Fetal Monitoring During Labor and Delivery

Fetal Monitoring During Labor and Delivery


1) Periodic auscultation - per minute basis


2) FHR - baseline without contraction should be 120-160 bpm. Baseline variability is dependent on fetal sleep wake states, medications, hypoxia. Marked acceleration (more than 180 bpm) may be related to prematurity, maternal fever, hypoxia, fetal infection, and drugs.


3) External Monitoring:

a. External Mode

• Tocotransducer - pressure-sensing device applied to maternal abdomen to monitor frequency and duration of contraction
• Ultrasound Transducer - continous monitor of FHR, which can be interpreted in relation to contraction
• Phonotransducer and abdominal electrodes - fetal electrocardiogram

b. Internal Mode

• Spiral electrode - applied to fetal presenting part; provides continuous measurement of FHR, baseline variability, and periodic changes
• Intrauterine catheter - pressure transducer inserted beyond presenting part; measures frequency, duration, and intensity of contractions

4) Fetal scalp sampling - a small sample of fetal blood is taken from a punctured wound made into the fetal scalp to test for the presence of fetal acidosis.
- Laboratory analysis of fetal pH is done; Normal value ranges from 7.25 to 7.35. A reported value of 7.20 or below means fetal acidosis.


Stress Test or OCT
Stress Test or OCT determines fetal well being and fetal ability to withstand stress of labor, done for abnormal NST or at risk fetus assesses placental function.
Monitoring requires indirect fetal external monitor, and positioning is fowler's position; same as NST but with the use of oxytocin.
Baseline and frequent maternal BP readings are taken, test takes 1-3 hours with close monitoring until there's contractions.

RESULTS:

1. Negative (normal) - absence of late decelarations of FHR with each of 3 contractions: negative window
2. Positive (abnormal) - presence of late decelarations of FHR with 3 contractions during 10-minute period: positive window
3. Equivocal or suspicious - absence of positive or negative window
4. Unsatisfactory - inadequate contractions of tracing
5. High risk pregnancies continue with weekly negative test

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