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 - The deceleration is delayed in timing, with the nadir of
bpm or fewer the deceleration occurring after the peak of the
—Moderate (normal): amplitude range 6–25 bpm contraction
—Marked: amplitude range > 25 bpm - In most cases the onset, nadir, and recovery of the
deceleration occur after the beginning, peak, and
ending of the contraction, respectively
 Cardiac Arrhythmia
o Findings include:  Variable deceleration
- Cord Compression Patterns
 Baseline bradycardia/ tachycardia
- MOST COMMON DECELERATION PATTERN
 Abrupt baseline spiking (MC)
- Visually apparent abrupt decrease in FHR
o Conduction Defects, MC AV block usually in assoc.
- An abrupt FHR decrease is defined as from the onset
with maternal connective tissue diseases
to the FHR nadir of < 30 sec
- The decrease in FHR is calculated from the onset to
the nadir of the deceleration
 Sinusoidal Heart Rates - The decrease in FHR is >/= 15 bpm, lasting >/=15 sec,
o may be observed with: and < 2 min in duration
 fetal intracranial hemorrhage - When variable decelerations are associated with
 severe fetal asphyxia uterine contraction, their onset, depth, and duration
 severe fetal anemia commonly vary with successive uterine contractions
 Rh alloimmunization
 fetomaternal hemorrhage  Prolonged deceleration
 twin-twin transfusion syndrome - Visually apparent decrease in the FHR below the
 vasa previa with bleeding baseline
- Decrease in FHR from the baseline that is >/=15 bpm,
lasting >/=2 min but < 10 min in duration
Periodic Fetal Heart Rate Changes - If a deceleration lasts >/= 10 min, it is a baseline
change
 Acceleration - Epidural, spinal, or paracervical analgesia may induce
- A visually apparent abrupt increase (onset to peak in < prolonged deceleration of the fetal heart rate.
30 sec) in the FHR
- At 32 weeks and beyond, an acceleration has a peak  Sinusoidal pattern
of 15 bpm or more above baseline, with a duration of - Visually apparent, smooth, sine wave-line undulating
15 sec or more but less than 2 min from onset to return pattern in FHR baseline with a cycle frequency of 3–5
- Before 32 weeks, an acceleration has a peak of 10 per minute which persists for 20 min or more
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
ADDITIONALS:
- If an acceleration lasts 10 min, it is a baseline change

 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.