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• Knowledge
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• You can’t apply what you don't know, but you have to be able to apply what you do

know.

- Go with majority: if something is 75% fatal, consider it fatal.

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Lecture 11 Fetal Heart Monitoring Fetal Monitoring Patterns During Labor and Delivery

• There are 7 fetal monitoring patterns you should know.
• Low Fetal Heart Rate (a fetal heart rate under 110)
• A fetal heart rate under 110 is BAD
• When the fetal monitor registers a fetal heart rate below 110 do LION

- L: Lay the mother on her Left side

- I: Increase IV fluids

- O: Apply oxygen

- N: Notify physician

• If Pitocin is running stop it immediately, then perform LION
• High Fetal Heart Rate (a fetal heart rate over 160)
• A fetal heart rate over 160 is no big deal, document.
• Take moms temperature. (Most likely has a fever)
• Low Baseline Variability (the baby’s heart rate remains relatively constant)
• A fetal heart rate that does not change frequently is BAD
• When the fetal heart rate does not vary do LION.

- L: Lay the mother on her Left side

- I: Increase IV fluids

- O: Apply oxygen

- N: Notify physician

• High Baseline Variability (the baby’s heart rate is constantly changing)
• When the babies heart rate is constantly changing that's good, document This study source was downloaded by 100000796901680 from CourseHero.com on 03-26-2021 18:19:15 GMT -05:00

https://www.coursehero.com/file/26890340/Lectures-11-Fetal-Heart-Monitoring-During-Labor-and-Delivery-docx/ This study resource was shared via CourseHero.com

5. Late Decelerations:

• Late deceleration refers to the baby’s heart rate decelerating (slowing

down) near or at the end of a contraction. This is BAD.

• If a fetal heart rate is showing late decelerations do LION.

- L: Lay the mother on her Left side

- I: Increase IV fluids

- O: Apply oxygen

- N: Notify physician

6. Early Decelerations:

• Early deceleration refers to the baby’s heart rate decelerating (slowing

down) before or at the beginning of a contraction.

• This is normal, document.

7. Variable Decelerations:

• Variable deceleration is when the baby’s heart rate decelerates (slows

down) and varies in duration, intensity, and uterine contractions.

• This is VERY BAD, this means prolapsed cord.
• Stick hand in mother’s vagina and push the baby’s head up.
• Position her in keen chest (hands and knees), with hand still on

baby’s head

• Rush to the operating room in this position for an emergency

cesarean section

• The fetal monitor heart rate patterns that start with “L” are bad and you do “LION”
• The fetal monitor heart rate patterns that don't start with “L” are normal

occurrences, document and continue monitoring.

• A fetal monitor heart rate that shows Variable deceleration is VERY BAD, this

means prolapsed cord.

• VEEL CHOP table for fetal heart rate monitoring.

C H OP

V (variable)Chord compression E (early deceleration) Head compression A (Acceleration) Okay (normal) L (late deceleration) Placental insufficiency Delivery of the Baby

• First you deliver the head.
• Suction the mouth and then nose. (While the body is still in the birth canal) This study source was downloaded by 100000796901680 from CourseHero.com on 03-26-2021 18:19:15 GMT -05:00

https://www.coursehero.com/file/26890340/Lectures-11-Fetal-Heart-Monitoring-During-Labor-and-Delivery-docx/ This study resource was shared via CourseHero.com

• Check for a Nuchal cord (when the umbilical cord is wrapped around the

neck.

• Main goal is to prevent cord compression.
• Then you deliver the body.
• The baby must have an ID band on before it leaves the delivery area.

Delivery of the Placenta

• First, make sure the placenta is all there.
• Second, check for a 3-vessel cord.
• 2 Arteries
• 1 vein

Recovery

• The first 2 hours after the delivery of the placenta.
• There are 4 things you do, 4 times and hour (every 15 minutes), in the 4

th stage.

1. Monitor vital signs for shock:

• Low blood pressures
• Increased heart rate
• Pale, cold, and clammy

2. Check the fundus:

• If the fundus is boggy (soft) you massage it.
• If the fundus is displaced (not midline) you catheterize.

3. Check the perineal pads:

• If she is bleeding excessively she will 100 % saturate a pad in less than 15

minutes.

• Give her a new pad.

4. Roll her over:

• Check for bleeding underneath of her.
• It’s possible for a pad to be half saturated but leaking underneath her.

Post-partum

- Post-partum assessment:

• Assessed every 4 to 8 hours depending on her condition (stable/unstable)
• What you are assessing is “BUBBLE head” This study source was downloaded by 100000796901680 from CourseHero.com on 03-26-2021 18:19:15 GMT -05:00

https://www.coursehero.com/file/26890340/Lectures-11-Fetal-Heart-Monitoring-During-Labor-and-Delivery-docx/ This study resource was shared via CourseHero.com

- BUBBLE HEAD:

- B: stands for Breasts

• U: Uterine Fundus: (important)
• Boggy you massage the fundus (should be firm)
• Displaced you catheterize them
• Height related to belly button
• Height relates to day postpartum. Measured from 1 – 6. Day 1

postpartum at 1, day 2 postpartum 2, day 3 postpartum 3, etc.

- B: Bladder

- B: Bowels

• L: Lochia (Important): Discharge from vagina after childbirth.

- Rubra: comes first, it is a red discharge

• 4 – 6 inches on a pad in 1 hour is normal, saturated in 15

minutes is bad

- Serosa: comes second, it is a pink discharge

• 4 – 6 inches on a pad in 1 hour is normal, saturated in 15

minutes is bad

- Alba: comes last, it is a white discharge

• 4 – 6 inches on a pad in 1 hour is normal, saturated in 15

minutes is bad

- E: Episiotomy

• An incision made on the posterior of the vagina to aid a baby stuck in

the birth canal

- H: Hemoglobin and hematocrit

- E: Extremity check (important)

• Checking for thrombophlebitis. Check for equal bilateral calf sizes.

- A: Affect (emotions)

- D: Discomforts

Variations in the Newborn

- Normal findings:

- Erythema toxicum neonatorum: A common red rash on various parts of the

newborn.

- Caput succedaneum: swelling, or edema, of the newborns scalp soon after

delivery. Appears as a lump or bump on the newborns head from prolonged pressure on the head during labor.

• The swelling crosses sutures and is symmetrical

- Cephalohematoma: a hematoma that occurs underneath the skin of the

newborns skull. Does not pose any risk to the newborn.

• The swelling does not cross sutures and is not symmetrical

- Hyperbillirubin anemia (Physiological jaundice): occurs after 24 hours. The

baby turns yellow because they cannot metabolize the remaining RBC from the mother. This study source was downloaded by 100000796901680 from CourseHero.com on 03-26-2021 18:19:15 GMT -05:00 https://www.coursehero.com/file/26890340/Lectures-11-Fetal-Heart-Monitoring-During-Labor-and-Delivery-docx/ This study resource was shared via CourseHero.com