Florida National University Internal Electronic Monitors Brochure Project I need a Brochure presentation.-Teach the mother that is going to be checked by e

Florida National University Internal Electronic Monitors Brochure Project I need a Brochure presentation.-Teach the mother that is going to be checked by electronic fetus monitor what to expect during electronic fetus monitor (the two types of electronic monitor, the external and internal electronic monitor. The electronic monitors are:Fetus scalp monitor (internal monitor) Tocodynameter(Toco) (external fetus monitor.)Iam going to attach a document with the information of the monitors from my Maternity book. 1-Initial Electronic Monitoring: Tocodynameter( toco): 1st electronic monitor
Electronic monitoring is noninvasive, easily applied, and does not require cervical dilatation or
fetal descent before it can be used, so it can be introduced at any time during labor. The
presence and duration of uterine contractions is gained by means of a pressure transducer or
tocodynamometer (toko is Greek for “contraction”) strapped to the woman’s abdomen or held
in place by stockinette (Fig. 15.16).
Place the transducer snugly over the uterine fundus or the area where contractions are most
easily felt. The transducer works to convert the pressure originated by the contraction into an
electronic signal that is then recorded on graph paper.
The FHR is monitored with the use of an ultrasonic sensor or monitor (see Fig. 15.16) also
strapped against a woman’s abdomen at the level of the fetal chest. The small Doppler unit
converts fetal heart movements into audible beeping sounds and also records them on graph
paper.
A woman who is worried something will happen to her child during labor can find it reassuring
to listen to the regular beeping sound of an undistressed fetal heartbeat from a fetal heart
transducer. Many women ask for and can have a short graph tracing to save for their baby
book.
A disadvantage is the woman may feel discomfort from the straps holding the monitors in
place, and the snugness of the sensor head may limit her ability to breathe deeply. If a woman
changes her position (and she should change position often during labor), the sensor often
needs to be repositioned. Remind a woman that the fetal heart signal may stop when she
changes position so she does not think by the silence that her baby’s heart has stopped beating.
Urge women not to lie on their backs for monitoring but to rest on their side, sit in a chair, or
bend forward over the foot of the bed or a birthing ball or rail so the likelihood of supine
hypotension syndrome is not increased.
2 Internal Electronic Monitoring: fetal scalp electrode: 2nd electronic monitor
Internal electronic monitoring is the most precise method for assessing FHR and uterine
contractions. It is most often used to assess whether contractions are strong enough to cause
cervical change in the case of a prolonged labor course. This can be done by wireless telemetry
but is usually managed by a pressure-sensing catheter passed through the vagina after the
membranes have ruptured, and the cervix has dilated to at least 3 cm. It is then passed into the
uterine cavity and alongside the fetus (Fig. 24.2). The end of the catheter extending from the
vagina is attached to a pressure recorder. As each uterine contraction puts pressure on the uterine
contents, the pressure exerted on the catheter is recorded. When contractions are monitored by an
internal pressure gauge in this way, the frequency, duration, baseline strength, and peak strength
of contractions can all be evaluated. Contraction strength is evaluated by the height of the peak
of the contraction on the tracing. Equally important to evaluate is the return of the uterine tone to
baseline strength between contractions. This ensures there is placental filling between
contractions. With contractions during the latent phase of labor, the baseline level is usually less
than 5 mmHg; with active contractions, it is about 12 mmHg. During the second stage of labor,
the baseline may be as high as 20 mmHg. Baseline readings that do not return to 20 mmHg or
less following a contraction suggest uterine hypertonia and a possible compromise of fetal wellbeing. An accurate FHR recording is obtained from a fetal scalp electrode. This type of
monitoring is most useful when babies are difficult to monitor because of maternal habitus or
during abnormal tracings due to FHR decelerations. Once the fetal head is engaged, the electrode
is inserted vaginally and attached to the fetal scalp with a small puncture of the skin. A fetal
electrocardiograph signal is obtained, amplified, and then fed into a cardiotachometer. The
output from the cardiotachometer is recorded on permanent graph paper. Although internal
monitoring produces clear details of fetal heartbeats, it is invasive, carries the risk of uterine
infection, and limits a woman’s movement. It is, therefore, reserved for women whose fetus is at
high risk during labor.
FETAL HEART RATE AND UTERINE CONTRACTION RECORDS
Labor monitors trace both the FHR and the duration and interval of uterine contractions onto
an oscilloscope screen and produce a permanent record on paper rolls (Fig. 15.17). Uterine
contraction information is recorded on the bottom half of the paper, whereas FHR is recorded
on the top half. Time can be calculated by counting the number of bold vertical lines on the
paper (the space between two bold lines represents 60 seconds).
Figure 15.17 A paper strip for recording electronic fetal monitoring data.
Assessing and interpreting FHR patterns involves evaluating three parameters: the baseline
rate, variabilities in the baseline rate, and periodic changes in the rate (acceleration and
deceleration)
The Baseline Fetal Heart Rate
A baseline FHR is determined by analyzing the pace of fetal heartbeats recorded in a minimum
of 2 minutes obtained between contractions. A normal rate is 110 to 160 beats/min.
Variability
FHR variability or the difference between the highest and lowest heart rates shown on a strip is
one of the most reliable indicators of fetal well-being. Variability is reflected on an FHR tracing
as a slight irregularity or “jitter” to the wave. The degree of baseline variability increases (5 to
15 beats/min) when a fetus moves; it slows if a fetus sleeps. If no variability is present, it
indicates the natural pacemaker activity of the fetal heart (effects of the sympathetic and
parasympathetic nervous systems) may be affected. This may occur as a response to narcotics
or barbiturates administered to a woman in labor, but the possibility of fetal hypoxia and
acidosis must also be considered and investigated. Very immature fetuses show diminished
baseline variability because of a reduced nervous system response to stimulation and immature
cardiac node function.
Variability should be recorded as:
• Absent: No amplitude range is detectable.
• Minimal: Amplitude range is detectable but is 5 beats/min or fewer.
• Moderate (normal): Amplitude range is 6 to 25 beats/min.
• Marked: Amplitude range is greater than 25 beats/min.
Other patterns in the baseline rate that can be detected include fetal bradycardia (FHR is lower
than 110 beats/min for 10 minutes) and fetal tachycardia (FHR is faster than 160 beats/min for
a 10-minute period).
Periodic Changes
Periodic changes or fluctuations in FHR occur in response to contractions and fetal movement
and are described in terms of accelerations or decelerations. Periodic changes are short-term
changes in rate other than baseline; they last from a few seconds to 1 or 2 minutes.
Accelerations
Nonperiodic accelerations are temporary normal increases in FHR caused by fetal movement, a
change in maternal position, or administration of an analgesic.
• An acceleration is a visually apparent abrupt increase (onset to peak in less than 30 seconds)
in the FHR.
• At 32 weeks of gestation and beyond, an acceleration has a peak of 15 beats/min or more
above baseline with a duration of 15 seconds or more but less than 2 minutes from onset to
return.
• Before 32 weeks of gestation, an acceleration has a peak of 10 beats/min or more above
baseline, with a duration of 10 seconds or more but less than 2 minutes from onset to return.
• Prolonged acceleration lasts 2 minutes or more but less than 10 minutes in duration.
• If an acceleration lasts 10 minutes or longer, it is a baseline change or a new baseline is
established.
Decelerations
Decelerations are visually apparent, usually symmetrical, periodic decreases in FHR resulting
from pressure on the fetal head during contractions as parasympathetic stimulation in response
to vagal nerve compression brings about a slowing of FHR. Early deceleration follows the
pattern of the contraction, beginning when the contraction begins and ending when the
contraction ends. However, the waveform of the FHR change is the inverse of the contraction
waveform, or the lowest point of the deceleration occurs with the peak of the contraction (a
mirror image of the contraction). The rate rarely falls below 100 beats/min, and it returns
quickly to between 110 and 160 beats/min at the end of the contraction.

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