Help! ? about fetal monitoring

flbeau · Oct 11, 2009

perhaps due to fetal size? At that gestational age isn't there more room to roam?

Lovelee82 · Oct 11, 2009

perhaps due to fetal size? At that gestational age isn't there more room to roam?

Makes sense. Ill put that in for now and add to it if she needs clarification.

Thanks

babyktchr, BSN, RN · Oct 11, 2009

ok, a 29 weeker that had a c/s. Need more information. Why c/s? Was the patient in labor? What was the indication for a c/s? A 29 weeker can be monitored, and be challenging. At that gestation the accel standard to classify a "reactive NST" is reduced to 10x10 instead of 15x15 (unless the fetus had been monitored previously and porduced a 15x15 accel, then it would be held to the higher standard). These babies do have more room to move and can be difficult to monitor, but not impossible. If there were issues, then you would have no choice then to monitor in some way (either by continuous EFM or aucultation). I would really like to hear more of the circumstances behind this delivery to further assist.

Lovelee82 · Oct 11, 2009

ok, a 29 weeker that had a c/s. Need more information. Why c/s? Was the patient in labor? What was the indication for a c/s? A 29 weeker can be monitored, and be challenging. At that gestation the accel standard to classify a "reactive NST" is reduced to 10x10 instead of 15x15 (unless the fetus had been monitored previously and porduced a 15x15 accel, then it would be held to the higher standard). These babies do have more room to move and can be difficult to monitor, but not impossible. If there were issues, then you would have no choice then to monitor in some way (either by continuous EFM or aucultation). I would really like to hear more of the circumstances behind this delivery to further assist.

its hard without my notebook but I beleive it was because of the decreased varilability on the strip that we did get. We had her on the monitor for about 20mins and then took her off. She was having small contractions with some late decels I believe. Ultrasound also showed possible abruption which is what was determined after the c-section.

CEG · Oct 11, 2009

Due to the immature neurological system a 29 week baby would not meet the same criteria as a term baby. It cn also be hard to continuously monitor these babies because of their size. Also, realistically speaking the c-section was already happening so what would be changed by monitoring? Although it may not have been standard practice or even good practice when I was an RN we didn't tend to waste time monitoring in the OR for a stat or emergent c-section. If you are already doing a stat or emergency c-section you are presumably already anticipating a compromised baby and working as quickly as possible. Working to get the baby on the monitor would slow down the process.

Lovelee82 · Oct 11, 2009

Due to the immature neurological system a 29 week baby would not meet the same criteria as a term baby. It cn also be hard to continuously monitor these babies because of their size. Also, realistically speaking the c-section was already happening so what would be changed by monitoring? Although it may not have been standard practice or even good practice when I was an RN we didn't tend to waste time monitoring in the OR for a stat or emergent c-section. If you are already doing a stat or emergency c-section you are presumably already anticipating a compromised baby and working as quickly as possible. Working to get the baby on the monitor would slow down the process.

Thanks.

Sorry if I wasnt clear. We didnt do any monitoring in the OR. This was all prior to the decision to c-section. Placenta abruption was confirmed after examining the placenta.

feebebe23 · Oct 12, 2009

If it was a true STAT and not just emergent then you wouldn't doppler for FHTs in the OR as long as you know you have a viable fetus. You can also skip the shave, the SCDs, surgical counts, ect....just spash and go. All other C-setions you should doppler fhts in the OR.

CEG · Oct 12, 2009

Thanks.
Sorry if I wasnt clear. We didnt do any monitoring in the OR. This was all prior to the decision to c-section. Placenta abruption was confirmed after examining the placenta.

Ahh, I see. In that case I actually also would have expected to monitor continuously prior to moving to the OR. If the thought was that there was an abruption then if there was a lag time before section I would certainly want continuous monitoring in case the status of the baby changed. It would probably be a pain to monitor a 29 weeker, there would be a lot of moving the U/S around. So not sure why you didn't monitor....