2. Fetal Assessment During Labor
We asses:
1. Amniotic fluid
2. Fetal Heart Rate (FHR):
the primary assessment
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3. 1. Amniotic fluid analysis:
• Amniotic fluid is a clear, colourless
or pale yellow fluid which is found
within the first 12 days following
conception within the amniotic sac.
• It surrounds the growing baby in the
uterus.
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5. 1. Amniotic fluid analysis:
• Amniotic fluid consists of water and baby's
urine.
• It also contains nutrients, hormones, and
antibodies
• It helps protect the baby from bumps and
injury.
• It maintains constant temperature for the
baby.
• It makes the baby moves easier.
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6. 1. Amniotic fluid analysis:
• Amniotic fluid volume increases steadily
throughout pregnancy to a maximum of
400–1200 ml at 34–38 weeks.
• If the levels of amniotic fluid levels are
too low or too high, this can pose a
problem.
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7. 1. Amniotic fluid analysis:
The Amniotic Fluid during Labour:
• Cloudy fluid with foul smell → Infection
• Green Fluid → Fetal Hypoxia due to
meconium (the first stool of the baby)
• Blood streak → Haemorrhage
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8. 2. Fetal Heart Rate (FHR) Monitoring
• Is the measuring of the fetus’s heart rate
during the labor by using a special
instruments.
• Types and methods of fetal heart
monitoring:
i. Intermittent Auscultation
ii. Electronic Fetal Monitoring (EFM)
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i. Intermittent Auscultation Technique:
• Auscultation is a method of listening
to the fetal heartbeat for about 60
seconds by using a fetal stethoscope
(Fetoscope or Pinard), or a hand-held
Doppler ultrasound device.
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• While listening to the heartbeat, the
doctor also palpates the mother’s uterus
by placing a hand on the abdomen to
measure the contractions.
• Intermittent auscultation should be done:
− Every 15-30 minutes during the active
phase of 1st stage,
− Every 5-15 minutes during the pushing
phase of 2nd stage.
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ii. Electronic Fetal Monitoring (EFM)
• EFM is an electronic monitor used to
continuously measures the fetus’s heart
rate and using a pressure sensor to
monitor the mother’s contractions at the
same time.
• There are 2 types of EFM:
1. External monitoring
2. Internal monitoring
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Indications for EFM
• Pregnancy complications (Diabetes, preeclampsia…)
• Pre-term labor.
• Previous caesarean.
• The baby is smaller than expected.
• Multiple fetuses.
• Overweight mother.
• Prolonged 1st stage of labor.
• The amniotic fluid contains significant amounts of
meconium (The baby's first poo).
• Induction of labor.
• A high temperature mother.
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1. External monitoring:
• Measuring the heart rate through an
ultrasound device, and measuring the
contractions by using a pressure sensor;
both devises are held against the
mother's belly with a belt.
• The reading of external monitoring is
affecting by changing position.
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2. Internal monitoring:
• Measure the heart rate through a wire called
(electrode) contains a needle, inserted
through the vagina and cervix, and placed
under the baby's scalp. And measuring the
contractions with a thin tube inserted into the
uterus.
• Internal monitoring can be done only after the
cervix has dilated to at least 2cm and the
amniotic sac has ruptured.
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Contraction Pattern
• Normal contractions:
5 or fewer contractions in 10 minutes
lasting about 60 seconds in the active
phase.
• Contraction intensity:
30 mmHg in early labor to 70 - 90 mmHg
in the second stage.
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Causes of Tachycardia
Tachycardia is a FHR above
160 bpm that lasts for at least
10 minutes
• Mother fever
• Mother and fetus infection
• Mother dehydration
• Mother and fetus anemia
• Fetus hypoxemia
• Fetal tachyarrhythmia
• Fetus cardiac abnormalities
Causes of Bradycardia
Fetal bradycardia is a
baseline FHR of less than 110
bpm that lasts for at least 10
minutes
• Mother Dehydration
• Mother Hypotension
• Rupture of uterus or vasa
previa
• Placental abruption
• Medications such as anesthetics
• Fetal hypoxia
• Late or profound hypoxemia
• Umbilical cord occlusion
• Fetal bradyarrythmias
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Baseline FHR Variability
• The normal fetal heart rate baseline is
from 120 to 160 BPM and has variability
usually with a range of 3-5 bpm from the
baseline.
• The heartbeat will normally go up when
the baby moves or during contractions.
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Baseline FHR Variability
• Characteristics:
1. Undetectable (less than 5 bpm)
2. Minimal (up to 5 bpm)
3. Moderate (6 to 25 bpm)
4. Marked (more than 25 bpm)
Abnormal if lasts
over 60 min.
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Periodic changes
Periodic changes are accelerations or
decelerations in the FHR that are in
relation to uterine contractions and persist
over time.
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Accelerations
• Accelerations are transient increases in the FHR
about (15 bpm) above baseline for about (15 sec. to
less than 2 min.) and then return normally to the
base line.
• Prolonged acceleration: Increase in heart rate lasts
for 2 to 10 minutes.
• The presence of accelerations is a sign of normal
fetus, because they are usually associated with
fetus stimulation, such as fetal movement, vaginal
examinations, and contractions.
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Decelerations
Transitory decrease in the FHR from the
baseline.
1. Early decelerations: the onset and return of a
deceleration is match to the contraction
2. Variable decelerations: variable in the time,
intensity, and duration of a deceleration
3. Late decelerations: the fetal heart rate return
to the baseline after the end of the
contraction
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Management
1. Early decelerations: No intervention is necessary,
just keep watching. It happen due to uterine
contractions.
2. Variable decelerations: Reposition of the mother,
oxygen mask, and stop oxytocin. It happen due to
Umbilical cord occlusion and problems.
3. Late decelerations: Reposition of the mother,
oxygen mask, stop oxytocin, give IV. It happen
due to reduction in O2
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What happens if the fetal heart rate pattern
is abnormal?
• An abnormal fetal heart rate may mean that
the fetus is not getting enough oxygen or that
there are other problems.
• We should first try to find the cause.
• Steps can be taken to help the baby get more
oxygen such as; change the position of the
mother, and giving her an oxygen mask.
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What happens if the fetal heart rate pattern
is abnormal?
• If the procedures do not work, and the
fetus still has a problem, we should
deliver the baby immediately.
• In this case, the delivery of the baby is
more likely to be by cesarean birth or with
forceps or vacuum delivery.