#116 Management of Intrapartum Fetal Heart Rate Tracings Flashcards
What is the management of a Category I fetal heart rate tracing?
Routine management
What characteristics of a category II fetal heart rate tracing allows for continued surveillance plus intrauterine resuscitative measures?
FHR accelerations of moderate FHR variability
What characteristics of a category II fetal heart rate tracing make you consider delivery?
Absent FHR accelerations and absent/minimal FHR variability
How do you manage a category III FHR tracing?
Prepare for delivery while performing intrauterine resuscitative measures, proceed to delivery if not improved
What is the most common FHR abnormality occuring during labor?
Intermittent variable decels
What is the management of intermittent variable decels?
Most often do not require any treatment and associated with normal perinatal outcomes
What features of a FHR tracing with recurrent variable decels can reassure you that the fetus is not current acidemic?
Moderate FHR variability or a spontaneous or induced acceleration
What causes recurrent late decelerations?
Transient or chronic uteroplacental insufficiency. Common causes: maternal hypotension, uterine tachysystole, maternal hypoxia
What is the initial management for recurrent late decels?
Maneuvers to promote uteroplacental perfusion: maternal lateral positioning, IVF bolus, maternal oxygen administration, evaluation for tachysystole
What is definition of fetal tachycardia
FHR >160bpm for at least 10 mins
What are identifiable underlying causes of fetal tachycardia
Infection (eg chorio, pyelo), medications (eg terb, cocaine, stimulants) maternal medical disorders (eg hyperthyroid), ob conditions (eg placental abruption, fetal bleeding), fetal tachyarrhythmias (usually w/ FHR > 200bpm)
Is tachycardia predictive of fetal acidemia?
Poorly predictive unless accompanied by minimal or absent FHR variability or recurrent decels or both
What is fetal bradycardia
FHR <110bpm for at least 10- minutes
What are identifiable causes of fetal bradychardia or prolonged decels?
Maternal hypotension, umbilical cord prolapse/occlusion, rapid fetal descent, tachysystole, placental abruption, uterine rupture. Rarely in fetus with congenital heart abnormalities or myocardial conduction defects (maternal collagen vascular disease), congenital heart block (usually occurs in 2nd trimester)
How long is a fetal sleep cycle?
Generally lasts 20 mins, but can persist up to 60mins.
How long after maternal opioid administration should FHR variability improve?
Within 1-2 hours
Patient with tachysystole on pitocin without associated fetal heart changes, how should you manage pitocin?
Consider decreasing oxytocin if Category 1.
What intervention should be done for a women in spontaneous labor with tachysystole without associated fetal heart changes (cat 1)?
No intervention required
How should you manage a patient in spontaneous labor with tachysystole with Cat II or III FHR tracing?
Intrauterine resuscitative measures. If no resolution, consider tocolytic.
How should you manage a patient with induced or augmented labor with tachysystole and category II or III FHR tracing?
Decrease or stop uterotonics. Intrauterine resuscitative measures. If no resolution, consider tocolytic.
What have category III tracings been associated with?
Increased risk for neonatal encephalopathy, cerebral palsy, and neonatal acidosis
Is a category III tracing a good predictor for abnormal neurologic outcomes?
Predictive value is poor
What is the decision-to-incision time for cesarean delivery in the setting of abnormal FHR pattern? What does the evidence say about this time line?
30 minutes. Multiple studies show lack of association between adverse outcomes and incision >30 mins
