I spent a great deal of time learning to the read an EKG, but once I understood the dynamics, I loved to use my skills in EKG Interpretation. When I set out to understand Fetal Monitoring Interpretation the dynamics were so different. This learned skill was difficult, but once understood, I loved to use my skills in Fetal Monitoring Interpretation.
To read a fetal heart monitor you have 2 graphs to understand that needs to be interpreted in conjunction. The upper graph records the fetal responses and the lower graph records the uterine contractions. You then learn how the correlation of uterine contractions affects the infant’s heart rate.
The infant’s heart rate increases and decreases ever so slightly at all times – this is a “good thing.” It is referred to as variability. No variability is a “bad thing” and too much variability is a “bad thing.”
The infant’s heart rate can go to fast which is a “bad thing” or to slow which is a “bad thing.”
The infant can have brief periods of heart accelerations which is a “good thing” or he can have brief periods of decelerations which is a “bad thing.”
The infant can have deep decelerations in conjunction with uterine contractions which is a “bad thing” and can indicate cord compression. These deep declarations are called variables not to be confused with variability.
Decelerations can occur late in the contraction which is a “bad thing” and indicates placental insufficiency.
Contractions increase over the course of labor and indicate progression of labor. This is a “good thing. They increase in intensity and durations. This is a “good thing.”
To record the fetal heart rate and uterine contractions we can do this noninvasively or invasively.
Noninvasively requires the nurse to palpate and auscultate. The nurse must use her hands and ears.
Invasively requires intrauterine catheters. One for the fetus called fetal spiral electrode and one for the uterus called an intrauterine catheter.
Now the fun begins – to interpret these findings. More fun happens when we figure out why these changes occur. An understanding of the fetal oxygen transport system and the maternal oxygen transport system gives us an understanding of these occurrences.
Stop and take a break and have a VEAL CHOP for lunch.
V = variable and may indicate C = cord compression
E = early decal and may be indicate H = head compression
A = accelerations and is O = OK
L = late decel’s may indicate P= placental insufficiency
Did you enjoy your lunch?
Antenatal testing is done to determine acute changes or chronic changes. This is done by:
- Fetal heart kicks – the number of kicks in a period of time
- Non-stress testing – without stimulation
- Contraction stress testing – with induced contractions
- Vibroacoustic stimulation testing – to determine fetal response
- The Biophysical Profile which determines fetal movement, fetal tone, fetal breathing and the amniotic fluid volume
Are you up to Intermediate Fetal Heart Monitoring?