fetal heart beat

?
why do we auscultate the fetal heart?
- check the wellbeing of the baby
- confirm the fetal heart presence
- recognise and react to any deviations from the norm
1 of 28
what do we use to auscultate the fetal heart?
- pinnard
- sonicaid doppler
- cardiotocograph monitor
2 of 28
what does the IA and the CTG allow for?
- a channel of communication between the baby and the midwife
- in labour listening to the baby is the only form of communication for the baby and the outside world
3 of 28
when and how should we auscultate the fetal heart?
antenatal
- for at least 1 full min
- should be recorded at a single rate
- palpate maternal pulse at the same time to differentiate between the two
- record any accelerations and deaccelerations if heard
4 of 28
when and how should we auscultate the fetal heart
intrapartum ?
- at first contact
- with each assessment for a full min
- immediately after a contraction
- should be recorded at a single rate
- palpate maternal pulse at the same time
- every 15 mins in first stage of labour
- every 5 mins in active second stage
5 of 28
the basics of the fetal heart rate
what should the rate be ?
what should the baseline variability be ?
- the fetal heart rate should be between 110-160bpm
- baseline variability - between 5-25 bpm
6 of 28
what are decelerations classed as?
abrupt decrease in the baseline fetal heart rate of greater than 15bpm for more than 15 seconds
7 of 28
what is fetal tachycardia classed as?

what is fetal bradycardia classed as?
tachycardia -
defined as a baseline heart rate more than 160bpm

bradycardia - defined as a baseline heart rate less than 100 bpm
8 of 28
what is a baseline variability ?

why does it occur?
- this refers to the variation between the fetal heart rate from one beat to the next

- occurs as a result of the interaction between the nervous system, chemoreceptors, baroreceptors and cardiac responsiveness
9 of 28
what can the baseline variability be a good indicator of ?
can be a good indicator of how healthy a fetus is at that particular moment in time

- a healthy fetus will be constantly be reacting to changes in the environment
10 of 28
what are the disadvantages to cardiotocograph monitors for low risk women?
- they can increase the risk of interventions
- do not improve outcomes for the baby
- can do more harm than good
- a healthy fetus is designed to be able to cope with the stress of labour
11 of 28
what are the 4 principles of IIA
- ASSESS the level of care on admission to ensure suitability for IA
- on going assessment of the fetal heart
- clear documentation and evidence throughout
- confidence in IA to detect hypoxia in low risk labours
12 of 28
reasons that might need to use the cardiotocograph monitor
- if the maternal pulse is 120 bpm on 2 occasions 20 mins apart
- raised diastolic blood pressure of 110mmHg or more and a raised systolic blood pressure of 140mmHg or more
- temp 38oc or above on a single reading
13 of 28
what to assess before putting on CTG monitor
DR - define risk - M - movements - C - contractions - Q - quality of care - Br - base rate - A - accelerations - V - variability - D -deaccelerations - O - overall
14 of 28
define the risk
assessment of mother
- pre - eclampsia
- diabetes
- induction of labour
- antepartum haemorrhage
15 of 28
define the risk
to the fetus
- fetal growth restriction
- multiple pregnancy
- reduced fetal movements
- polyhydramnios/ oligohydramnios
16 of 28
what is important to consider when providing care and looking at the fetal heartbeat?
- important not to make a decision about a woman's care in labour on the basis of the CTG findings alone
- take into account the womans preferences and how she is feeling, the progress of labour
17 of 28
what also to take into account when assessing the woman overall
- any signs of vaginal bleeding
- whether there is meconium or blood in the amniotic fluid
- assessment of wellbeing and behaviour
- maternal observations and vital signs
- her report of the babys movements
18 of 28
MOTHERS assessment
- meconium
- oxytocin
- temperature
- hypertension/haemorrhage
- epidural
- rate of progress
- scar?
19 of 28
what is the most critical feature when looking and assessing a partogram ?
- if there increasing baseline fetal heart rate but no deaccelerations this could indicate signs of hypoxia developing and acidosis
20 of 28
what is used to document fetal heart rate?
- a partogram
21 of 28
what are accelerations ?
what are they are sign of ?
- abrupt increase in the baseline fetal heart rate of more than 15bpm for more than 15 seconds

- the presence of accelerations are reassuring
- accelerations alongside uterine contractions is a sign of a healthy fetus
22 of 28
what is a normal variability ?
what does it indicate?
what can it be categorized in?
- between 5-25 bpm
can indicate an intact neurological system in the fetus
- reassuring - 5-25bpm
- non reassuring - less than 5bpm for between 30-35 mins
more than 25 bpm for 15-25 mins
23 of 28
what can reduced variability be caused by?
- fetal sleeping should last no longer than 40 mins
- fetal acidosis (due to hypoxia)
- fetal tachycardia
- drugs eg opiates
- prematurity
- more than 50 mins is abnormal
24 of 28
what can late decelerations indicate ?
what can it cause ?
why does reduced uteroplacental blood flow occur ?
- insufficient blood flow to the uterus and placenta
- this can cause fetal hypoxia and acidocis
- can occur due to maternal hypertension and pre- eclampsia
25 of 28
why do early decelerations occur?
- do to the increase of intercranial pressure which causes increased vaginal tone
26 of 28
why do variable decelerations occur ?
what are they caused by?
- when the woman has a reduced amniotic fluid volume
- usually caused by umbilical cord compression
27 of 28
what conservative measures can be done if there is concern about the wellbeing of the fetus?
- encourage the woman to mobilise and adopt an alternative position avoiding being in a supine position
- offer fluids to the woman
if no improvement consider reducing contraction frequency by reducing oxytocin is being used or offering tocolytic drug
28 of 28

Other cards in this set

Card 2

Front

what do we use to auscultate the fetal heart?

Back

- pinnard
- sonicaid doppler
- cardiotocograph monitor

Card 3

Front

what does the IA and the CTG allow for?

Back

Preview of the front of card 3

Card 4

Front

when and how should we auscultate the fetal heart?
antenatal

Back

Preview of the front of card 4

Card 5

Front

when and how should we auscultate the fetal heart
intrapartum ?

Back

Preview of the front of card 5
View more cards

Comments

No comments have yet been made

Similar All resources:

See all All resources »See all fetal heart beat resources »