Chapter 24: INTRAPARTUM ASSESSMENT - transducer is placed on the maternal abdomen at a

site where fetal heart action is best detected. The

Outline: device is held in position by a belt.
Electronic Fetal Monitoring
Other Intrapartum Assessment Techniques
Fetal Distress
Fetal Heart Rate Patterns
Meconium in the Amnionic Fluid
FHR Patterns and Brain Damage Baseline Fetal Heart Activity
Current Recommendations
Intrapartum Surveillance of Uterine Activity  Rate
o NORMAL: 120-160 bpm
ELECTRONIC FETAL MONITORING
o Bradycardia: <110 bpm
I. Internal (Direct) Electronic Monitoring 1. Reassuring- 80 to 120 bpm with good variability
- attaching a bipolar spiral electrode directly to the fetal 2. Nonreassuring- <80 bpm
scalp
- Vaginal body fluids create a saline electrical bridge  Some Causes:
that completes the circuit - Congenital heart block
- Serious fetal compromise
- Maternal hypothermia

o Tachycardia: >160 bpm

 Causes:
- Maternal fever from
chorioamnionitis (Most common)
- Infection
- Fetal compromise
- Cardiac arrhythmias
- Maternal administration of
PARASYMPATHETIC (Atropine)
or SYMPATHOMIMETIC
(Terbutaline) drugs.
 Heart Rate decelerations- key feature to
distinguish fetal compromise in association
with tachycardia

o Wandering Baseline
 baseline rate is unsteady and “wanders”
between 120 and 160 bpm
 suggestive of a neurologically abnormal
fetus

 Beat-to-beat Variability
o Baseline variability
 important index of cardiovascular function
 regulated largely by the autonomic nervous
system
1. Increased variability
- During fetal breathing
- Assoc. with advancing gestation
2. Decreased variability
- defined as 5 or fewer bpm
excursion of the baseline
- Indicating seriously
II. External (Indirect) Electronic Monitoring
compromised fetus
- does not provide the precision of fetal heart rate
- In combination with
measurement afforded by internal monitoring
deceleration= fetal acidemia
- detected through the maternal abdominal wall using
- Assoc. with: Severe maternal
the ultrasound Doppler principle
academia, analgesic drugs,
- unit consists of a transducer that emits ultrasound and
Magnesium Sulfate
a sensor to detect a shift in frequency of the reflected
 Variability is visually quantified as the amplitude
sound
of peak-to-trough in bpm
—Absent: amplitude range undetectable
 —Minimal: amplitude range detectable but $ 5
bpm or fewer
—Moderate (normal): amplitude range 6–25 bpm
—Marked: amplitude range > 25 bpm
 Cardiac Arrhythmia
o Findings include:
 Baseline bradycardia/ tachycardia
 Abrupt baseline spiking (MC)
o Conduction Defects, MC AV block usually in assoc.
with maternal connective tissue diseases
 Sinusoidal Heart Rates
o may be observed with:
 fetal intracranial hemorrhage
 severe fetal asphyxia
 severe fetal anemia
 Rh alloimmunization
 fetomaternal hemorrhage
 twin-twin transfusion syndrome
 vasa previa with bleeding
Periodic Fetal Heart Rate Changes
 Acceleration
- A visually apparent abrupt increase (onset to peak in <
30 sec) in the FHR
- At 32 weeks and beyond, an acceleration has a peak
of 15 bpm or more above baseline, with a duration of
15 sec or more but less than 2 min from onset to return
- Before 32 weeks, an acceleration has a peak of 10
bpm or more above baseline, with a duration of >/= 10
sec but < 2 min from onset to return
- Prolonged acceleration lasts >/= 2 min, but < 10 min
- If an acceleration lasts 10 min, it is a baseline change
- The deceleration is delayed in timing, with the nadir of
the deceleration occurring after the peak of the
contraction
- In most cases the onset, nadir, and recovery of the
deceleration occur after the beginning, peak, and
ending of the contraction, respectively
 Variable deceleration
- Cord Compression Patterns
- MOST COMMON DECELERATION PATTERN
- Visually apparent abrupt decrease in FHR
- An abrupt FHR decrease is defined as from the onset
to the FHR nadir of < 30 sec
- The decrease in FHR is calculated from the onset to
the nadir of the deceleration
- The decrease in FHR is >/= 15 bpm, lasting >/=15 sec,
and < 2 min in duration
- When variable decelerations are associated with
uterine contraction, their onset, depth, and duration
commonly vary with successive uterine contractions
 Prolonged deceleration
- Visually apparent decrease in the FHR below the
baseline
- Decrease in FHR from the baseline that is >/=15 bpm,
lasting >/=2 min but < 10 min in duration
- If a deceleration lasts >/= 10 min, it is a baseline
change
- Epidural, spinal, or paracervical analgesia may induce
prolonged deceleration of the fetal heart rate.
 Sinusoidal pattern
- Visually apparent, smooth, sine wave-line undulating
pattern in FHR baseline with a cycle frequency of 3–5
per minute which persists for 20 min or more
ADDITIONALS:

 Early deceleration
- Head compression
- Visually apparent usually symmetrical gradual
decrease and return of the FHR associated with a
uterine contraction
- A gradual FHR decrease is defined as from the onset
to the FHR nadir of >/= 30 sec
- The decrease in FHR is calculated from the onset to
the nadir of the deceleration
- The nadir of the deceleration occurs at the same time
as the peak of the contraction
- In most cases the onset, nadir, and recovery of the
deceleration are coincident with the beginning, peak,
and ending of the contraction, respectively

 Late deceleration
- Uteroplacental insufficiency
- Visually apparent usually symmetrical gradual
decrease and return of the FHR associated with a
uterine contraction
- A gradual FHR decrease is defined as from the onset
to the FHR nadir of >/= 30 sec
- The decrease in FHR is calculated from the onset to
the nadir of the deceleration
 A typical CTG output for a woman not in labour. A: Fetal heartbeat; B:
Indicator showing movements felt by mother (caused by pressing a button);
C: Fetal movement; D: Uterine contractions

Fin.