Fetal Heart Monitoring Like A Pro

I typically go to all the deliveries as my main job and um, catch the baby from there and help what we call transition. Um, and I've been doing ob for the last 10 years, so just smile a little area that I love. Um, all right, so let's get started and if you guys have any questions you can type them in and we'll get to them at the end. So then you monic that I first want to start with, um, to help you all is something called veal chop.
Okay.
And the only reason why I'm not doing this screenshare right now is because these are just easier for me to draw out there. Um, anyways, so this will hopefully help, but this veal chop variables is RVs. So write this down so you guys will remember if you don't already know it. And then when I draw these out, it'll make sense. So variables happen with cord compression, sorry, it's all smudged in there. Then early d cells, this happens with head compression. R A is acceleration and that o just stands for. Okay, I'm late d cells and that is for placental insufficiency.
Alright, so will you have this written down? And then we will go through, um, each one of these ashy, what it looks like and then it will all make way better sets. But this is the helpful pneumonic. And I still in my head when somebody asked me a question and I'm going through it to figure out what's what's happening with what, all right, so our first one, Our v and our C, which is the variables and that goes with cord compression. Okay. So we have on the bottom of a fetal monitoring strip, it is either have not seen that and at the end I'm going to put some real ones up, so that'll be helpful. So at the bottom of the fetal Mirin Strip, you have contractions. So the contractions are these little, um, mountains that you see. Um, so at the top you're going to have the fetal heart rate.
A lot of times you also have the maternal heart rate, but we're just gonna focus on babies. So you'll see that later when I pull up those real ones. But right now, so we're not confused. Let's just do baby. Um, okay, so variability, it can be good and bad. Um, right here we're talking about the heart rate. Good variability. We have heart rate going up and down, kind of all over the place that just what we call good Berry Valley. When we're talking about not good, it's court compression. So that is going to look like you'll have your heart rate and we're going to kind of have these debts. So you'll see these dips in the heart rate. They don't really match up with contraction patterns like some of the other ones, they're just happening. So those are our variables and that's happening with core compressions.
So what's core compression or how is that happening? So core compression is going to be where you could have ab ab pulling on. Um, it's a little bungee cord. I'm pulling on that cord and squeezing it, compressing it. That's going to be core compression. Um, you could have the baby positioned like leaning on it, um, against the side of the uterus, um, causing corporate pressure. So anything that would cause a squeeze to the cord, um, will be core compression. And that is what that strip will look like. So this one is not really a good thing. The things that we'll do to fix this or with any one that's not good. But I'll remind you for each one, we will give the mom some oxygen because extra oxygen to mom will go to the baby and we'll help fix the heart rate. So oxygen, if she is, um, getting pitocin,
which is what stimulates contractions, we will stop it to try to fix this. It's kind of slow the contractions to make sure that it's not something with the contractions causing it. And then we'll also, the big thing here is turn the patient. Um, the left lateral side is going to be the best, but if she's already in the left lateral side, then we're going to flip to the right or flip on her back, whatever it may be, just to try to, um, reposition. All right, so that's our variables. The next one is R, e and r h. So those were the early desales and this one goes with head compression. Okay. So we have our contractions at the bottom here again and we are going to have a heart rate that dips and returns with each contraction. The keywords that you will see on an exam for when striving these. And I always suggest to people to draw this out. So when you are given an example on a test and it's telling you what's happening or on in class, draw it out and just so you can get a visual of what's going on. But the key term that you'll usually hear is the word mirror image.
The other key thing here is it will say that the contraction or the heart rate dips with the contraction and then were turned at the end of the contraction. So it's literally be flippant, a mirror image of the contraction, the dips happen with the contraction and then return. So head compression. What's happening here? This is when the baby's getting lower into the birth canal. So it's a narrow or space. The head is getting squeezed in that pelvis in the vagina. So it's going to cause head compression. This is good. Okay. So this one is not a bad one. Um, this is good. It means that the baby's getting closer to delivering. So usually if we see earlys, we're gonna check the mom and see is she fully dilated? Is she ready to have this baby? So this one is the early desales with head compression.
Okay. Our next one is our accelerations. And if you remember that, oh, is okay. So these are going to be good also. So we're not going to be concerned about this. We have contractions and accelerations are happening. So that just means your heart rate is jumping up. We're happy versus the variability that you saw. We were having those drums. Um, so acceleration means that that baby is moving and the heart rates going up. So think about if you kind of fight a stairs, you rob the flight of stairs, even walking up the place, there's, your heart rate is going to increase. Same thing with the baby. The baby flips and turns, that heart rate's going to jump up. So it's showing that the baby's got good oxygen and that everything is okay. Um, so no intervention needed here. And our last one is very bad. So the last one is the late decelerations. And this one means placental insufficiency, which that doesn't sound good, right? Our Placenta is not being sufficient at what it's supposed to do. So with this one we have our contractions and you will have the baby's heart rate
dipping.
Sometimes it will return, sometimes it won't and it will just stay down. So you might think this looks a little bit like earlys, right? So this one is not a mirror image. The heart rate dip happens after. I feel like that one looks more like an early one I'm looking at on the screen. So the dip happens after the start of the contraction, not with the start. So after and sometimes it will return to baseline and like I said, other times it will dip and stay down. So this one is bad. So what are we going to do? Same thing, we're going to give her oxygen. It doesn't matter if her oxygen level is 100% you give her oxygen, usually 10 liters a non rebreather mask thrown on there. On that extraction, we'll go to the baby and help the heart rate. So oxygen, we are definitely going to stop the pitocin here.
If she's getting pitocin, oxytocin to cause these contractions, we're going to stop that and then we are going to turn her and remember that left side is the best side. Um, so I've turned the patient. So this, um, it was, you might also give a fluid Bolus to, so what would cause placental insufficiencies? So a big thing, um, over a big cause is an abruption. So for those that haven't started ob yet, and abruption is where the placenta comes detached, uh, before it's supposed to. So the placenta starts detaching from that uterus. Um, obviously not good cause that's the baby's lifeline. So if the placenta comes detached before we've had the baby born, um, then the oxygen isn't going to be getting to the placenta and to the baby. So abruption, um, any type of separation. It could also be that we are over contracting.
So what happens when the uterus is contracting, it then stops contracting and it's at its resting state where it refills with blood and oxygen. I guess the Placenta, if it is hyper-stimulated and over contracting, it doesn't have time to refill itself and recover. Um, so that hyperstimulated uterus can cause that as well. Um, so those are the big things for really anything placental related or if we are hyperstimulated uterus is going to cause our late decelerations. I am willing to share my screen with you guys now so that I can show you this awesome cheat sheet that we have. Um, so bear with me for just a second.
We'll do entire screen. Okay. Can you guys see my screen before I flip us over? Okay. So first I'll show you guys how I got to this. You can pull it up for yourself. Also if you type in, I type in monitoring cause I couldn't get it up but it's actually called fetal monitoring. I was putting in fetal heart monitoring, but it's right there in your ob lessons. So if we click that, um, this'll take you into the video where we go through everything and then obviously all our ob content over here, if you're looking for something else, um, and then the cheat sheet is right here. So I pulled it up. I've already downloaded it so we can look at it. So let me open that. Okay, so let's go through these. These are actually real strips, um, from a labor patient that we had.
So here we have our variables, which if you remember, that's our cord compression. So I know it's hard to see. Um, hopefully you can see it cause I downloaded it. But when you guys open it, if you don't download it, it is hard to see. Let me blow it up a little bit. Okay, so these are the contractions at the bottom. You see how there's two lines. So the bottom line is going to be the mom's heart rate and the top one is the baby. Sometimes they crisscross, you just got to follow it. But you'll see with this one you can see these variable, we've got dips happening or kind of all there was, there was an excel. But here's our big variable here. We got this big dip happening. So that's our variability. Then down here we have our early, so here's our contractions again and then you'll see.
So this is mom, this is baby. So here is smear image. This little dip happening right there. It's going to be our early deceleration. You can kind of see there was one right here that matched up with that contraction. Our acceleration. And this will tell you to your intervention. So yeah, we're going to check cervix cause we're probably ready for delivery. Our accelerations. Remember these are okay, nothing needed. We're just monitoring, we have contractions and we have a baby that's happy moving around and we have a good heart rate happening right there. And then here's our lights. So this one, the mom's heart rate and the baby's Kinda overlaps. So just try to follow the line here and you can see that drop. And if you notice, you can see the peak of the contraction. Here it happens after. So we have a dip and then here's the baby's here dropping again.
So here we're gonna reposition, give oxygen. We might need to go to the o r we can't fix this cause we don't want to leave a baby in this kind of environment. I'm not getting good oxygen flow. And then this one just to show you all this poor variability. So this baby is just sleepy, right? So you can just see how it's kind of like a flat line. Um, it's just staying right there and not moving around at all. We don't have good accels happening. Um, there's no good variability. So a sleepy baby hopefully is all that it is and you just try to wake it, um, by Kinda cushion on the stomach. Sometimes a acoustic vibrator on the uh, Belina wake it up or give mom some sugar, like some juice to hopefully help with that.
All right,
you guys have any questions? You can start typing them in. I'm gonna,
I'm sharing. I'll give you guys this link. Okay.
Here is the link that will take you right into the academy to that lesson on fetal heart monitoring. Um, and there's some other images in there as well. And let me know whatever questions you guys have, um, on any of this or anything you've seen, anything ob related, I'm happy to help answer it. If you all are not doing anything on the 24th, we'll be here again and talking about all like Frankie, any part of the screening, uh, and what that looks like for a pregnant patient.
You're welcome.
Okay.
I'm mentioned giving stopping fluids for which instance will we need to increase the fluid Bolus in which would we slow or step. Okay, so the, so you wouldn't need to worry about stopping that. Um, if it's talking about like an IB fluid Bolus, if the baby's Kinda really flat, not having 'em.
Okay.
Usually you're giving fluid if the mom's contracting, um, but isn't like early or not really in labor, but it's just contracting, contracting, um, preterm labor. Um, we would get fluid boluses as far as with the fetal monitoring. Sometimes they'll do something called an amnioinfusion. So I just want to explain that real quick. The, the infusion is where they put amniotic fluid in or not enough fluid, sorry. Sailing into the mom and as a place of amniotic fluid. Um, so if the baby's leaning on that cord just to kind of help get that baby, the court put some fluid in for the baby to move around. Um, so it's not done as often anymore, but that is something, um, you'll probably might still see on questions and then as far as the fluid Bolus, so mom would get an IB fluid Bolus sometimes if she's having late decelerations just to try to see what can we do to fix this?
Like make sure she's not dehydrated. Um, d hydrated mom can make for an angry baby. So it would never be, um, it would never hurt anything to give a fluid Bolus. I should put it that way. So yeah, we went slower DC, it would be the pitocin that we would stop. Um, and that would be stopped for, um, late decelerations that are happening. So remember Petosin oxytocin is going to cause contractions and if that baby's not tolerating labor or not tolerating the contractions, then we want to stop them. Um, of course, if she's just having them and isn't getting placenta, then that's not, or getting pitocin, then that's not going to help very much. Um, so getting a fluid, fluid Bolus and all that. Sometimes if she's got a hyperstimulated uterus, we can give a Toca lytic like [inaudible] and that will help her uterus calm down. It stops the contractions if we needed to, but more than likely we're going to be running our to the r for some fast delivery. You're welcome. Um, high personally, she say uterus needs time to refill. Yes. So the hyperstimulated uterus is going to be where we are over contracting, so there's no rest time in between. So in that resting time, it kind of refills.
Um, yes. So the amniotic bullets, so that is, it's called an Amnio and fusion. And what that is, is they take like this little tube and stick in, um, to the uterus. So this will be the mom's in labor. Her water's been broken, more than likely someone that's had her water's been broken for a while and just, um, the baby is not able, you know, they move around in that fluid. So when there's no fluid in there, it's hard to, and I think it kind of stuck. Um, and the court can get stack up against them so that any infusion shoots amniotic fluid in there and will help kind of relieve that pressure on the cord. But I don't, they're not doing them quite as often. So it's phasing out probably, but I don't know how much you guys would be asked that on tests. So always good to kind of know about, cause it is a thing.
Sometimes they also do that. Amniotic Fluid Bolus if there's big thick McCone out. So if that baby has had that thick Tory store while it's inside the uterus, sometimes they will do an amniotic fluid in there to kind of wash it out and bend it out. Um, so that the baby, if it does inhale any of it, it's not as bad as if it was spic. You're welcome Brianna. Okay. What other questions do you guys have? So our hyperstimulated uterus to see is when, um, I think it's more than, uh, three contractions in five minutes. Um, and then over, let me, right,
okay.
They measure the contraction strength. So a hyperstimulated uterus would be over 20 millimeters of mercury when they're measuring and that's when they have some special instrument in to measure the contraction strength. So that's happening or frequent contractions, no resting time. And another sign of that is a really, um, like the abdomen is very painful cause it's just contracting, attracting, contracting. Yes. So the variable cord compression.
Okay.
I'll just write it or draw it back up for you and then explain, okay. So we have contractions and then our variability is going to be where we have big sharp dips in the heart rate happening. And it might be lined up with contractions. It might not be, um, but these big dips and that's cord compression. So that's where either the baby's pulling on its core and a bungee cord. It's leaning his head on it or the cord has gotten somehow lodged between the baby and, uh, the uterus. And is just getting compressed, just anything that can compress it. Also, uh, when the court gets starts to be delivered a prolapsed cord before the babies come out, you will see a big variabilities happening. So that is um, the core compression. Did that help? Oh, hold it up there for a second. So you can see, sometimes you'll have where it's not good variability or poor variability. And that was like that. The last one on that cheat sheet that we saw where it was kind of, um, put it up here. So that's our poor variability, kind of that flat line.
Yeah. You're welcome.
What other questions do you guys have about anything good. I'm glad. I felt like my brain was all over the place, so I hope that it was helpful, but look at that cheat sheet. Um, I just thought sometimes when I draw it out it's a little bit easier to see. Cause of course it's like these teeny little details that you see on the strip, which can be hard to detect when you're first looking at them.
Yeah.
Um, so poor variability that the baby could be sleepy. Yes. So that more of that flat line, um, they will usually call what I drew up there at variable decelerations. So where poor variability is just kind of that flat line. I'm Mary, I have a hard time drawing stuff too. That's why I worry that you all were hoping that you were all were following me. Um, so yes, poor variability is usually that baby's just kind of flatline that baby's sleeping needs to be woken up and stimulated in some way. So ways that we can do that are giving moms some sugar, some orange juice, apple juice, whatever. Um, try and get that baby woken up. And then in the hospitals we have in the doctor's office, um, the vibroacoustic stimulators, so it's literally like this. Ours is a white like, looks like a giant vibrator. You stick out your belly and it Kinda vibrates her stomach. So the fluid moves and then the baby's Kinda like, whoa. And then wakes up and starts to move in. You're welcome.
And you'll see if you, for those of you that have not gone to clinical yet and had your ob rotation, you'll look on those monitor strips since like, whoa. I mean you might have a patient that has a beautiful strip all day. Um, and then other times you might have where she has like all four of the veal chop things happening on her placenta or on her stretch, which is actually that cheat sheet with one patient that just gave me all that helpful stuff for that cheat sheet. Um, you didn't have an ob rotation. What is wrong? Why does your school do away with ob? Oh, no, ps either. So what are you supposed to do for all that info?
Okay.
I guess sometimes too on the ad clicks, I mean it's basic patient management of care and not always detailed on ob and p, but you can definitely do OBM piece on NRSNG and get, uh, some good information. I can't believe it. A week around where I am, I'm in Virginia and a lot of our schools are kind of, they're combining ob and p for when I did it as two separate classes. You didn't have good clinicals all the time. Interesting. So they got rid of ob and P it's because they didn't have clinical sites. But did you learn about it in class? Well that's very interesting.
Best rotation. All the patients I must say I didn't get to see anything bad. Well sometimes that's good. It's not as bad. Like a good adrenaline rush. Oh your clinical sites are not very good. Okay. I'm glad you did learn about it. I'm surprised that you didn't have to do clinical hours though. But that's interesting. Yeah. So I didn't really get to see anything super exciting in um, clinical for ob either. And I felt like all my patients were about to deliver and it was time to get a post conference and leave. So I thought I'm missed all the fun. Um, give meds. Yeah, it's hard and ob too, cause you can't really plan. Like they don't know what's going to come in. Cause I taught ob be clinical for a little while and it was hard cause Sundays we'd be there and there'd be absolutely nothing where I had worked the day before and there had been so many things. Um, so it's definitely hard. Okay. Briana? Yeah. So you get the p patients in the Er. That's true. That's good. Yes. He almost passed out and this c-section it is and it gets hot in there. You've got to make sure you eat before you go in there. For anyone that has not done their ob rotation at that, it's a good piece of advice. Um, I'm glad you guys like it. I always like, everyone's like they either love ob or they hate it and obviously I love it. So,
so fun.
Well, and no matter where you work, you will always have some time where you come across an ob patient. So if you're in the ICU, you might have a patient going to d or like ob land might have somebody go into dic and end up in your world on ICU. Or you might be in the Er and someone's going come in and deliver a baby in the Er. So you will forever be surrounded by them whether you like it or not, I guess. All right guys, what other questions? Any other questions? So I hope you all will join me on the 24th at this same time, same place, and we'll talk about different antepartum testing. Awesome. No problem. Okay. See you guys on a 24 happy nursing.