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Fetal Heart Rate

NORMAL

Accelerations present

Moderate variability

110-160 bpm

Utero-Placental Sufficiency

Placenta

During labor, there is an interruption of blood flow.

This is normally tolerated well.

Long stong contractions(normally occuring or medication caused)

Umbilical Cord

Changes in blood flow

Compression

Stretch

Physical

Psychological

Increase in norepinephrine and epinephrine

Blood flow to vital organs-less oxygen being delivered to uterus

Common causes

Rise in mothers temperature

Drugs: scopalomine, atropine,

phenothiazines, terbutaline,

ritodrine, or epinephrinein

Less common causes

fetal hyperthyroidism, fetal

anemia, fetal heart failure, and

fetal tachyarrhythmias, fetal

infection

Tachycardia with other signs of reassuring heart patterns-baby is most likely oxygenated.

Tachycardia with other signs of fetal distress-may have oxygen deprivation.

Normal variant-90-120

Make sure that it's not the mother's heart rate

Common Causes

Hypothermia

Drugs-magnesium may cause hypothermia

Complete heart block in infant(makes monitoring of fetal heart rate useless as the brain does not comunicate with the heart.

Hypoglycemia

Sever oxygen deprivation

difference in the heart rate from beat to beat

Sympathetic-increases heart rate

Parasympathetic-decreases heart rate

Moderate

6-25 bpm

Minimal

Causes

Severe oxygen deprivation

Baby's sleep cycles

CNS depression

fetal anomalies or previous damage to the fetal brain

lower gestational age

Marked

> 25 bpm

Absent

Undetectable from baseline

Heart Rate Patterns

Accelerations

Presence

Absence

Other concerning patterns present-50% are hypoxic

Other reassuring patterns-rarely indicates hypoxia

Early Decelerations

Gradual decrease of the fetal heart rate. From the onset to the nadir, it is > or = 30 bpm.

The nadir of the deceleration occurs at the same time as the peak of the contraction.

It is thought that these are caused by the cervix overriding the front fontanel of the baby's head.

This causes an altered cerebral blood flow, with a subsequent slowing of the fhr due to the vagal reflex.

It usually occurs between 4-6cm dilation.

It is not an indication of hypoxia.

Late Decelerations

Tachycardia

Bradycardia

Changes in Baseline

< or = 5 bpm

Variability

Moderate variability indicates the absence of severe hypoxia, but should be evaluated in context.

Hypotension

Mom on back pressing artery

Epidural

Diseases that cause poor perfusion

Hypertension

Pre-eclampsia

Collagen Vascular Disease

Diabetic Vasculopahty

Prolonged pregnancy

Problems

Hemorrage

Placenta previa

Placental abruption

Stress

Prolonged Decelerations

Decrease is > or = 15bpm and is between 2-10 min.

These look much like early decelerations, but they begin after the peak of the contraction.

Variable Decelerations

Sinusoidal Patterns

Abrupt increase(<30 sec) in the FHR above baseline. Acme is > or = 15bpm and lasts > or = to 15 sec. It lasts between 15 sec and 2 min. before returning to baseline. Almost all are in respone to fetal movement.

Almost always rules out hypoxia

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