[Animaniacs]

This is for my class assignment. I would like to know the ongoing assessment of the fetus in the active phase of labor with the expected normal findings?

The textbook mainly describes monitoring fetal heart rate q15-30 min, noting any significant deviation from baseline.

Advice is appreciated.

[SmilingBluEyes]

This would depend on variables, such as risk factors in pregnancy. In low risk cases, intermittent monitoring/dopplering is all that is warranted and is typical. In HIGH risk pregnancies (or ones where there is anesthesia ongoing) the assessment does include continuous monitoring and documention of fetal heart tones and variances. You also document what you do about problems such as decelerations (position changes, oxygen therapy, intravenous hydration etc.)
How specifically can we help? I would like to help you but I am unsure the specifics of what you need.

One thing to note is if we practice in the USA, we are held to AWHONN standards.

www.awhonn.org

hope this helps.

[Animaniacs]

yeah, the question seems very vague for the assignment. the instructor asks for the "assessment of the fetus in the active phase" and the "expected findings". i am assuming that means the normal findings you would expect in a normal low risk pregnancy? such as, what should the FHR be in one minute? what are the normal changes of the FHR during the stage 1: active phase of labor? is it normal for FHR to increase over the baseline intermittenly? i guess stuff like that mainly. the expected normal findings while doing assessment

[SmilingBluEyes]

yeah, the question seems very vague for the assignment. the instructor asks for the "assessment of the fetus in the active phase" and the "expected findings".


i am assuming that means the normal findings you would expect in a normal low risk pregnancy? such as, what should the FHR be in one minute?

Normal FHR's are 110-160 with accelerations of 15-20 BPM above baseline.
"abnormal" may show decelerations, especially those occuring AFTER a contraction (late). In the presence of these, the baby is telling us he/she is stressed for some reason----lack of sufficient oxygenation too much uterine contraction and too little resting time, poor maternal health/conditions; the reasons vary and are many. The interventions are to provide supplemental oxygen by mask, IV hydration, position changes (to relieve cord compression) and turning off pitocin or giving Brethine to slow uterine stimulation. Always appropriate to notify the doctor or midwife if these decelerations persist.

what are the normal changes of the FHR during the stage 1: active phase of labor? It is normal to see "early" decelerations, ones the occur right before or at the beginning of a uterine contraction, but always END PRIOR to the end of the contraction. These indicate head compression and a normal vagal response by the fetus to this, as the head decends. There is no necessary intervention for these, except to continue to observe the FHR pattern and fetal response to labor. Variable decelerations are v-shaped deep drops in heart rate that almost mirror the contraction in pattern. These are often due to cord compression/position changes---often, too you see these when there is a "nuchal" cord (cord around the neck). These are to be watched carefully, and can sometimes be alleviated or mitigated a bit by maternal position changes or hydration. Watch for them to worsen or get longer, or for the baseline heartrate to change. If this does, it indicates the fetus is stressing a bit, and warrants notification of the health care provider.

is it normal for FHR to increase over the baseline intermittenly? YES! Accelerations are healthy. But a steady increase of baseline that does not go back down may indicate maternal fever or fetal condition changes. Periodic accelerations are a healthy sign of well being in the fetal nervous system and a normal healthy condition in labor. INTERMITTENTLY is your key word here. YES "intermittently" ---rises in fetal heart rate are normal, expected findings in healthy fetuses.

i guess stuff like that mainly. the expected normal findings while doing assessment[/quote]

Hope this helps!