Table of Contents
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Preface |
ix |
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Reviewers |
x |
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SECTION
ONE |
THEORETICAL
BASIS FOR FETAL HEART MONITORING |
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Chapter 1 |
Intrapartum Fetal Monitoring: a Historical
Perspective Patricia
Robin McCartney |
3 |
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Introduction |
3 |
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History of
Fetal Heart Rate Surveillance |
3 |
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Fetal Heart Rate |
3 |
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Uterine Activity |
5 |
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Electronic
Fetal Monitoring (EFM) |
6 |
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Technology and
Intrapartal Nursing Practice |
6 |
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Adjunct
Surveillance Methods |
7 |
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Evidence for FHR
Assessment |
10 |
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Standardization
and Professional Guidelines |
12 |
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Standardized Language, Controversy, and Consensus |
13 |
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Professional Guidelines |
15 |
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Fetal
Monitoring Education |
15 |
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Development of
FHM Education |
15 |
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Competence Validation and Certification |
16 |
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Instruction and
Evaluation Methods |
16 |
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Development of
the Awhonn Fetal Heart Monitoring Program |
16 |
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The Nursing
Process and the Fetal Heart Monitoring Program |
18 |
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References |
18 |
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Chapter 2 |
Physiologic Basis for Fetal
Monitoring Nancy O’Brien-Abel |
21 |
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Physiology
Underlying Extrinsic Influences on the FHR |
21 |
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Maternal-Fetal
Exchange |
21 |
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Placenta |
21 |
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Maternal Uteroplacental Circulation |
22 |
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Fetal-Placentat
Circulation |
23 |
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Placental
Transfer |
23 |
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Maternal Oxygen
Transport Physiology |
23 |
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Oxygen Content |
24 |
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Oxygen Affinity |
26 |
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Oxygen Delivery |
27 |
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Oxygen Consumption |
28 |
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Uterine Blood
Flow |
28 |
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Umbilical Cord |
29 |
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Amniotic Fluid |
30 |
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Physiology
Underlying Intrinsic Influences on the FHR |
30 |
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Fetal
Circulation |
30 |
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Oxygen
Transport to Fetal Tissue |
32 |
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Fetal Heart
Rate Control |
34 |
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Parasympathetic
Nervous System |
34 |
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Sympathetic
Nervous System |
36 |
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Baroreceptors |
37 |
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Chemoreceptors |
37 |
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Hormonal
Influences |
38 |
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FHR and Cardiac
Output |
38 |
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Fetal State
Patterns |
39 |
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Fetal
Homeostatic Responses |
40 |
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References |
41 |
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SECTION
TWO |
MATERNAL-FETAL
ASSESSMENT |
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Chapter 3 |
Maternal-Fetal
Assessment Dodi
Gauthier |
45 |
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Introduction to
Maternal-Fetal Assessment |
45 |
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Prenatal Records |
45 |
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Interviews |
45 |
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Historical Data |
47 |
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Demographic Factors |
47 |
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Socioeconomic Factors |
47 |
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Medical and Surgical History |
47 |
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Obstetric History |
49 |
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Current and Past |
49 |
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Gestational Age
Assessment |
51 |
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Fetal Activity |
52 |
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Leopold’s
Maneuvers |
52 |
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Psychosocial Assessment |
52 |
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Physical
Examination |
54 |
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Clinical Assessment of Maternal Vital Signs |
54 |
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Maternal
Height, Weight, and Weight Gain |
54 |
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Uterine Activity |
55 |
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Membrane Status |
55 |
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Vaginal Examination |
57 |
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Vaginal
Bleeding or Discharge |
57 |
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Cervical
Examination |
58 |
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Biochemical Assessment |
59 |
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Laboratory
Values |
59 |
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Group B Streptococcus Prevention and Prophylaxis |
60 |
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Infectious
Disease Evaluation |
60 |
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Fetal Assessment |
60 |
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Antenatal Assessment |
61 |
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Method of Fetal
Monitoring |
61 |
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Summary |
62 |
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References |
62 |
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Chapter 4 |
Techniques for Fetal Heart
Assessment Karen M. Harmon |
65 |
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Introduction |
.65 |
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Auscultation |
65 |
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Auscultation as Compared with EFM |
65 |
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Auscultation Devices |
66 |
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Benefits and Limitations of Auscultation |
67 |
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Auscultation Procedure |
67 |
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Auscultation Technique |
68 |
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Listening and Counting |
68 |
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Frequency of
Auscultation |
70 |
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What Cannot be
Assessed via Intermittent Auscultation? |
70 |
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Interpreting
Auscultated FHR Characteristics |
71 |
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Clinical
Management |
72 |
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Staffing Issues
and IA |
72 |
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Palpation |
74 |
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Palpation
Technique |
74 |
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Electronic
Fetal Heart Rate Monitoring |
75 |
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Doppler Ultrasound |
75 |
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Second-Generation
Monitors and Autocorrelation |
76 |
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Maternal or
Fetal Heart Rate? |
76 |
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Artifact |
78 |
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Fetal Spiral
Electrode |
78 |
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ST-Segment
Analysis |
80 |
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Overview |
80 |
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ST-Segment Pathophysiology |
81 |
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Future Research and Implications for Practice |
82 |
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Electronic
Uterine Activity Monitoring |
82 |
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Tocodynamometer (Toco Transducer) |
82 |
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Intrauterine
Pressure Catheter |
85 |
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Friedman Curve |
87 |
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Fluid-Filled Intrauterine Pressure Catheter |
90 |
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Transducer-Tipped
Intrauterine Pressure Catheters |
90 |
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Air-Coupled Intrauterine Pressure Catheters (Sensor-Tipped) |
91 |
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Transducer-Tipped versus Sensor-Tipped? |
91 |
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Monitor Tracing
Issues |
92 |
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Intrapartum Fetal Surveillance Technology and the Nurse’s Role |
92 |
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Patient
Education |
92 |
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Labor Support |
93 |
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Institutional
Policies |
93 |
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Professional
Education Regarding Monitoring Methods |
93 |
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Future Research |
94 |
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Summary |
94 |
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References |
94 |
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FETAL
MONITORING: DIAGNOSIS AND INTERVENTION |
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Chapter 5 |
Fetal Heart Rate
Interpretation Audrey
Lyndon, |
101 |
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Introduction |
101 |
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Assumptions of the NICHD Terminology |
102 |
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Definitions of Terms |
104 |
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Systematic Assessment of FHR Data |
104 |
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Characteristics
of the FHR and Uterine Activity |
106 |
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Baseline Fetal
Heart Rate |
106 |
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Tachycardia |
107 |
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Bradycardia |
107 |
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Baseline Fetal Heart Rate Variability |
109 |
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Moderate
Variability |
109 |
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Alterations in
Fetal Heart Rate Variability |
109 |
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Minimal
Variability |
109 |
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Absent
Variability |
111 |
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Marked
Variability |
111 |
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Periodic and Episodic Changes |
112 |
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Accelerations |
112 |
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Decreases in
Fetal Heart Rate |
113 |
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Decelerations |
113 |
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Early
Decelerations |
113 |
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Late
Decelerations |
114 |
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Variable
Decelerations |
116 |
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Prolonged
Decelerations |
117 |
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Quantification
of Decelerations |
118 |
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Uterine Activity |
120 |
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Unusual Fetal
Heart Rate Characteristics |
122 |
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Sinusoidal Heart Rate Pattern |
122 |
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Fetal
Arrhythmias |
123 |
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Interpretation
of Electronic Fetal Monitoring Findings Across the Continuum |
124 |
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Electronic FHR Patterns and Fetal Acid-Base Status |
124 |
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Evolution of FHR
Patterns Over Time |
126 |
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Interpretation
of Intermittent Auscultation Findings Across the Continuum |
129 |
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Summary |
130 |
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References |
130 |
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Chapter 6 |
Physiologic Interventions for
Fetal Heart Rate Patterns Kathleen Rice Simpson |
135 |
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Promoting Fetal
Well-Being |
135 |
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Classification
of Electronically Obtained Fetal Heart Rate Patterns |
135 |
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Systematic
Interpretation of the Fetal Heart Rate Tracing |
137 |
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Interventions
for Category II and III Fetal Heart Rate Patterns |
138 |
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Intrauterine Resuscitation Techniques |
138 |
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Lateral
Positioning or Change in Position |
139 |
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Reduction of
Uterine Activity |
140 |
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Intravenous
Fluid Administration |
143 |
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Oxygen
Administration |
144 |
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Interventions
for Anesthesia–Related Hypotension |
146 |
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Amnioinfusion |
146 |
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|
Modification of
Maternal Pushing Efforts during Second-Stage Labor |
147 |
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Interventions
to Support Coping and Labor Progress |
150 |
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Summary |
150 |
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References |
152 |
|
Chapter 7 |
Assessment of Fetal Oxygenation
and Acid-Base Status Rebecca
L. Cypher |
157 |
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Fetal Acid-Base
Balance: Key Concepts |
157 |
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Terminology |
158 |
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Physiologic and Pathophysiobgic Factors Affecting Intrapartum Acid-Base Assessment |
158 |
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|
Fetal
Oxygenation and Acid-Base Assessment |
161 |
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Indirect Methods of Acid-Base Assessment during the Intrapartum Period |
161 |
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Fetal Scalp
Stimulation |
161 |
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Vibroacoustic
Stimulation |
161 |
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Entrapartum Use
of Vibroacoustic Stimulation |
162 |
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Safety |
163 |
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Fetal Pulse
Oximetry |
163 |
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|
The Critical
Threshold |
164 |
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Current Status
of Fetal Pulse Oximetry Technology |
164 |
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|
Direct Methods
of Acid–Base Assessment |
164 |
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|
Fetal Scalp
Sampling |
165 |
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|
Contraindications |
165 |
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Factors and
Limitations that Affect Fetal Scalp Sampling |
165 |
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Interpretation
of Results from Fetal Scalp Sampling |
165 |
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Umbilical Cord Blood Sampling |
166 |
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Indications and
Contraindications |
166 |
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Factors
Affecting Sampling and Interpretation of Results |
168 |
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Interpretation
of Umbilical Cord Blood Acid-Base Values |
168 |
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Summary |
169 |
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References |
170 |
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SECTION
FOUR |
APPLICATION
OF FETAL HEART MONITORING DATA |
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|
Chapter 8 |
Communication of Fetal Heart
Monitoring Information Kathleen
Rice Simpson and G. Eric Knox |
177 |
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Purpose and
Significance |
177 |
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|
Communication
Among Professional Colleagues |
177 |
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Nurse to
Primary Health Care Provider Communication |
178 |
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|
Handoff
Communications |
182 |
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|
Strategies for
Successful Communication Among Professional Colleagues |
184 |
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|
Common Expectations and Standardized Definitions of Fetal Heart Rate
Patterns |
184 |
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|
Joint Nurse–Midwife–Physician Education Regarding Fetal Assessment |
185 |
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|
Communication
with Pregnant Women and their Families or Support Persons |
186 |
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|
Medical Record
Documentation |
186 |
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|
Overview |
186 |
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Decreasing Liability Exposure Related to Documentation |
187 |
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|
Flow Sheets and Narrative Notes |
189 |
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|
Fetal Heart Rate and Uterine Activity Assessment and Documentation |
198 |
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|
Evaluating the Quality of Medical Record Documentation |
202 |
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|
Risk Management and Communication of Fetal Heart Monitoring
Information |
202 |
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|
Effective
Conflict Management |
204 |
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|
Chain of
Command or Authority |
205 |
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|
Summary |
206 |
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|
References |
207 |
|
Chapter 9 |
Intermediate Fetal Heart
Monitoring Course Skills Station Linda Usher An |
211 |
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Overview |
211 |
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Leopold’s
Maneuvers |
211 |
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Objectives |
211 |
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Principles of Leopold’s Maneuvers |
212 |
|
|
Steps in Skill Performance |
212 |
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Criteria for
Passing |
214 |
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Auscultation of
the Fetal Heart |
214 |
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|
Objectives |
214 |
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Principles of Auscultation |
214 |
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Steps in Skill Performance |
214 |
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|
Criteria for
Passing |
215 |
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|
FSE and IUPC
Placement |
215 |
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Objectives |
215 |
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|
Principles of FSE and IUPC Placement |
215 |
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Steps in Skill Performance |
216 |
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FSE Placement |
216 |
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IUPC Placement |
217 |
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Criteria for
Passing |
219 |
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Integration of
Fetal Heart Monitoring Knowledgeand Practice |
219 |
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Objectives |
219 |
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Principles for Integrating FHR Monitor Data into Practice |
219 |
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Steps in Skill Performance |
220 |
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Criterion for Passing |
220 |
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Communication
of Fetal Heart, Monitoring Data |
220 |
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Objectives |
220 |
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Principles of
Communication |
221 |
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Steps in Skill
Performance |
221 |
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Communication
with the Primary Health Care Provider |
221 |
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Communication
with the Woman in Labor and Her Support Person(s) |
222 |
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Communication
with Another Clinician |
222 |
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Guidelines for
Recording Fetal Heart Monitoring Information |
222 |
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Criteria for Passing |
222 |
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Chapter 10 |
Case Study
Exercises Rebecca L. Cypher |
223 |
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Objectives |
223 |
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Case Study
Exercise A: Skylar |
225 |
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Case Study
Exercise B: Margaret |
228 |
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Case Study
Exercise C: Susan |
232 |
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Case Study
Exercise D: Lori |
236 |
|
SECTION
FIVE |
ADVANCED
FETAL HEART MONITORING PRINCIPLES AND PRACTICES |
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|
Chapter 11 |
Antenatal Fetal Assessment and
Testing Catharine M. Treanor |
241 |
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|
Introduction |
241 |
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|
Fetal
Antepartum Surveillance Methods |
242 |
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|
Fetal Movement
Detection |
243 |
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|
Development of Fetal Gross Body Movements |
243 |
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|
Fetal Movement Counting |
243 |
|
|
Factors Influencing Fetal Movement |
244 |
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|
Doppler-Detected Fetal Movement |
245 |
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|
Nonstress Test |
246 |
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|
Physiology of the Nonstress Test |
246 |
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|
Clinical Application of the Nonstress Test |
247 |
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|
Test Procedure and Interpretation |
247 |
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|
Variable Decelerations during a Nonstress Test |
248 |
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|
Efficacy of Nonstress Tests |
249 |
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|
Fetal
Stimulation |
250 |
|
|
Vibroacoustic Stimulation |
250 |
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|
Test Procedure and Interpretation |
251 |
|
|
Contraction
Stress Test and the Oxytocin Challenge Test |
251 |
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|
Clinical Application of the Contraction Stress Test |
252 |
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Uterine Contractions |
252 |
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Test Procedure |
252 |
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Interpretation |
253 |
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|
Efficacy of the Contraction Stress Test |
253 |
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|
Fetal
Biophysical Profile |
253 |
|
|
Clinical Application of the Biophysical Profile |
256 |
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Test Procedure and Interpretation |
257 |
|
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Efficacy of the Biophysical Profile |
258 |
|
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Nursing Role in Biophysical Profile Testing |
258 |
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|
Modified Biophysical Profile |
259 |
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|
Doppler
Ultrasound Velocimetry of the Umbilical Artery |
259 |
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|
Summary |
260 |
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|
References |
261 |
|
Chapter 12 |
Fetal
Arrhythmias Joanne D. Barnes |
267 |
|
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Introduction |
267 |
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|
Definition |
267 |
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Fetal Cardiac
Development and Function |
268 |
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Cardiac Development |
268 |
|
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Differences Between Fetal and Adult Cardiac Functioning |
268 |
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Cardiac Physiology |
269 |
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Etiologies of
Fetal Rhythm Disturbances |
271 |
|
|
Diagnosis of
Fetal Arrhythmias |
271 |
|
|
Fetal Echocardiogram |
271 |
|
|
Fetal Magnetocardiography |
271 |
|
|
M-Mode Echocg |
271 |
|
|
Pulsed Doppler Echocg |
272 |
|
|
More Common
Clinically Significant Fetal Arrhythmias |
272 |
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|
Tachyarrhythmias: Sinus Tachycardia and SVT |
272 |
|
|
Sinus
Tachycardia |
272 |
|
|
Interventions |
273 |
|
|
Supraventricular
Tachycardia |
273 |
|
|
Treatment |
275 |
|
|
Bradyarrhythmias: Sinus Bradycardia and
Atrioventricular Blocks |
276 |
|
|
Sinus
Bradycardia |
276 |
|
|
Interventions |
276 |
|
|
Atrioventricular
Blocks |
276 |
|
|
Treatment |
279 |
|
|
Less Common
Fetal Arrhythmias |
279 |
|
|
Atrial
Arrhythmias |
279 |
|
|
Premature
Atrial Contractions |
279 |
|
|
Atrial Flutter |
281 |
|
|
Atrial
Fibrillation |
282 |
|
|
Treatment of
Atrial Flutter and Fibrillation |
282 |
|
|
Premature
Ventricular Contractions |
282 |
|
|
Consequences of
Fetal Arrhythmias |
282 |
|
|
Treatment Issues |
284 |
|
|
Prognosis |
289 |
|
|
Summary |
289 |
|
|
References |
289 |
|
Chapter 13 |
Advanced Case Study
Exercises Rebecca L. Cypher |
293 |
|
|
Objectives |
293 |
|
|
Case Study
Exercise A: Mary |
295 |
|
|
Case Study
Exercise B: Eleanor |
299 |
|
|
Case Study
Exercise C: |
304 |
|
|
Case Study
Exercise D: Ruth |
309 |
|
|
Case Study
Exercise D2: Ruth |
313 |
|
|
Glossary of Key Terms |
315 |
|
|
Index |
323 |
|
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