Intrapartum Fetal Surveillance

Duration = 6:34

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APGO educational topic number 26
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intrapartum fetal surveillance the goal
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of intrapartum fetal surveillance is to
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detect events that occur during labor
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that could compromise fetal oxygenation
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fetal heart rate monitoring is a
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modality intended to determine if the
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fetus is well oxygenated and will be the
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focus of this video in the United States
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85% of Labor’s involve electronic fetal
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heart rate monitoring electronic fetal
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monitoring may be performed externally
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with a Doppler device or internally with
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a fetal scalp electrode the objectives
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of this video are to describe the
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techniques of fetal surveillance and to
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interpret electronic fetal heart rate
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monitoring here is a fetal heart rate
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tracing the top portion is the fetal
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heart rate and the bottom portion
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records uterine contractions the x-axis
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is time and each thicker white line
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signifies one minute and this blue line
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is fetal heart rate this purple line is
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maternal heart rate the green line
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depicts uterine activity and this is a
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uterine contraction it is important to
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approach the interpretation of fetal
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heart rate racing’s in a systematic and
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stepwise fashion the first step is to
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look at the baseline a normal baseline
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is between 110 and 160 beats per minute
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fetal bradycardia is when the heart rate
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is less than 110 fetal tachycardia is
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when the heart rate is greater than 160
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we will move next to variability
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variability is the beat to beat change
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in the fetal heart rate there are four
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terms used to describe variability
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absent minimal moderate and marked with
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absent variability there is no variation
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in the fetal heart rate with minimal
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variability the fetal heart rate varies
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less than five from beat to beat with
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moderate variability the fetal heart
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rate varies from 6 to 25 from beat to
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beat and with marked variability the
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fetal heart rate varies greater than 26
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from beat to beat moderate variability
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is reassuring moderate variability is a
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reassuring sign that reflects adequate
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fetal oxygenation and normal brain
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function here is a fetal heart rate with
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moderate variability the heart rate
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fluctuates between 6 to 25 beats
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decreased variability is associated with
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fetal hypoxia acid emia tachycardia or
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fetal CNS and cardiac anomalies drugs
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that depress the fetal CNS system such
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as morphine or magnesium can also
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decreased variability decreased
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variability can also be from a prolonged
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uterine contraction here is a fetal
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heart rate tracing with minimal
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variability the fetal heart rate
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fluctuates less than five from beat to
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beat the next step in the assessment of
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fetal heart rate tracing is the
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characterization of accelerations and
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decelerations
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an acceleration is an increase in the
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fetal heart rate from the baseline
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decelerations are visually apparent
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decreases in the fetal heart rate this
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clever veal chop acronym can help you
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remember the different types and causes
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of accelerations and decelerations v
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stands for a variable deceleration this
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is when there is an acute fall in the
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fetal heart rate with a rapid downslope
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and a rapid recovery back to baseline
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they are characteristically variable in
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duration intensity and timing they
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resemble the letter V and may not have
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any specific relationship to uterine
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contractions v is associated with sea
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variables are caused by cord compression
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east ants for early deceleration and
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early deceleration has a slow onset and
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a slow recovery that corresponds to the
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start and end of the contraction E is
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associated with H early accelerations
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are caused by head compression these are
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favorable and reassuring when seen on a
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fetal heart tracing a stands for
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acceleration
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these are transient increases in the
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fetal heart rate they do not have any
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specific relationship to uterine
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contractions and an acceleration lasts
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for more than 15 seconds with an
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increase of at least 15 beats above the
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baseline after 32 weeks estimated
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gestational age a is associated with o
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as an OK meaning that the presence of
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accelerations is a reassuring sign of
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fetal well-being l stands for a late
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deceleration a late deceleration is a
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symmetric fall and rise in the fetal
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heart rate racing that begins at or
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after the peak of the uterine
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contraction has ended the descent and
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return are gradual and smooth a pattern
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of persistent late decelerations is non
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reassuring L is associated with pea late
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decelerations are caused by placental
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insufficiency
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here is another fetal heart rate tracing
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and the arrows depict the accelerations
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the heart rate goes above the baseline
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greater than 15 beats and lasts more
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than 15 seconds
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this fetal heart rate has the
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characteristic v-shaped variable
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deceleration the heart rate goes rapidly
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down and rapidly back up to baseline
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here is an early deceleration with a
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slow decrease and a slow increase back
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to baseline and it occurs at the same
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time as the contraction this late
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deceleration has the same slow decrease
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and slow increase back to baseline but
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it occurs after the contraction has
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occurred we’ve now reviewed the steps
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for fetal heart rate interpretation we
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use these tools to classify fetal heart
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rate tracings into three categories 1 2
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& 3 category 1 is a tracing that has a
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baseline rate between 110 to 160 beats
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per minute has moderate baseline
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variability no late or variable
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decelerations early decelerations may be
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present or absent and accelerations may
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be present or absent here is a category
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1 fetal heart rate racing with a
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baseline of 130 moderate variability at
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a nice acceleration category 3 is a
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tracing that has absent baseline fetal
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heart rate variability and any of the
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following recurrent late decelerations
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recurrent variable decelerations
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bradycardia or there is a sinusoidal
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wave pattern a sinusoidal pattern is
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very unusual and is ominous it is
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characterized by visually apparent
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smooth sine wave like undulating
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patterns in the fetal heart rate
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baseline with a cycle frequency or 3 to
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5 per minute which persists for 20
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minutes or more a sinusoidal pattern
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requires immediate delivery category 2
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tracings are everything in between
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category 1 and 3 here is a category 2
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fetal heart rate tracing there is
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moderate variability but she is having
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variable decelerations a category 3
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tracing is an indication for immediate
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delivery
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this fetal heart rate tracing
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demonstrates a category 3 tracing for
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there is absent fetal heart rate
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variability and recurrent late
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decelerations
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the team should be moving towards
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immediate delivery this concludes the
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aapko video on intrapartum fetal
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surveillance we reviewed the techniques
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for fetal surveillance and the steps for
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interpreting electronic fetal heart rate
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monitoring