Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Residency > 116 - Management of Intrapartum Fetal Heart Rate Tracings > Flashcards

116 - Management of Intrapartum Fetal Heart Rate Tracings Flashcards

1
Q

Normal uterine activity

A

5 or fever contractions in 10 minutes averaged over a 30 minute window

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Tachysystole

A

More than 5 contractions in 10 minutes averaged over 30 minutes. Should be categorized by the presence or absence of FHR decelerations.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How often should a category I tracing be reviewed?

A
  • q30 minutes during 1st stage

- q15 minutes during 2nd stage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

For a category II tracing, what features are highly predictive of normal fetal acid-base status?

A
  • Accelerations

- Moderate variability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Intermittent variable decelerations

A
  • Occur with less than 50% of contractions

- Most common FHR abnormality during labor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Recurrent variable decelerations

A
  • Occur with greater than or equal to 50% of contractions

- Can progress to greater depth and longer duration are more indicative of impending fetal acidemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Management of recurrent variable decelerations should be directed at

A

Relieving umbilical cord compression:

  • Initiate maternal repositioning
  • Oxygenation
  • Initiate amnioinfusion
  • If prolapsed umbilical cord is noted, elevate the presenting fetal part while preparations are underway for operative delivery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Recurrent late decelerations are thought to reflect

A

Transient or chronic uteroplacental insuffieciency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Common causes of recurrent late decelerations

A
  • Maternal hypotension (eg postepidural)
  • Uterine tachysystole
  • Maternal hypoxia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Management of recurrent late decelerations

A

Involves maneuvers to promote uteroplacental perfusion:

  • Initiate lateral positioning (left or right)
  • Adminiter maternal oxygen administration
  • Administer IV fluid bolus
  • Reduce uterine contraction frequency (oxytocin)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Fetal tachycardia

A

Baseline heart rate greater than 160 bpm for at least 10 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Causes of fetal tachycardia

A
  • Infectiong (eg chorioamnionitis, pyelonephritis or other maternal infections)
  • Medications (eg terbutaline, cocaine, or other stimulants)
  • Maternal medical disorders (eg hyperthyroidism)
  • Obstetric conditions (eg placental abruption or fetal bleeding)
  • Fetal tachyarrhythmias (often associated with FHR greater than 200 bpm)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

In isolation, is fetal tachycardia predictive of fetal hypoxemia or acidemia?

A

No, unless accompanied by minimal or absent FHR variability or recurrent decelerations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Fetal bradycardia

A

Baseline heart rate of less than 110 bpm for at least 10 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Prolonged decelerations

A

FHR decreases of at least 15 bpm below baseline that last at least 2 minutes but less than 10 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Common causes of fetal bradycardia

A
  • Maternal hypotension (eg postepidural)
  • Umbilical cord prolapse or occlusion
  • Rapid fetal descent
  • Tachysystole
  • Placental abruption
  • Uterine rupture
  • Congenital heart abnormalities
  • Myocardial conduction defects (such as those associated with maternal collagen vascular disease)
17
Q

Causes of minimal FHR variability

A
  • Maternal medications (eg opioid, magnesium sulfate)
  • Fetal sleep cycle
  • Fetal acidemia
18
Q

How long does it take for minimal variability thought to be due to recent maternal opioid administration to return to normal?

A

FHR variability often improves and returns to moderate variability within 1-2 hours

19
Q

How long do fetal sleep cycles last?

A

20 minutes, but can persist up to 60 minutes

20
Q

Management of minimal FHR variability if thought to be due to decreased fetal oxygenation

A
  • Initiate lateral positioning (either left or right)
  • Administer maternal oxygen
  • Adminiter IV fluid bolus
  • Reduce uterine contraction frequency (oxytocin)
21
Q

If no improvement in FHR variability is seen with initial measures and there are no FHR accelerations, what additional assessments may be done?

A

Digital scalp or vibroacoustic stimulation

22
Q

For women with spontaneous labor, tachysystole coupled with recurrent FHR decelerations require what evaluation and treatment

A
  • Category I: no interventions required

- Category II or III: intrauterine resuscitative measures and if no resolution, consider tocolytic

23
Q

For women in labor induction, tachysystole couple with recurrent FHR decelerations require what evaluation and treatment

A
  • Category I: decrease uterotonics
  • Category II or III: decrease or stop uterotonics, intrauterine resuscitative measures, and if still no resolution, consider a tocolytic
24
Q

Category III tracings have been associated with an increased risk for

A
  • Neonatal encephalopathy
  • Cerebral palsy
  • Neonatal acidosis
25
Q

Potential logistical considerations in preparation for operative delivery in setting of category III tracing

A
  • Obtain informed consent (verbal or written as feasible)
  • Assemble surgical team (surgeon, scrub tech, and anesthesia personnel)
  • Assess patient transient time and location for operative delivery
  • Ensure IV access
  • Review status of lab tests (blood type and screen) and assess need for availability of blood products
  • Assess need for preoperative placement of indwelling foley catheter
  • Assemble personnel for neonatal resuscitation
26
Q

Category I - baseline rate, FHR variability, presence of: late, variable or early decelerations and accelerations

A
  • Baseline rate: 110-160 bpm
  • Baseline FHR variability: moderate
  • Late or variable decelerations: absent
  • Early decelerations: present or absent
  • Accelerations: present or absent
27
Q

Category II - baseline rate, FHR variability, presence of: late, variable or early decelerations and accelerations

A

Baseline rate:
- Bradycardia not accompanied by absent baseline variability
- Tachycardia
Baseline FHR variability:
- Minimal baseline variability
- Absent baseline variability with no recurrent decelerations
- Marked baseline variability
Accelerations:
- Absence of induced accelerations after fetal stimulation
Periodic or episodic decelerations:
- Recurrent variable decelerations accompanied by minimal or moderate baseline variability
- Prolonged deceleration more than 2 minutes but less than 10 minutes
- Recurrent late decelerations with moderate baseline variability
- Variable decelerations with other characteristics such as slow return to baseline, overshoots or shoulders

28
Q

Category III - baseline rate, FHR variability, presence of: late, variable or early decelerations and accelerations

A 
Absent baseline FHR variability and any of the following:
- Recurrent late decelerations
- Recurrent variable decelerations
- Bradycardia
Sinusoidal pattern

Residency (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions