Fetal Basics of Electronical Fetal Monitoring (Nursing)

00:01 So this is what the graph actually looks like.

00:04 What you'll notice is there are actually two graphs on this piece of paper.

00:08 The top graph measures fetal heart rate, so the actual number; and the bottom graph is going to be where we record the contractions.

00:17 So now we're going to go through each of these graphs and talk about the axis and what we're actually recording were.

00:25 So this again is a representation of the graph in the very top of the last picture.

00:30 This measures fetal heart rate in beats per minute.

00:34 If you look at the vertical axis, what you're actually going to see are numbers.

00:39 They go from 30 all the way up to 240 and they represent fetal heart rate.

00:44 On the horizontal axis, this represents time and it's measured in seconds, so if you see the little peach box at the very bottom, you'll see that it covers one box.

00:55 That box is equivalent to ten seconds of time.

00:59 If we put six of those boxes together, guess what it equals? Exactly, one minute.

01:06 Now what's really great about this monitor is that you can actually see the two dark lines that in between that space represents a minute, so if the nurse or the health care provider is standing all the way across the room, they can actually look at the fetal monitoring strips and really get some information about fetal heart rate without being right on top of the computer, so that's 10 seconds in 1 box, and 6 boxes make 1 minute of time.

01:32 Now, remember the fetal heart rate range in terms of being normal.

01:37 The range is 110 beats per minute all the way to 160 beats a minute and this is represented by the blue box that you will see here on the vertical axis.

01:47 You'll see that it goes from 110 to a 160 beats, that's a normal fetal heart rate, so anywhere within that range is going to be considered good and normal.

01:58 So now we understand the reference of time.

02:02 We also understand the reference of heart rate.

02:06 So let's try to put all of this together in a real strip to see what it looks like.

02:11 Here we go. So now, we again, have the two graphs, the upper graph showing the fetal heart rate, and the bottom graph showing the contractions.

02:20 We're going to talk about what those hills at the bottom mean, but let's go back to the graph on the top.

02:26 Do you see that sort of blue area that's highlighted? Remember in the previous slide we used that to show the normal fetal heart rate, so we can see that all the way across the room, that mostly, the line across the top, is within that blue range, so we already know that we have a heart rate that's within the normal rate.

02:46 The next thing I want to call your attention to, again, are those dark lines, do you see them? That represents one minute, so again, you can see, what the heart rate is over time without standing right next to the computer.

03:00 So let's talk about what's happening with the line in between those dark lines, you see it moving.

03:06 So what you're actually seeing is the continuation of the change in the heart rate over time, so as I stand here, my heart rate is 78, 72, 82 or it was a 102 when I started recording this lecture today, but it changes and so the graph is actually connecting all those dots to give us this picture.

03:28 So now we can determine what the fetal heart rate is by drawing a line through those data points and getting an average of that.

03:37 So, from what I'm seeing on this graph right now, we would determine this heart rate to be about 145 beats a minute.

03:45 Now, what I want to do is not try to figure out what that average is in the middle of a contraction.

03:51 Those contractions are represented by the hills at the bottom, because if you were to squeeze me, my heart rate would change and that does not give me a baseline rate.

04:00 I'm going to look in-between those contractions to figure out the average.

04:04 So again, the average on this tracing is 145 beats a minute which is between a 110 and a 160, so it's completely normal.

04:16 Now, let's get to the bottom graph.

04:18 So what you see are contractions, so let's look a little bit more close at that.

04:24 So we're back on the bottom graph now and you'll see that the numbers on the vertical axis have changed.

04:30 They go from 0 all the way to 12, so we're going to ignore that part of the graph, we're going to look at the second part that goes from 0 to 75, that is measurements in millimeters of mercury.

04:43 This is going to tell us something about the strength of the contraction.

04:47 Now if you notice those same dark lines are still present, so they still measure the same thing at the top graph, so this is time, and each one of those little boxes still equal 10 seconds and 6 boxes together still equals a minute, so the only thing that's changed on the bottom graph is the measurement of strength of the contraction.

05:07 Now we're going to move to putting all this information together to begin to interpret fetal monitoring strips.

05:14 Now the terminology we used is not arbitrary.

05:17 It was actually the result of a group that came together called the National Institute of Child Health and Human Development and they sat down and really worked through all of this to come up with universal definitions for the terms, so I'm not just picking this for me, these are terms that are used all across the country and in some places in the world.

05:36 So we want to commit those to memory and that will help us quite a bit.

05:41 As we talk about fetal monitoring, we want to keep in mind that the patterns that are created are gestationally dependent, so that means that a strip for a baby that is 32 weeks may look very different from a baby that's 38 weeks.

05:55 We also know that the status of the mother could change the fetal heart rate tracing as well, so knowing that information about the maternal history is going to matter in interpreting the fetal monitor strip.

06:08 Information that we have about the fetus, use of medications or other factors may play into what happens on that fetal monitor strip, so knowing your patient's history will make a big difference in what you do with this information.

06:22 Now, we tend to use fetal heart rate tracing in intrapartum, so when the patient's in the hospital and we're going to talk about that mostly today, but know that the fetal monitor can actually be used on the patient in the antepartum setting.

06:36 So in the outpatient clinic or in the doctor, midwife, or nurse practitioners office, we can actually take the fetal monitor there and do the very same thing.

06:46 We don't do it often, but it is possible so I want to bring that to your attention.