Electronic Fetal Monitoring
Assessment of fetal heart rate (FHR) and assessment of fetal tolerance to labor
Two points of data – FHR and uterine contractions
With each contraction, there is a temporary, transient reduction in maternal blood flow to fetus,
electronic fetal monitoring provides visual picture of how fetus is responding to stress of contractions
The RN is responsible to read and interpret the FHR pattern/contractions to evaluate fetal well-being
2 types of monitoring: Internal vs. External
Contraction monitor at top of fundus
Always check that you are tracing baby (moms pulse vs reading)
External Internal
intermittent Continuous **Can only be continuous!!
Low risk, early labor, active labor, ** have to have rupture of membranes (ROM)
non-medicated, no preeclampsia (treated - Internal monitors placed by physician or
rupture with medications – CNM
Assess fetal HR Pitocin or Internal assessment of contractions & FHR
- Handheld magnesium), higher Done because external monitoring is not
doppler risk pregnancies, adequate
- Ultrasound twins
stethoscope Assess contractions: Done when labor is not progressing, for accurate
- Fetoscope Tocotransducer dosage of Pitocin
Assess before/during/ - Frequency
after a contraction in - Duration Intrauterine pressure catheter (IUPC)
labor - NOT intensity assesses contractions
- Use palpation Assess fetal HR: - Catheter sits between uterine wall and
to assess for Ultrasound doppler fetus, connects to monitor
contraction - Baseline - Strength expressed as Montevideo units
Seen a lot with - Variability (MVU)
midwife care - Presence of - Assess intensity (strength) of contraction
accelerations Only way to determine the
or strength/intensity of a contraction, and
deceleration external monitor cannot
Of every 15 minutes, Fetal scalp electrode (FSE)
we take 10 minutes assesses FHR
and document - Spiral electrode placed into fetal
contractions vs fetal presenting part
HR - Cable from electrode to monitor
Risks: bleeding, hematoma, infection,
Caution in patients (mom) with HIV
Monitor strip basics
, Top line Bottom line Vertical line
FHR tracing Uterine contraction tracing Time (10 seconds)
*The intervals between vertical lines represents one minute
Fetal Heart Rate Uterine Contractions
FHR baseline Frequency
Variability Intensity
Presence of accelerations and decelerations - Mild = nose
- Moderate = chin
- Strong = forehead
Duration
- Visual representation of the FHR and the maternal contraction pattern
- Information about fetal oxygenation & changes in FHR
- FHR pattern changes can indicate fetal hypoxemia – the most common etiology of fetal
injury/death
- Optimal fetal surveillance during labor to detect FHR changes combined with early interventions
can help prevent fetal injury/death
Normal baseline 110 – 160 bpm
- Assess over 10 minutes to determine baseline (at least 2 minutes of identifiable baseline –
otherwise baseline may be indeterminate)
- Round to nearest 5 bpm
Bradycardia Tachycardia
Less than 110 bpm Over 160 bpm
Causes: late fetal hypoxemia, maternal Causes: maternal fever (most common), early
hypotension (may be from epidural), uterine fetal hypoxemia, maternal dehydration
rupture, placental abruption, medication
(opioids), maternal supine position Intervention: requires additional assessment to
determine cause – fluids
Can come from prolonged deceleration, only fix Fever = temperature check, Tylenol, cold
is delivery compress, increase fluids
**mother will receive fluids before epidural to
prevent hypotension and bradycardia in the
fetus, if persists can give more fluids and/or epi
Intervention: Increase placental perfusion,
decrease uterine activity, correct hypotension
(position)
Variability – the push pull between the sympathetic and parasympathetic nervous system
*Absent, minimal, moderate, marked*
- The most important predictor of adequate fetal oxygenation and fetal reserve during labor
- Absent – no “push – pull”
- Minimal – baby may not be awake, so less variability. Could be from pain medications (mg,
staidol)
- Moderate variability indicates well developed and well oxygenated autonomic and CNS
o Good sign on fetal well-being
- Marked – goes over 25 bpm, not a huge deal but don’t like this too much
Assessment of fetal heart rate (FHR) and assessment of fetal tolerance to labor
Two points of data – FHR and uterine contractions
With each contraction, there is a temporary, transient reduction in maternal blood flow to fetus,
electronic fetal monitoring provides visual picture of how fetus is responding to stress of contractions
The RN is responsible to read and interpret the FHR pattern/contractions to evaluate fetal well-being
2 types of monitoring: Internal vs. External
Contraction monitor at top of fundus
Always check that you are tracing baby (moms pulse vs reading)
External Internal
intermittent Continuous **Can only be continuous!!
Low risk, early labor, active labor, ** have to have rupture of membranes (ROM)
non-medicated, no preeclampsia (treated - Internal monitors placed by physician or
rupture with medications – CNM
Assess fetal HR Pitocin or Internal assessment of contractions & FHR
- Handheld magnesium), higher Done because external monitoring is not
doppler risk pregnancies, adequate
- Ultrasound twins
stethoscope Assess contractions: Done when labor is not progressing, for accurate
- Fetoscope Tocotransducer dosage of Pitocin
Assess before/during/ - Frequency
after a contraction in - Duration Intrauterine pressure catheter (IUPC)
labor - NOT intensity assesses contractions
- Use palpation Assess fetal HR: - Catheter sits between uterine wall and
to assess for Ultrasound doppler fetus, connects to monitor
contraction - Baseline - Strength expressed as Montevideo units
Seen a lot with - Variability (MVU)
midwife care - Presence of - Assess intensity (strength) of contraction
accelerations Only way to determine the
or strength/intensity of a contraction, and
deceleration external monitor cannot
Of every 15 minutes, Fetal scalp electrode (FSE)
we take 10 minutes assesses FHR
and document - Spiral electrode placed into fetal
contractions vs fetal presenting part
HR - Cable from electrode to monitor
Risks: bleeding, hematoma, infection,
Caution in patients (mom) with HIV
Monitor strip basics
, Top line Bottom line Vertical line
FHR tracing Uterine contraction tracing Time (10 seconds)
*The intervals between vertical lines represents one minute
Fetal Heart Rate Uterine Contractions
FHR baseline Frequency
Variability Intensity
Presence of accelerations and decelerations - Mild = nose
- Moderate = chin
- Strong = forehead
Duration
- Visual representation of the FHR and the maternal contraction pattern
- Information about fetal oxygenation & changes in FHR
- FHR pattern changes can indicate fetal hypoxemia – the most common etiology of fetal
injury/death
- Optimal fetal surveillance during labor to detect FHR changes combined with early interventions
can help prevent fetal injury/death
Normal baseline 110 – 160 bpm
- Assess over 10 minutes to determine baseline (at least 2 minutes of identifiable baseline –
otherwise baseline may be indeterminate)
- Round to nearest 5 bpm
Bradycardia Tachycardia
Less than 110 bpm Over 160 bpm
Causes: late fetal hypoxemia, maternal Causes: maternal fever (most common), early
hypotension (may be from epidural), uterine fetal hypoxemia, maternal dehydration
rupture, placental abruption, medication
(opioids), maternal supine position Intervention: requires additional assessment to
determine cause – fluids
Can come from prolonged deceleration, only fix Fever = temperature check, Tylenol, cold
is delivery compress, increase fluids
**mother will receive fluids before epidural to
prevent hypotension and bradycardia in the
fetus, if persists can give more fluids and/or epi
Intervention: Increase placental perfusion,
decrease uterine activity, correct hypotension
(position)
Variability – the push pull between the sympathetic and parasympathetic nervous system
*Absent, minimal, moderate, marked*
- The most important predictor of adequate fetal oxygenation and fetal reserve during labor
- Absent – no “push – pull”
- Minimal – baby may not be awake, so less variability. Could be from pain medications (mg,
staidol)
- Moderate variability indicates well developed and well oxygenated autonomic and CNS
o Good sign on fetal well-being
- Marked – goes over 25 bpm, not a huge deal but don’t like this too much
