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4.4 Intrapartum Care and Fetal Monitoring

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NCLEX-RN Registered Nurse

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1 Introduction

About the NCLEX-RN Exam Next Generation NCLEX (NGN) Clinical Judgment Measurement Model (NCJMM) How to Use This Course

2 Chapter 2: Management of Care

2.1 Legal Rights and Responsibilities 2.2 Advance Directives and Self-Determination 2.3 Informed Consent Protocols 2.4 Client Advocacy and Rights (HIPAA) 2.5 Assignment, Delegation, and Supervision 2.6 Five Rights of Delegation 2.7 Scope of Practice (RN vs LPN vs UAP) 2.8 Ethical Practice Principles

3 Chapter 3: Safety and Infection Prevention and Control

3.1 Standard Precautions and Hand Hygiene 3.2 Transmission-Based Precautions (Contact, Droplet, Airborne) 3.3 PPE Donning and Doffing Sequences 3.4 Fall Prevention and Restraints 3.5 Fire Safety (RACE/PASS) 3.6 Disaster Triage and Emergency Response

4 Chapter 4: Health Promotion and Maintenance

4.1 Growth and Development (Erikson/Piaget) 4.2 Developmental Stages: Infancy through Older Adult 4.3 Maternal and Newborn Care (Antepartum) 4.4 Intrapartum Care and Fetal Monitoring 4.5 Postpartum Care (BUBBLE-HE) 4.6 Health Screening Guidelines 4.7 Immunization Schedules

5 Chapter 5: Psychosocial Integrity

5.1 Therapeutic Communication Techniques 5.2 Non-Therapeutic Communication (What to Avoid) 5.3 Anxiety Disorders and Mental Health Concepts 5.4 Schizophrenia: Hallucinations and Delusions 5.5 Depression and Suicide Assessment 5.6 Substance Misuse and Withdrawal 5.7 Grief and End-of-Life Care

6 Chapter 6: Basic Care and Comfort

6.1 Mobility and Hazards of Immobility 6.2 Assistive Devices (Crutches, Canes, Walkers) 6.3 Nutrition and Diet Therapy 6.4 Enteral Nutrition (Tube Feeding) 6.5 Bowel Elimination and Ostomy Care 6.6 Urinary Elimination and Catheter Care

7 Chapter 7: Pharmacological and Parenteral Therapies

7.1 Medication Administration Rights 7.2 Medication Calculations 7.3 High-Alert Medications: Insulins 7.4 High-Alert Medications: Anticoagulants 7.5 High-Alert Medications: Opioids 7.6 High-Alert Medications: Digoxin and Electrolytes 7.7 IV Therapy and Complications 7.8 Blood Product Administration 7.9 Total Parenteral Nutrition (TPN)

8 Chapter 8: Reduction of Risk Potential

8.1 Laboratory Values: Hematology (CBC) 8.2 Laboratory Values: Metabolic Panel (BMP) 8.3 Laboratory Values: Coagulation Studies 8.4 Vital Signs and Trend Recognition 8.5 Perioperative Care (Pre-Op and Post-Op) 8.6 Nasogastric Tubes and Therapeutic Procedures

9 Chapter 9: Physiological Adaptation

9.1 Fluid Imbalances (Hypovolemia and Hypervolemia) 9.2 Arterial Blood Gases (ABGs) and Acid-Base Balance 9.3 Medical Emergencies: Stroke (CVA) 9.4 Medical Emergencies: Myocardial Infarction (MONA) 9.5 Diabetic Emergencies (Hypoglycemia and DKA) 9.6 Respiratory Conditions (COPD, Pneumonia) 9.7 Cardiac Conditions (Heart Failure) 9.8 Neurological Conditions (Seizures)

4.4 Intrapartum Care and Fetal Monitoring

Key Takeaways Explain This Topic AI

Normal fetal heart rate baseline is 110-160 bpm; moderate variability (6-25 bpm fluctuation) indicates a well-oxygenated fetus

VEAL CHOP helps interpret FHR patterns: Variable/Cord, Early/Head, Accelerations/Okay, Late/Placental insufficiency

Late decelerations indicate uteroplacental insufficiency and require LION intervention: Left lateral position, IV fluids, Oxygen, Notify provider

Variable decelerations (cord compression) are the most common deceleration type and respond to position changes to relieve cord pressure

Category II FHR tracings are indeterminate and require continued monitoring; Category III tracings are abnormal and require immediate intervention

Last updated: January 2026

Intrapartum Care Fundamentals

Intrapartum care spans from the onset of true labor through delivery of the placenta. The nurse's primary responsibilities include monitoring maternal and fetal well-being, supporting the laboring woman, and recognizing complications.

Stages of Labor

  • Stage Definition Duration (Primigravida)
  • First Onset of labor to full dilation (10 cm) 12-16 hours
  • Second Full dilation to birth 1-2 hours
  • Third Birth to placenta delivery 5-30 minutes
  • Fourth First 1-2 hours postpartum Recovery period
  • First Stage Phases
  • Phase Dilation Contractions Client Behavior
  • Latent 0-6 cm Mild, irregular Talkative, excited
  • Active 6-10 cm Strong, regular Focused, serious
  • Transition 8-10 cm Intense, 60-90 sec Irritable, exhausted
  • Electronic Fetal Monitoring (EFM)

Electronic fetal monitoring assesses fetal oxygenation status through heart rate patterns.

  • Baseline FHR
  • Normal range: 110-160 bpm
  • Abnormality Rate Possible Causes
  • Tachycardia >160 bpm Maternal fever, infection, fetal hypoxia, medications
  • Bradycardia <110 bpm Late hypoxia, cord compression, fetal head compression
  • Variability

Variability refers to the fluctuation of the FHR from the baseline - the most important indicator of fetal oxygenation.

  • Category Beat-to-Beat Variation Interpretation
  • Absent None visible Concerning - may indicate hypoxia
  • Minimal ≤5 bpm May indicate sleep or medication effect
  • Moderate 6-25 bpm REASSURING - well-oxygenated fetus
  • Marked >25 bpm May indicate early hypoxia

Key Point : Moderate variability is the BEST indicator of fetal well-being.

VEAL CHOP Mnemonic

Use this mnemonic to remember deceleration causes:

  • FHR Pattern Cause
  • V ariable decelerations C ord compression
  • E arly decelerations H ead compression
  • A ccelerations O kay (reassuring)
  • L ate decelerations P lacental insufficiency
  • Variable Decelerations

Pattern : Abrupt decrease, variable shape (looks like a "V" or "W") Cause : Umbilical cord compression Characteristics :

  • Most common deceleration type
  • Variable in timing, shape, and depth
  • Abrupt onset and return to baseline

Interventions :

  • Change maternal position (relieve cord pressure)
  • Assess for cord prolapse
  • IV fluids if indicated
  • If severe/repetitive: notify provider
  • Early Decelerations

Pattern : Gradual decrease that mirrors contraction (looks like a "U") Cause : Fetal head compression during contractions Characteristics :

  • Onset, nadir, and recovery mirror contraction
  • Usually benign
  • Common during active labor and pushing

Interventions :

  • Monitor and document
  • No specific intervention required
  • Reassure patient
  • Late Decelerations

Pattern : Gradual decrease occurring AFTER contraction peak Cause : Placental insufficiency (uteroplacental insufficiency) Characteristics :

  • Onset after contraction begins
  • Nadir after contraction peak
  • Return to baseline after contraction ends
  • ALWAYS concerning

Interventions - LION Mnemonic :

  • L ie on left side (improve uterine blood flow)
  • I V fluids (improve hydration and placental perfusion)
  • O xygen (8-10 L/min via non-rebreather mask)
  • N otify provider immediately
  • Accelerations

Pattern : Temporary increase in FHR ≥15 bpm for ≥15 seconds Cause : Fetal movement, stimulation Significance : REASSURING - indicates well-oxygenated fetus

FHR Category System

  • Category Interpretation Action
  • Category I Normal Continue monitoring
  • Category II Indeterminate Continue close monitoring, evaluate
  • Category III Abnormal Immediate intervention required
  • Category I (Normal)

All of the following:

  • Baseline 110-160 bpm
  • Moderate variability
  • No late or variable decelerations
  • Accelerations may or may not be present
  • Category III (Abnormal)

Either:

  • Absent variability WITH recurrent late decelerations, OR
  • Absent variability WITH recurrent variable decelerations, OR
  • Absent variability WITH bradycardia, OR
  • Sinusoidal pattern
  • Action : Immediate intervention, prepare for emergency delivery
  • Fetal Monitoring Diagram

Normal (Reassuring) Tracing:

  • Baseline 110-160 bpm
  • Moderate variability (6-25 bpm fluctuation)
  • Accelerations with fetal movement
  • No late decelerations

Non-Reassuring Signs:

  • Absent or minimal variability
  • Late decelerations (especially recurrent)
  • Severe variable decelerations
  • Prolonged bradycardia
  • Nursing Interventions for Non-Reassuring FHR
  • Immediate Actions
  • Position change - Left lateral preferred (improves placental perfusion)
  • IV fluids - Bolus to improve blood volume
  • Oxygen - 8-10 L/min via non-rebreather if indicated
  • Discontinue Pitocin - If hyperstimulation present
  • Notify provider - Communicate findings clearly
  • Prepare for Potential Emergency Delivery
  • Ensure consent is on file
  • Notify OR/surgical team if cesarean section may be needed
  • Keep patient NPO
  • Verify blood type and crossmatch
  • Exam Tips
  • Moderate variability = Fetal well-being (most important indicator)
  • Late decelerations = Always concerning, always intervene
  • Early decelerations = Benign, continue monitoring
  • Variable decelerations = Most common, usually respond to position change
  • VEAL CHOP = Essential mnemonic for matching patterns to causes
  • LION = Remember this intervention sequence for late decelerations