![]() ![]() A transvaginal fetal Doppler probe is now available. However, it may be difficult to perform transabdominally in women who are obese. Other care measures such as ambulation and the use of baths or showers are easier to carry out when IA is used. It is often more comfortable for the woman and gives her more freedom of movement. ![]() IA is easy to use, inexpensive, and less invasive than EFM. When distinct discrepancies in FHR are noted during listening periods, auscultate for longer period during, after, and between contractions to identify significant changes that may indicate need for another mode of FHR monitoring.įHR, Fetal heart rate UA, uterine activity.įrom Miller LA, Miller DA, Tucker SM: Mosby’s pocket guide to fetal monitoring: a multidisciplinary approach, ed 7, St Louis, 2013, Mosby.įig 15-2 A, Ultrasound fetoscope. ![]() Auscultate FHR before, during, and after contraction to identify FHR during the contraction or as a response to the contraction and to assess for absence or presence of increases or decreases in FHR.ħ. Count FHR for 30 to 60 seconds after a uterine contraction to identify auscultated baseline rate and changes (increases or decreases) in it.Ħ. Palpate abdomen for presence or absence of UA to count FHR between contractions.ĥ. Count maternal radial pulse while listening to FHR to differentiate it from fetal rate.Ĥ. If using fetoscope, firm pressure may be needed.ģ. This location is usually over the fetal back. 15-1 and 15-2) over area of maximal intensity and clarity of fetal heart sounds to obtain clearest and loudest sound, which is easiest to count. Apply ultrasonic gel to device if using Doppler ultrasound. Palpate maternal abdomen to identify fetal presentation and position.Ģ. MVUs are used only with internal monitoring of contractions.ĭata from Macones GA, Hankins GD, Spong CY, et al: The 2008 National Institute of Child Health and Human Development Workshop Report on Electronic Fetal Monitoring: update on definitions, interpretation, and research guidelines, J Obstet Gynecol Neonatal Nurs 37(5):510–515, 2008 Miller LA, Miller DA, Tucker SM: Mosby’s pocket guide to fetal monitoring: a multidisciplinary approach, ed 7, St Louis, 2013, Mosby.ġ. Contraction intensities of 40 mm Hg or more and MVUs of 80-120 are generally sufficient to initiate spontaneous labor. MVUs usually range from 100-250 in first stage may rise to 300-400 in the second stage. Relaxation time is commonly 60 seconds or more in first stage and 45 seconds or more in second stage. Contractions palpated as “mild” would likely peak at less than 50 mm Hg if measured internally, whereas contractions palpated as “moderate” or greater would likely peak at 50 mm Hg or greater if measured internally.Īverage resting tone during labor is 10 mm Hg if using palpation, should palpate as “soft” (i.e., easily indented, no palpable resistance). Uterine contractions generally range from peaking at 40-70 mm Hg in first stage of labor to over 80 mm Hg in second stage. A group of fetal monitoring experts recommended that FHR tracings demonstrating certain reassuring characteristics be described as normal (category I) ( Box 15-1).Ĭontraction frequency overall generally ranges from two to five per 10 minutes during labor, with lower frequencies seen in first stage of labor and higher frequencies (up to five contractions in 10 minutes) seen during second stage of labor.Ĭontraction duration remains fairly stable throughout first and second stages, ranging from 45-80 seconds, not generally exceeding 90 seconds.
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