{"id":126,"date":"2020-08-12T20:33:03","date_gmt":"2020-08-12T20:33:03","guid":{"rendered":"https:\/\/brooksidepress.org\/basic_obgyn\/?page_id=126"},"modified":"2021-05-09T20:42:12","modified_gmt":"2021-05-09T20:42:12","slug":"26-intrapartum-fetal-surveillance","status":"publish","type":"page","link":"https:\/\/brooksidepress.org\/pa_obgyn\/overview\/26-intrapartum-fetal-surveillance\/","title":{"rendered":"26. Fetal Surveillance"},"content":{"rendered":"<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/pt03jy6T2Mk\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><span data-mce-type=\"bookmark\" style=\"display: inline-block; width: 0px; overflow: hidden; line-height: 0;\" class=\"mce_SELRES_start\">\ufeff<\/span><\/iframe><\/p>\n<p>Duration = 6:34<\/p>\n<input type='hidden' bg_collapse_expand='69e9b581d6a450050371963' value='69e9b581d6a450050371963'><input type='hidden' id='bg-show-more-text-69e9b581d6a450050371963' value='Show Transcript'><input type='hidden' id='bg-show-less-text-69e9b581d6a450050371963' value='Hide Transcript'><button id='bg-showmore-action-69e9b581d6a450050371963' class='bg-showmore-plg-button bg-blue-button  '   style=\" color:#ffffff;\">Show Transcript<\/button><div id='bg-showmore-hidden-69e9b581d6a450050371963' ><\/p>\n<p>00:00<br \/>\nAPGO educational topic number 26<br \/>\n00:02<br \/>\nintrapartum fetal surveillance the goal<br \/>\n00:05<br \/>\nof intrapartum fetal surveillance is to<br \/>\n00:07<br \/>\ndetect events that occur during labor<br \/>\n00:08<br \/>\nthat could compromise fetal oxygenation<br \/>\n00:10<br \/>\nfetal heart rate monitoring is a<br \/>\n00:12<br \/>\nmodality intended to determine if the<br \/>\n00:15<br \/>\nfetus is well oxygenated and will be the<br \/>\n00:16<br \/>\nfocus of this video in the United States<br \/>\n00:19<br \/>\n85% of Labor&#8217;s involve electronic fetal<br \/>\n00:21<br \/>\nheart rate monitoring electronic fetal<br \/>\n00:23<br \/>\nmonitoring may be performed externally<br \/>\n00:25<br \/>\nwith a Doppler device or internally with<br \/>\n00:27<br \/>\na fetal scalp electrode the objectives<br \/>\n00:30<br \/>\nof this video are to describe the<br \/>\n00:31<br \/>\ntechniques of fetal surveillance and to<br \/>\n00:34<br \/>\ninterpret electronic fetal heart rate<br \/>\n00:35<br \/>\nmonitoring here is a fetal heart rate<br \/>\n00:38<br \/>\ntracing the top portion is the fetal<br \/>\n00:40<br \/>\nheart rate and the bottom portion<br \/>\n00:42<br \/>\nrecords uterine contractions the x-axis<br \/>\n00:45<br \/>\nis time and each thicker white line<br \/>\n00:48<br \/>\nsignifies one minute and this blue line<br \/>\n00:50<br \/>\nis fetal heart rate this purple line is<br \/>\n00:53<br \/>\nmaternal heart rate the green line<br \/>\n00:55<br \/>\ndepicts uterine activity and this is a<br \/>\n00:57<br \/>\nuterine contraction it is important to<br \/>\n00:59<br \/>\napproach the interpretation of fetal<br \/>\n01:01<br \/>\nheart rate racing&#8217;s in a systematic and<br \/>\n01:03<br \/>\nstepwise fashion the first step is to<br \/>\n01:05<br \/>\nlook at the baseline a normal baseline<br \/>\n01:08<br \/>\nis between 110 and 160 beats per minute<br \/>\n01:10<br \/>\nfetal bradycardia is when the heart rate<br \/>\n01:12<br \/>\nis less than 110 fetal tachycardia is<br \/>\n01:15<br \/>\nwhen the heart rate is greater than 160<br \/>\n01:17<br \/>\nwe will move next to variability<br \/>\n01:19<br \/>\nvariability is the beat to beat change<br \/>\n01:22<br \/>\nin the fetal heart rate there are four<br \/>\n01:24<br \/>\nterms used to describe variability<br \/>\n01:26<br \/>\nabsent minimal moderate and marked with<br \/>\n01:28<br \/>\nabsent variability there is no variation<br \/>\n01:31<br \/>\nin the fetal heart rate with minimal<br \/>\n01:33<br \/>\nvariability the fetal heart rate varies<br \/>\n01:35<br \/>\nless than five from beat to beat with<br \/>\n01:37<br \/>\nmoderate variability the fetal heart<br \/>\n01:38<br \/>\nrate varies from 6 to 25 from beat to<br \/>\n01:41<br \/>\nbeat and with marked variability the<br \/>\n01:43<br \/>\nfetal heart rate varies greater than 26<br \/>\n01:45<br \/>\nfrom beat to beat moderate variability<br \/>\n01:47<br \/>\nis reassuring moderate variability is a<br \/>\n01:50<br \/>\nreassuring sign that reflects adequate<br \/>\n01:52<br \/>\nfetal oxygenation and normal brain<br \/>\n01:54<br \/>\nfunction here is a fetal heart rate with<br \/>\n01:56<br \/>\nmoderate variability the heart rate<br \/>\n01:58<br \/>\nfluctuates between 6 to 25 beats<br \/>\n02:00<br \/>\ndecreased variability is associated with<br \/>\n02:02<br \/>\nfetal hypoxia acid emia tachycardia or<br \/>\n02:05<br \/>\nfetal CNS and cardiac anomalies drugs<br \/>\n02:08<br \/>\nthat depress the fetal CNS system such<br \/>\n02:11<br \/>\nas morphine or magnesium can also<br \/>\n02:13<br \/>\ndecreased variability decreased<br \/>\n02:15<br \/>\nvariability can also be from a prolonged<br \/>\n02:17<br \/>\nuterine contraction here is a fetal<br \/>\n02:19<br \/>\nheart rate tracing with minimal<br \/>\n02:21<br \/>\nvariability the fetal heart rate<br \/>\n02:22<br \/>\nfluctuates less than five from beat to<br \/>\n02:24<br \/>\nbeat the next step in the assessment of<br \/>\n02:26<br \/>\nfetal heart rate tracing is the<br \/>\n02:28<br \/>\ncharacterization of accelerations and<br \/>\n02:29<br \/>\ndecelerations<br \/>\n02:30<br \/>\nan acceleration is an increase in the<br \/>\n02:32<br \/>\nfetal heart rate from the baseline<br \/>\n02:34<br \/>\ndecelerations are visually apparent<br \/>\n02:36<br \/>\ndecreases in the fetal heart rate this<br \/>\n02:38<br \/>\nclever veal chop acronym can help you<br \/>\n02:41<br \/>\nremember the different types and causes<br \/>\n02:42<br \/>\nof accelerations and decelerations v<br \/>\n02:46<br \/>\nstands for a variable deceleration this<br \/>\n02:48<br \/>\nis when there is an acute fall in the<br \/>\n02:49<br \/>\nfetal heart rate with a rapid downslope<br \/>\n02:52<br \/>\nand a rapid recovery back to baseline<br \/>\n02:54<br \/>\nthey are characteristically variable in<br \/>\n02:56<br \/>\nduration intensity and timing they<br \/>\n02:58<br \/>\nresemble the letter V and may not have<br \/>\n03:00<br \/>\nany specific relationship to uterine<br \/>\n03:02<br \/>\ncontractions v is associated with sea<br \/>\n03:05<br \/>\nvariables are caused by cord compression<br \/>\n03:07<br \/>\neast ants for early deceleration and<br \/>\n03:10<br \/>\nearly deceleration has a slow onset and<br \/>\n03:13<br \/>\na slow recovery that corresponds to the<br \/>\n03:16<br \/>\nstart and end of the contraction E is<br \/>\n03:20<br \/>\nassociated with H early accelerations<br \/>\n03:22<br \/>\nare caused by head compression these are<br \/>\n03:24<br \/>\nfavorable and reassuring when seen on a<br \/>\n03:26<br \/>\nfetal heart tracing a stands for<br \/>\n03:28<br \/>\nacceleration<br \/>\n03:29<br \/>\nthese are transient increases in the<br \/>\n03:31<br \/>\nfetal heart rate they do not have any<br \/>\n03:33<br \/>\nspecific relationship to uterine<br \/>\n03:34<br \/>\ncontractions and an acceleration lasts<br \/>\n03:37<br \/>\nfor more than 15 seconds with an<br \/>\n03:38<br \/>\nincrease of at least 15 beats above the<br \/>\n03:40<br \/>\nbaseline after 32 weeks estimated<br \/>\n03:42<br \/>\ngestational age a is associated with o<br \/>\n03:45<br \/>\nas an OK meaning that the presence of<br \/>\n03:47<br \/>\naccelerations is a reassuring sign of<br \/>\n03:49<br \/>\nfetal well-being l stands for a late<br \/>\n03:52<br \/>\ndeceleration a late deceleration is a<br \/>\n03:54<br \/>\nsymmetric fall and rise in the fetal<br \/>\n03:56<br \/>\nheart rate racing that begins at or<br \/>\n04:01<br \/>\nafter the peak of the uterine<br \/>\n04:02<br \/>\ncontraction has ended the descent and<br \/>\n04:05<br \/>\nreturn are gradual and smooth a pattern<br \/>\n04:09<br \/>\nof persistent late decelerations is non<br \/>\n04:11<br \/>\nreassuring L is associated with pea late<br \/>\n04:14<br \/>\ndecelerations are caused by placental<br \/>\n04:16<br \/>\ninsufficiency<br \/>\n04:17<br \/>\nhere is another fetal heart rate tracing<br \/>\n04:19<br \/>\nand the arrows depict the accelerations<br \/>\n04:21<br \/>\nthe heart rate goes above the baseline<br \/>\n04:23<br \/>\ngreater than 15 beats and lasts more<br \/>\n04:25<br \/>\nthan 15 seconds<br \/>\n04:26<br \/>\nthis fetal heart rate has the<br \/>\n04:27<br \/>\ncharacteristic v-shaped variable<br \/>\n04:29<br \/>\ndeceleration the heart rate goes rapidly<br \/>\n04:31<br \/>\ndown and rapidly back up to baseline<br \/>\n04:34<br \/>\nhere is an early deceleration with a<br \/>\n04:36<br \/>\nslow decrease and a slow increase back<br \/>\n04:38<br \/>\nto baseline and it occurs at the same<br \/>\n04:40<br \/>\ntime as the contraction this late<br \/>\n04:42<br \/>\ndeceleration has the same slow decrease<br \/>\n04:44<br \/>\nand slow increase back to baseline but<br \/>\n04:47<br \/>\nit occurs after the contraction has<br \/>\n04:48<br \/>\noccurred we&#8217;ve now reviewed the steps<br \/>\n04:51<br \/>\nfor fetal heart rate interpretation we<br \/>\n04:53<br \/>\nuse these tools to classify fetal heart<br \/>\n04:55<br \/>\nrate tracings into three categories 1 2<br \/>\n04:58<br \/>\n&amp; 3 category 1 is a tracing that has a<br \/>\n05:01<br \/>\nbaseline rate between 110 to 160 beats<br \/>\n05:03<br \/>\nper minute has moderate baseline<br \/>\n05:05<br \/>\nvariability no late or variable<br \/>\n05:07<br \/>\ndecelerations early decelerations may be<br \/>\n05:09<br \/>\npresent or absent and accelerations may<br \/>\n05:11<br \/>\nbe present or absent here is a category<br \/>\n05:14<br \/>\n1 fetal heart rate racing with a<br \/>\n05:15<br \/>\nbaseline of 130 moderate variability at<br \/>\n05:18<br \/>\na nice acceleration category 3 is a<br \/>\n05:20<br \/>\ntracing that has absent baseline fetal<br \/>\n05:22<br \/>\nheart rate variability and any of the<br \/>\n05:24<br \/>\nfollowing recurrent late decelerations<br \/>\n05:26<br \/>\nrecurrent variable decelerations<br \/>\n05:28<br \/>\nbradycardia or there is a sinusoidal<br \/>\n05:30<br \/>\nwave pattern a sinusoidal pattern is<br \/>\n05:33<br \/>\nvery unusual and is ominous it is<br \/>\n05:35<br \/>\ncharacterized by visually apparent<br \/>\n05:36<br \/>\nsmooth sine wave like undulating<br \/>\n05:38<br \/>\npatterns in the fetal heart rate<br \/>\n05:40<br \/>\nbaseline with a cycle frequency or 3 to<br \/>\n05:42<br \/>\n5 per minute which persists for 20<br \/>\n05:44<br \/>\nminutes or more a sinusoidal pattern<br \/>\n05:46<br \/>\nrequires immediate delivery category 2<br \/>\n05:48<br \/>\ntracings are everything in between<br \/>\n05:50<br \/>\ncategory 1 and 3 here is a category 2<br \/>\n05:53<br \/>\nfetal heart rate tracing there is<br \/>\n05:54<br \/>\nmoderate variability but she is having<br \/>\n05:56<br \/>\nvariable decelerations a category 3<br \/>\n05:59<br \/>\ntracing is an indication for immediate<br \/>\n06:01<br \/>\ndelivery<br \/>\n06:01<br \/>\nthis fetal heart rate tracing<br \/>\n06:03<br \/>\ndemonstrates a category 3 tracing for<br \/>\n06:05<br \/>\nthere is absent fetal heart rate<br \/>\n06:07<br \/>\nvariability and recurrent late<br \/>\n06:08<br \/>\ndecelerations<br \/>\n06:09<br \/>\nthe team should be moving towards<br \/>\n06:10<br \/>\nimmediate delivery this concludes the<br \/>\n06:12<br \/>\naapko video on intrapartum fetal<br \/>\n06:14<br \/>\nsurveillance we reviewed the techniques<br \/>\n06:16<br \/>\nfor fetal surveillance and the steps for<br \/>\n06:18<br \/>\ninterpreting electronic fetal heart rate<br \/>\n06:19<br \/>\nmonitoring<\/p>\n<p><\/div>\n<hr>\n","protected":false},"excerpt":{"rendered":"<p>\ufeff Duration = 6:34<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":46,"menu_order":26,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-126","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/126","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/comments?post=126"}],"version-history":[{"count":2,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/126\/revisions"}],"predecessor-version":[{"id":2832,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/126\/revisions\/2832"}],"up":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/46"}],"wp:attachment":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/media?parent=126"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}