Basic Fetal MonitoringReview
Ana H. Corona, FNP-C
Nursing Instructor
February 2009
Methods of Electronic Fetal Monitoring
External
Noninvasive method
Utilizes an ultrasonic transducer to monitor the fetal heart
Utilizes the tocodynamometer (toco) to monitor uterine contraction pattern
Methods of Electronic Fetal Monitoring
Internal Fetal Monitoring
Invasive
FHR is monitored via a fetal scalp electrode
Uterine activity is monitored by an intrauterine pressure catheter (IUPC)
A combination of external and internal fetal monitoring is common practice
Fetal Heart Monitoring Tracing
How Do Uterine Contractions Affect Fetal Heart Rate? 
Can affect FHR by increasing or decreasing the rate in association with any given contraction. 
3 primary mechanisms by which UCs can cause a decrease in FHR
         Fetal head
         Umbilical cord
         Uterine myometrial vessels
Examples of Periodic Changes
Variable decelerations: Result from some type of cord compression.
Nuchal cord, True knot
Decreased amniotic fluid
Early Deceleration
Occur as a result of vagal stimulation to the fetal head during contractions which push the fetal head toward the pelvis.
Late Decelerations
Occur in response to uteroplacental insufficiency. (blood flow to the fetus is compromised and there is less oxygen available to the fetus)
Late Decelerations with Absent Variability
Note the smoothness of the FHR pattern
Decreased FHR caused by uteroplacental insufficiency
Compromised blood flow to fetus

Example Prolonged Deceleration
Note the duration of the deceleration lasts more than 2 minutes.
Example Accelerations
Note the increase from the fetal heart baseline

Sinusoidal Pattern
Persistent wave variation of the baseline only seen in about 2% of patients.
Related to severe fetal anemia, hypoxia, or acidosis.
Segments of Contractions
Increment: Beginning, building of pressure
Acme: Most intense part of the contraction
Decrement: Diminishing of the contraction
Rest: Period of time between contractions
Variable decelerations in FHR during labor are severe dips occurring at the peak of contraction. This FHR problem is associated with which one of the following conditions?
Utero-placental insufficiency
Fetal head compression
Uterine insufficiency
Pressure on the umbilical cord
Answer is D
These decelerations are common during labor.
The FHR drops during the contraction resulting from stimulation from chemoreceptors and baroreceptors as the cord is compressed.
The nurse should recognize these readings on the fetal monitor as normal.
A nurse is caring for a client in labor and is monitoring the FHR patterns. The nurse notes the presence of episodic accelerations on the electronic fetal monitor tracing. Which of the following actions is most appropriate?
Document the findings and tell the mother that the monitor indicates fetal well-being
Take the mothers vital signs and tell the mother that bed rest is required to conserve oxygen.
Notify the physician of the findings.
Reposition the mother and check the monitor for changes in the fetal tracing
Answer is 1
Accelerations are transient increases in the fetal heart rate that often accompany contractions or are caused by fetal movement.
Episodic accelerations are thought to be a sign of fetal-well being and adequate oxygen reserve.
A nurse is admitting a pregnant client to the labor room and attaches an external electronic fetal monitor to the client’s abdomen. After attachment of the monitor, the initial nursing assessment is which of the following?
Identifying the types of accelerations
Assessing the baseline fetal heart rate
Determining the frequency of the contractions
Determining the intensity of the contractions
Answer is 2
Assessing the baseline fetal heart rate is important so that abnormal variations of the baseline rate will be identified if they occur.
Options 1 and 3 are important to assess, but not as the first priority.
A nurse is monitoring a client in labor. The nurse suspects umbilical cord compression if which of the following is noted on the external monitor tracing during a contraction?
Early decelerations
Variable decelerations
Late decelerations
Short-term variability
Answer is 2
Variable decelerations occur if the umbilical cord becomes compressed, thus reducing blood flow between the placenta and the fetus.
Early decelerations result from pressure on the fetal head during a contraction.
Late decelerations are an suggests utero-placental insufficiency during a contraction.
Short-term variability refers to the beat-to-beat range in the fetal heart rate.
The physician asks the nurse the frequency of a laboring client’s contractions. The nurse assesses the client’s contractions by timing from the beginning of one contraction:
Until the time it is completely over
To the end of a second contraction
To the beginning of the next contraction
Until the time that the uterus becomes very firm
Answer is 3
This is the way to determine the frequency of the contractions
When monitoring the FHR of a client in labor, the nurse identifies an elevation of 15 beats above the baseline rate of 135 beats per minute lasting for 15 seconds. This should be documented as:
An acceleration
An early elevation
A sonographic motion
A tachycardic heart rate
Answer is 1
An acceleration is an abrupt elevation above the baseline of 15 beats per minute for 15 seconds; if the acceleration persists for more than 10 minutes it is considered a change in baseline rate.
A tachycardic FHR is above 160 beats per minute.
Which of the following findings meets the criteria of a reassuring FHR pattern?
FHR does not change as a result of fetal activity
Average baseline rate ranges between 100 - 140 BPM
Mild late deceleration patterns occur with some contractions
Variability averages between 6 - 10 BPM
Answer is 4
Variability indicates a well oxygenated fetus with a functioning autonomic nervous system.
FHR should accelerate with fetal movement.
Baseline range for the FHR is 120 to 160 beats per minute.
Late deceleration patterns are never reassuring, though early and mild variable decelerations are expected, reassuring findings.
References
AWHONN Clinical Position Statement
P. Burroughs, MSN, RN
Martin, E.J., (2002) Intrapartum Management Modules: A Perinatal Education Program. (pp 119-123). Lippincott Williams & Wilkins 3rd Edition.
Simpson, I., & Creehan, P. (2001) Perinatal Nursing 2nd Edition, (pp 379-383). Philadelphia, New York, Baltimore, Lippincott.

Default Design
Basic Fetal MonitoringReview
Ana H. Corona, FNP-C
Nursing Instructor
February 2009
Methods of Electronic Fetal Monitoring
External
Noninvasive method
Utilizes an ultrasonic transducer to monitor the fetal heart
Utilizes the tocodynamometer (toco) to monitor uterine contraction pattern
Methods of Electronic Fetal Monitoring
Internal Fetal Monitoring
Invasive
FHR is monitored via a fetal scalp electrode
Uterine activity is monitored by an intrauterine pressure catheter (IUPC)
A combination of external and internal fetal monitoring is common practice
Fetal Heart Monitoring Tracing
How Do Uterine Contractions Affect Fetal Heart Rate? 
Can affect FHR by increasing or decreasing the rate in association with any given contraction. 
3 primary mechanisms by which UCs can cause a decrease in FHR
         Fetal head
         Umbilical cord
         Uterine myometrial vessels
Examples of Periodic Changes
Variable decelerations: Result from some type of cord compression.
Nuchal cord, True knot
Decreased amniotic fluid
Early Deceleration
Occur as a result of vagal stimulation to the fetal head during contractions which push the fetal head toward the pelvis.
Late Decelerations
Occur in response to uteroplacental insufficiency. (blood flow to the fetus is compromised and there is less oxygen available to the fetus)
Late Decelerations with Absent Variability
Note the smoothness of the FHR pattern
Decreased FHR caused by uteroplacental insufficiency
Compromised blood flow to fetus

Example Prolonged Deceleration
Note the duration of the deceleration lasts more than 2 minutes.
Example Accelerations
Note the increase from the fetal heart baseline

Sinusoid

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