MOSBY's® Pocket Guide to Fetal Monitoring (Nursing Pocket Guides)

1 Physiologic Basis for Electronic Fetal Monitoring
Transfer of Oxygen From the Environment to the Fetus
External Environment
Maternal Lungs
Maternal Blood
Maternal Heart
Maternal Vasculature
Uterus
Placenta
Intervillous Space Pao2
Intervillous Space Blood Flow
Chorionic Villous Surface Area
Diffusion Across the “Blood-Blood” Barrier
Interruption of Placental Blood Vessels
Summary of Placental Causes of Disrupted Oxygenation
Fetal Blood
Umbilical Cord
Fetal Response to Interrupted Oxygen Transfer
Mechanisms of Injury
Injury Threshold
Summary

2 Methods and Instrumentation
Intermittent Auscultation of the Fetal Heart Rate
Description
Leopold's Maneuver
Utilization of Intermittent Auscultation
Procedure for Intermittent Auscultation
Frequency of Intermittent Auscultation
Interpretation of Auscultated Fetal Heart Rate
Benefits and Limitations of Auscultation
Electronic Fetal Monitoring
Overview
Converting Raw Data Into a Visual Display of Fetal Heart Rate
External Mode of Monitoring
Ultrasound Transducer
Tocotransducer
Advantages and Limitations of External Transducers
Internal Mode of Monitoring
Fetal Spiral Electrode
Contraindications
Intrauterine Pressure Catheter
Contraindications
Advantages and Limitations of Internal Monitoring
Display of Fetal Heart Rate, Uterine Activity, and Other Information
Monitor Tracing Scale
Monitoring Multiple Gestations
Offset Feature
Systematic Labeling Parameters
Fetal Heart Rate Artifact and Detection
Signal Ambiguity (Coincidence) With Maternal Heart Rate
Telemetry
Electronic Fetal Monitoring Troubleshooting
Selected Troubleshooting Actions
Computerized Perinatal Data Systems
Clinical Decision Support
Computer Decision Analysis of the Fetal Heart Rate
Summary

3 Evaluation and Management of Uterine Activity
Assessment Methods: Palpation and Electronic Monitoring
Manual Palpation
Electronic Monitoring of Uterine Activity
Electronic Display of Uterine Activity
Normal Labor Parameters
Defining Adequate Uterine Activity
Defining Excessive Uterine Activity
Common Underlying Causes of Excessive Uterine Activity
Corrective Measures to Decrease Excessive Uterine Activity
Labor Support and Management
Latent-Phase Abnormalities
Management Strategies for Latent-Phase Disorders
Active-Phase Abnormalities
Management Strategies for Active-Phase Disorders
Second-Stage Abnormalities
Uterine Activity and Oxytocin Use
Summary

4 Fetal Heart Rate Pattern Recognition and Interpretation
The Evolution of Standardized FHR Definitions
The 2008 National Institute of Child Health and Human Development Consensus Report
Evidence-Based Interpretation of Fetal Heart Rate Patterns
National Institute of Child Health and Human Development Definitions: General Considerations
Five Essential Components of a Fetal Heart Rate Tracing
Definitions, Physiology, and Interpretation of Specific Fetal Heart Rate Patterns
Baseline Rate
Categories of Baseline Rate
Tachycardia
Bradycardia
Baseline Fetal Heart Rate Variability
Categories of Baseline Variability
Absent Variability
Minimal Variability
Moderate Variability
Marked Variability
Periodic and Episodic Fetal Heart Rate Patterns
Acceleration
Decelerations
Types of Decelerations
Early Deceleration
Late Deceleration
Variable Deceleration
Prolonged Deceleration
Fetal Cardiac Arrythmias
Terms and Concepts Not Supported by Evidence or Consensus
Wandering Baseline
Lambda Pattern
Shoulder
Checkmark Pattern
End-Stage Bradycardia and Terminal Bradycardia
Uniform Accelerations
Variable Deceleration Terminology
Variable Deceleration With a Late Component
Mild, Moderate, and Severe Variable Decelerations
V-Shaped Variables and W-Shaped Variable Decelerations
Variability Within a Deceleration
Other Mechanisms That Lack Scientific Basis
Summary

5 Intrapartum Management of the Fetal Heart Rate Tracing
Fundamental Principles
Standard of Care
Confirm Fetal Heart Rate and Uterine Activity
Evaluate Fetal Heart Rate Components
A Standardized “ABCD” Approach to Fetal Heart Rate Management
A: Assess the Oxygen Pathway and Consider Other Causes of Fetal Heart Rate Changes
B: Begin Corrective Measures as Indicated
C: Clear Obstacles to Rapid Delivery
D: Delivery Plan
Expectant Management Versus Delivery
Other Methods of Fetal Monitoring
Intrapartum Fetal Scalp pH and Lactate Determination
Fetal Scalp Stimulation and Vibroacoustic Stimulation
Computer Analysis of Fetal Heart Rate
Umbilical Cord Blood Gas Analysis
Summary

6 Influence of Gestational Age on Fetal Heart Rate
The Preterm Fetus
Physiologic Principles in the Preterm Fetus
Preterm Fetal Heart Rate
Preterm Baseline Variability
Preterm Accelerations
Prostaglandin Synthase Inhibitors
Calcium Channel Blocker
Beta-Adrenergic Receptor Agonists
Fetal Neuroprotection
Monitoring the Preterm Fetus
The Late-Term and Postterm Fetus
Risks Associated With Postterm Pregnancy
Summary

7 Fetal Assessment in Nonobstetric Settings
Pregnancy Anatomy and Physiology
Obstetric Patients in the Emergency Department
Emergency Medical Treatment and Active Labor Act
Pregnant Trauma Victim Assessment and Care
Prehospital Care
In-Hospital Care
Traumatic Cardiac Arrest and Resuscitative Cesarean Delivery
Stabilization and Discharge
Nonobstetric Surgical Procedures: Maternal-Fetal Assessment and Care
Intraoperative Fetal Surveillance
Fundamentals of Nonobstetric Surgery
A Culture of Patient Safety
Summary

8 Antepartum Fetal Testing
Comparing Antepartum Testing Methods
Methods of Testing
Contraction Stress Test and Oxytocin Challenge Test
Nonstress Test
Doppler Velocimetry of Maternal and Fetal Blood Vessels
Biophysical Profile
The Modified Biophysical Profile
Fetal Movement Counts
Amniocentesis
Biochemical Assessment for Fetal Lung Maturity
Summary

9 Patient Safety and Risk Management
Risk Management
The Decision-Making Process in Electronic Fetal Monitoring and Intermittent Auscultation
Understanding Liability Claims
Components of Care: Assessment, Communication, and Documentation
Liability in Fetal Monitoring
Summary

10 Fetal Monitoring Documentation
Electronic Health Records
The Clear Concept
Standardized Terminology
Intermittent Auscultation Documentation
Electronic Fetal Monitoring Documentation
Documentation of Uterine Activity
Appropriate Use of Fetal Heart Rate and Uterine Activity Terminology
Electronic Fetal Monitoring Assessment and Documentation Frequency
Location of Nursing Assessment and Documentation
Late Entry
Frequent Documentation Questions
Three-Tier Fetal Heart Rate Categories
Reassuring and Nonreassuring Terminology
Quantification of Decelerations
Patterns That Do Not Meet Standardized Definitions
Montevideo Units
Chain of Communication (Chain of Command)
Electronic Fetal Monitoring Documentation Guidance
Summary

11 Obstetric Models of Care and International Fetal Surveillance Concepts
Obstetric Continuity of Care Models
Midwifery Model of Care
Physician Model of Care
Interprofessional and Intraprofessional Models of Care
Birth Setting
Electronic Fetal Monitoring: Cardiotocography
International Intermittent Auscultation and Cardiotocography Guidelines
Guidelines for Terminology and Interpretation
Methods of Determining Fetal Acid-Base Status
Fetal Blood Sampling
Criteria and Procedure
pH and Lactate Results
Umbilical Cord Gas Analysis
ST Analysis of the Fetal Electrocardiogram
Criteria and Procedure
Role of ST Analysis in Contemporary Practice
Summary

APPENDIX A: Intrapartum Amnioinfusion
Potential Indications for Intrapartum Amnioinfusion
Potential Amnioinfusion Risks
Contraindications for Amnioinfusion
Equipment and Supplies
Procedure
Preprocedure
Procedure
Patient Care

APPENDIX B: Fetal Heart Rate Tracings Review
Key for Appendix B Fetal Heart Rate Tracings

APPENDIX C: Self-Assessment
Answer Key for Self-Assessment
Index