FHR - antepartum units?

nursejohio, ASN, RN · Mar 21, 2008

We have a 24 bed ante unit, staffed with their own set of nurses. L&D nurses can get floated to them, and they can be pulled to the high-risk obs area of L&D. They don't do continuous on the unit, ever. Depending on the dx and ega docs will order doptones, 20-30 minutes strips or NSTs every 4, 8, 12 or daily.

Seems silly to order continuous monitoring on pts who are in for something completely unrelated to labor/pregnancy. Those poor women are gonna be in for a few days-weeks and the docs really think it's good for them to be woken up a million times a night to adjust the u/s?!?!?!?!

We always do a 24-48 hr stay in our perinatal ICU (with ivf, cont. efm and toco) for the ptl, r/o pre-e, pprom, and anything else that can affect baby really. Once the docs decide she's stable, she goes down the hall to ante and stays there until dc or delivery.

ABQLNDRN · Mar 22, 2008

Holy smokes that's a lot of monitoring! We do FHRs q shift and PRN, NSTs once or twice a day. If the patient needs continuous monitoring, they are transported to L&D. Also, L&D nurses do not staff our antepartum unit. We are our own entity. :)

BirthCenterRN · Mar 23, 2008

I work on a unit where we have one unit. Everyone that is 20weeks and up is admitted to our unit. We have a variety of monitoring based on MD preference and reason for admission. The most common are...

1. Continuous (usually only for PTL or an issue with baby if bay looks ok we may due continuous toco and spot check FHR with an NST at one of the intervals below.

2. NST q4

3. NST q8

4. NST qd

5. 2 out of every four hours

Now given this info...it never seems that we can get the meds, vitals, and labs to match with the monitoring. Basically the patients get awaken often anyway:(

allthingsbright · Mar 23, 2008

On our APU unit we do some continuous, some NST and some 20min strips q shift or 2x shift--we monitor based on admitting dx and adjust as things change! It makes life so much easier...

Best wishes!

HappyNurse2005, RN · Mar 23, 2008

We are a labor & delivery and antepartum unit together, staffed by same nurses, both in close proximity to the OR. The rooms are separated a bit. the unit is shaped like a P, with the labor and delivery on the round part of the P, antepartum on the leg of the P.

We get everything here, and often transfers from other places-aka really sick ladies sometimes, 20 weeks or more. Less than 20 if it is a IUFD.

Anyhoo, less than 23 weeks is just FHT q shift or qday.

MOst are continuous on admission, no matter what the reason. PTL, pre-eclamptic often stay on continuous. pprom and ptl are occasionally changed to BID or qshift (tid) depending on severity. Have one lady who's been on continuous monitoring for over 2 weeks straight.

Then it depends. we have diabetics with blood sugar issues, chronic pain, post appy, seizures, neuro, drug abuse/withdrawal, etc etc etc and their monitoring is dependent on them.

The most fun is twins on continuous monitoring!

WOrking nights, it certainly isn't fun to readjust monitors all night, but you gotta do what you gotta do.

Elvish, BSN, DNP, RN, NP · Mar 24, 2008

While pts are in L/D they are on continuous EFM if they're in for a high-risk pregnancy reason (vs. being in low-risk normal labor).

Once they are deemed stable enough to be transferred to the floor (antepartum mixed in c GYN & mother baby where I am), it just depends on the reason for their being there how often we monitor.

Everybody gets FHTs qshift. NSTs vary from twice weekly (someone who is high risk but has proven themselves to be very very stable, and no ROM) to TID. Most of the time it's qd or BID. If someone has ROM, they get q4 temps. And, of course, we have standing orders to do EFM/toco any time something changes.

Interesting to see how different places do it.