </li></ul>
  4. 4. Overview <ul><li>NICHD definitions </li></ul><ul><li>Method for fetal heart tracing interpretation using NICHD terminology </li></ul><ul><li>Descriptions of baseline FHR, variable and late decelerations </li></ul><ul><li>Practicum </li></ul><ul><li>Emergency response video </li></ul>
  5. 5. FHR tracing evaluation <ul><li>Qualitative & quantitative description of: </li></ul><ul><ul><li>Baseline rate </li></ul></ul><ul><ul><li>Baseline variability </li></ul></ul><ul><ul><li>Presence of accelerations </li></ul></ul><ul><ul><li>Periodic or episodic decelerations </li></ul></ul><ul><ul><li>Changes or trends over time </li></ul></ul><ul><li>2008 ACOG report added uterine contractions to complete tracing evaluation </li></ul>
  6. 6. Baseline FHR <ul><li>Approximate mean FHR rounded to increments of 5 beats/min </li></ul><ul><li>Read over 10 minutes (2 minute minimum) </li></ul><ul><li>Excludes accelerations, decelerations, marked variability, and any segments differing by > 25 beats/min </li></ul><ul><li>Bradycardia : baseline < 110 beats/min </li></ul><ul><li>Tachycardia : baseline > 160 beats/min </li></ul>
  7. 7. Baseline FHR Variability <ul><li>Fluctuations in baseline FHR that are irregular in amplitude and frequency </li></ul><ul><li>Variability is quantitated as amplitude of peak to trough in beats/min </li></ul><ul><ul><ul><li>Absent : Undetectable </li></ul></ul></ul><ul><ul><ul><li>Minimal : > Undetectable but < 5 beats/min </li></ul></ul></ul><ul><ul><ul><li>Moderate : 6-25 beats/min </li></ul></ul></ul><ul><ul><ul><li>Marked : > 25 beats/min </li></ul></ul></ul>
  8. 8. Qualification of Waveform <ul><li>Abrupt - Onset to nadir (or peak) is < 30 seconds </li></ul><ul><li>Gradual - Onset to nadir (or peak) is > 30 seconds </li></ul>
  9. 9. Accelerations <ul><li>At 32 weeks and beyond, an acceleration is defined as an abrupt increase above the baseline with an acme of > 15 beats/min and a duration of > 15 seconds but < 2 minutes </li></ul><ul><li>Before 32 weeks gestation, an acceleration is defined as an abrupt increase above the baseline with an acme of > 10 beats/min and a duration of > 10 seconds but < 2 minutes </li></ul><ul><li>An acceleration lasting > 2 minutes but < 10 minutes is defined as a prolonged acceleration </li></ul>
  10. 10. Late Decelerations <ul><li>Defined as a gradual decrease and return to baseline associated with a contraction </li></ul><ul><li>Delayed onset, with nadir occurring after the peak of the contraction and offset usually after the end of the contraction </li></ul><ul><li>Because of the importance in timing related to uterine contractions, be careful regarding the use of a toco versus palpation or IUPC </li></ul>
  11. 11. Variable Decelerations <ul><li>Defined as an abrupt decrease in FHR below the baseline of > 15 beats/min lasting > 15 seconds but < 2 minutes </li></ul><ul><li>When associated with uterine contractions, they may vary in onset, depth, and duration from contraction to contraction </li></ul><ul><li>May be accompanied by other characteristics, the clinical significance of which requires more research </li></ul>
  12. 12. Prolonged Decelerations <ul><li>Defined as a decrease of > 15 beats/min from baseline that has a duration of > 2 minutes but < 10 minutes </li></ul><ul><li>Onset may be gradual or abrupt </li></ul><ul><li>Duration of > 10 minutes is considered a change in baseline </li></ul>
  13. 13. FHR tracing practicum <ul><li>Interpret the following monitor strips using the standardized terminology for documentation </li></ul><ul><li>You will have a few minutes and then we will review the strips as a group </li></ul><ul><li>Assume you have a ten-minute window on each page </li></ul>
  14. 14. FHR Practicum # 1 Baseline rate: closest to 180 beats/min Baseline variability: Minimal ( < 5beats/min)
  15. 15. FHR Practicum # 2 Baseline rate: closest to 135 beats/min Baseline variability: Moderate (6-25 beats/min) Variable deceleration: Abrupt (<30 seconds) onset, meets 15 beats/min by 15 second minimum, lasts less than 2 minutes onset to offset
  16. 16. FHR Practicum # 3 Baseline: closest to 135 beats/min Baseline variability: Moderate (6-25 beats/min) Prolonged deceleration: Onset may be gradual or abrupt, key here is that the deceleration is 2 minutes or more onset to offset.
  17. 17. FHR Practicum # 4 Baseline: 180 beats/min Baseline variability: Absent (undetectable) Late decelerations: Gradual (30 seconds or more) onset, onset occurs after U/C begins, nadir occurs after peak of U/C, & return to baseline after U/C concludes
  18. 18. Emergency Response <ul><li>Video by Michael Fox presented by Kaiser Permanente </li></ul><ul><li>http://www.youtube.com/watch?v=1PwGRDnXwow&feature=related </li></ul>
  19. 19. Questions? <ul><li>Thank you </li></ul><ul><li>Upcoming modules will include physiology, fetal oxygenation, nursing interventions and documentation </li></ul>
  20. 20. References <ul><li>ACOG (2009). Intrapartum fetal heart rate monitoring: nomenclature, interpretation, and general management principles. ACOG Practice Bulletin, No.106. Obstetrics & Gynecology, 114( 1 ), pp 192-202. </li></ul><ul><li>Miller, L. (2008). Fetal Heart Rate Interpretation. ACOG HANYS Perinatal Safety Initiative </li></ul><ul><li>Simpson, K. & Creehan, P. (2008). Perinatal Nursing, (3 rd ed.). Philadelphia, Pa.: Lippincott, Williams, & Wilkens </li></ul>

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