This document discusses fetal heart rate monitoring techniques and patterns. It describes intermittent auscultation using a fetoscope or Doppler ultrasound, and continuous electronic fetal monitoring using cardiotocography. Normal fetal heart rate is between 120-160 bpm; patterns like late decelerations, variable decelerations, or a sinusoidal pattern are non-reassuring. The document outlines how to interpret and manage different fetal heart rate patterns.

1. NON-REASSURING FETAL HEART RATE PATTERN
NATNAEL DECHASA (MSc . )

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 FHR monitoring in real sense is fetal brain monitoring because
fetal brain responds to hypoxia by altering FHR.
 Methods of fetal heart rate monitoring styles .
 Intermittent auscultation
 Fetoscope.
 Doppler US device.
 Continuous electrical FHR monitoring (EFM).
 Cardiotocography (CTG).
FHRM…

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Intermittent auscultation
Advantages
 widely available, easy inexpensive.
 Effective if done in consistent manner at appropriate
interval for the stage of labor.
Limitation
 Sometimes difficult in obesity & polyhydramnios .
 Can’t detect early fetal heart beat abnormality.
FHRM…

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Advantages of EFM over clinical monitoring.
 Can detect hypoxia early and can explain the mechanism of
hypoxia and its specific treatment.
 It is an important record for medico legal purpose.
FHRM…

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Drawbacks:
 Due to error of interpretation C/S rate may be high.
 Instruments are expensive and trained personnel are required to
interpret a trace.
 Mother has to be confined in bed.
FHRM…

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Indications for electronic fetal monitoring
 Previous history of stillbirth.
 Induction of Labor.
 Preterm labor.
 Non- reassuring fetal status; decreased fetal mov’t
 Meconium staining of amniotic fluid.
FHRM…

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Full description of a FHR tracings.
FHRM…

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Base line rate.
 Average fetal heart rate of a ten minutes recording.
 Draw a horizontal line by excluding acceleration and deceleration.
 Normal = 120 to 160 bpm
 Bradycardia <120 bpm
 Tachycardia >160 bpm
FHRM…

9. Periodic changes…
Acceleration
 An abrupt increase in the FHR above the baseline. Before 32
weeks of gestation, accelerations should last 10 sec and peak 10
bpm above baseline.
 After of 32 weeks gestation, accelerations should last 15 sec and
peak 15 bpm above baseline.
 A prolonged acceleration is lasting 2 minutes above the base
line but less than 10 minutes.
 An acceleration of 10 minutes or more is considered a change in
baseline.
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Periodic changes…

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Periodic changes…

11. Periodic changes…
 Except those associated with variable deceleration, accelerations are
physiologic response to fetal movement.
 Presence of acceleration –reassuring.
 Absence of acceleration-fetus is not moving (doesn’t necessarily mean
hypoxia).
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Periodic changes…

12. Deceleration; Four principal type based on timing, relationships to
contractions, duration and shape.
Early deceleration
 Gradual decrease in FHR and return to base line associated with
a uterine contraction.
 The onset, nadir and recovery of decelerations are coincident
with the beginning , peak and ending of contraction
respectively.
 Caused by compression of fetal head by the uterine cervix (it
stimulates vagal nerve).
 Not associated with fetal hypoxia, acidemia or low APGAR
scores.
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Periodic changes…

13. Late deceleration
 Gradual decrease and return to baseline FHR associated with
uterine contraction.
 The onset of deceleration occur at or after the pick of uterine
contraction and returning to baseline only after the
contraction has ended.
Causes
• Excessive Ux contraction (oxytocin).
• Feto-placental insufficiency .
• Maternal hypotension (epidural ).
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Periodic changes…

14. Variable deceleration
 Abrupt decrease in FHR below the base line, onset, depth and
duration have no relation with contractions.
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Periodic changes…

15. Causes of variable deceleration.
*Cord compression/occlusion/.*
 Oligohydramnios
 Nuchal cord/cord stretching.
 Cord prolapse/ compression.
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Periodic changes…

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Periodic changes…

17. • Prolonged deceleration
 Decrease in FHR below the baseline ≥15bpm, lasting ≥2min
but <10min from the onset to return to baseline.
 May be caused by any of the mechanisms mentioned so far,
but are of a profound and sustained nature.
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Periodic changes…

18. Sinusoid pattern
 Rare but significant
 True sinusoidal pattern – associated with fetal anemia ( iso-
immunization, ruptured vasa previa, TTT).
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Periodic changes…

19. Sinusoid pattern…
Criteria for identifying sinusoidal FHR pattern
 A stable baseline FHR of 120-160bpm with regular sine
wave-like oscillations.
 An amplitude of 5-15bpm.
 Oscillation of sine wave above and below the baseline
and absence of accelerations.
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Periodic changes…

20. Sinusoid pattern…
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Periodic changes…

21. Interpretation of FHR patterns
 The FHR pattern recorded by an electronic FHR monitor is typically
interpreted as Reassuring FHRP or Non reassuring FHRP.
Reassuring fetal heart rate pattern includes
 A baseline fetal heart rate of 120 to 160 bpm.
 Absence of late or variable FHR decelerations .
 Moderate FHR variability (6 to 25 bpm).
 Early decelerations may or may not be present.
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Periodic changes…

22. Interpretation of FHR patterns…
Nonreassuring FHRP
 Replaces the term fetal distress.
Non reassuring FHRP includes
 Late decelerations (>50% of contraction).
 Variable deceleration.
 Sinusoidal tracing
 Prolonged decelerations./recurrent/*
 Bradycardia / tachycardia.
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Periodic changes…

23. Management of non reassuring FHR patterns.
Cause.????
Non-surgical intervention.
 Lateral positioning.
 Oxygen administration.
 Hydration.
 Discontinue Oxytocin.
 Tocolysis.
 Amnioinfusion.
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Periodic changes…

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THANK YOU
Nhati Dream