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OB > 5. Fetal Assessment > Flashcards

5. Fetal Assessment Flashcards

1
Q

Two tools for Hand Held FHR monitoring

A
  • Fetoscope

* Doppler

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2
Q

Two tools for External Electronic Fetal Monitoring

A

o US transducer –High frequency sound waves

o Tocometer—Measures uterine activity via a pressure sensing device on the abdomen.

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3
Q

Two tools for Internal Electronic Fetal Monitoring

A

o Scalp elecrode (FSE / ISE)

o Intrauterine pressure catheter (IUPC)

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4
Q

How to assess the “baseline” FHR (2)

A
  • Heartrate assessed between contractions

* Look at a 10 minute strip

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5
Q

Fetal tachycardia (def)

A

FHR baseline of more than 160 BPM for 10 minutes or longer

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6
Q

Maternal Causes of fetal tachycardia (5)

A
  • Fever, Choriamnitis
  • Maternal hyperthyroidism
  • Drugs (Tocolytics, etc)
  • Dehydration
  • Anxiety
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7
Q

Fetal causes of fetal tachycardia (5)

A
  • Early fetal hypoxia
  • Asphyxia
  • Fetal anemia (Decreased RBCs, Decreased Oxygen)
  • Infection
  • Prematurity
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8
Q

What is fetal bradycardia a sign of?

A

Can be a late sign of fetal hypoxia, fetal distress

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9
Q

Causes of fetal bradycardia (5)

A
  • Placental transfer of drugs such as anesthetics
  • Prolonged compression of the umbilical cord
  • Maternal hypothermia and maternal hypotension
  • Maternal supine hypotension syndrome
  • These responses in the mother subsequently result in decrease of FHR and ultimately fetal bradycardia.
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10
Q

What causes maternal hypotension syndrome?

A

• Caused by the weight and pressure of the gravid uterus on the inferior vena cava

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11
Q

What is maternal hypotension syndrome?

A

• Decreases the return of blood flow which then reduces maternal cardiac output and blood pressure

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12
Q

Fetal Bradycardia (def)

A

A baseline FHR of less than 110 bpm for a duration of 10 minutes or longer.

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13
Q

Long term v Short Term variability

A

Long Term variability
• Irregularity of FHR over 10 minutes: Rhythmic waves or cycles from baseline

Short-Term variability
• Fluctuations from beat to beat

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14
Q

Four categories of variability. Which is optimal?

A
  • Absent variability
  • Minimal variability
  • ** Moderate (avg) variability **
  • Marked variability

(Moderate variability is optimal)

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15
Q

Absent variability parameters

A

VARIABILITY UNDETECTABLE

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16
Q

Minimal variability parameters

A

Detectable, but less than or = to 5 bpm

17
Q

Moderate variability parameters

A

6 to 25 bpm

18
Q

Marked variability parameters

A

> 25 bpm

19
Q

Accelerations (def)

A

Increase in baseline of 15 bpm for 15 seconds. Indicates fetal well-being.

20
Q

Decelerations (def)

A

Decrease in baseline of 15 bpm for 15 seconds.

21
Q

What do accelerations indicate?

A

Fetal well-being

22
Q

What do decelerations indicate?

A

May be benign or non-reassuring

23
Q

Periodic changes and what they mean (pneumonic)

A

VEAL CHOP:

Variable Cord Compressions
Early Head Compressions
Accelerations OK
Late Placental Insufficiency

24
Q 
Characteristics of Early Decelerations
•	Prognosis
•	Severity
•	 Pattern, shape
•	Correlation with contractions
A
  • Prognosis: OK or benign
  • Rarely goes more than 30 or 40 below baseline
  • Shape is round (like head, the letter U).
  • Mirror contractions.
25
Q

Characteristics of Early Decelerations
• Related to…
• Secondary to…

A
  • Related to vagal nerve stimulation

* Secondary to head compression

26
Q

Characteristics of Late decelerations
• Shape / pattern
• Related to…

A
  • Slow decrease, slow recovery (shape is rolling hills)

* Related to placental insufficiency

27
Q

Characteristics of Variable Decelerations
• Related to…
• Correlation with contraction

A
  • Related to Cord compressions

* Late in contraction

28
Q

Characteristics of Variable Decelerations: Shape / Pattern (3)

A
  • Shape: Looks like a V, U or W.
  • Shoulders
  • Abrupt decrease with an abrupt return to baseline.
29
Q

What are shoulders?

A

Little overcompensations after deceleration. ONLY OCCUR WITH VARIABLE DECELERATIONS.

30
Q

Early deceleration: Range

A

Within normal range: 120-160

31
Q

Late deceleration: Range

A

Within normal range: 120-130

32
Q

How often to document FHR assessment during each stage of labor?
• Latent phase
• Active phase
• 2nd stage

A
  • Latent phase: Q1hour
  • Active phase: Q15-30 minutes
  • 2nd stage: Q5minutes or between contractions
33
Q

Characteristics of a “reassuring” FHR pattern (4)

A
  • Baseline between 110-116
  • No decelerations or changes in baseline
  • Accelerations with fetal movement
  • Moderate variability
34
Q

Characteristics of a “non-reassuring” FHR pattern (5)

A
  • Tachycardia
  • Bradycardia
  • Decreased or absent variability
  • Late decelerations
  • Severe variable decelerations
35
Q

What is the first thing you do if there are decelerations

A

TURN OFF THE PITOCIN

36
Q

Nursing management of FHR changes (5 - in order)

A 
o	If pitocin is infusing, turn off pitocin with decelerations
o	Position change (left lateral)
o	Increase IV fluids
o	O2 (8-10L via face mask)
o	Notify Provider
37
Q

Other interventions for FHR changes (4)

A

o Fetal stimulation
o Amnioinfusion
o Discourage valsalva maneuver
o Change maternal position

38
Q 
Scalp elecrode (FSE / ISE)
•	What is it
•	What does it do
A
  • Tiny thing screwed in clockwise

* Takes a fetal ECG and turns it into a fetal HR

39
Q

Intrauterine pressure catheter (IUPC)

• what does it do?

A

Measures the pressure inside the uterus

OB (15 decks)

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