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OB > 5.2c Fetal Heart Rate Patterns > Flashcards

5.2c Fetal Heart Rate Patterns Flashcards

1
Q

Baseline FHR

A
  • Increases in sympathetic response also increases FHR
  • Increases in parasympathetic response slows FHR
  • Baseline is average FHR during a 10 minute segment
    EXCLUDES
  • Periodic/episodic changes
  • Periods of marked variability
  • Segments of baseline that differ more than 25 bpm
  • Normal FHR is 110-160 bpm
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2
Q

Variability

A
  • Irregular/fluctuations from baseline

- Does not include accelerations or decelerations

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3
Q

Absent Variability

A
  • Fluctuation not detectable by unaided eye
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4
Q

Minimal Variability

A 
- Less than 5 bpm variation
Caused by
- Fetal hypoxia
- Metabolic acidemia
- Fetal sleep cycles
- Fetal tachycardia
- Extreme pre-maturity 
- Medications causing CNS depression
- Congenital anomalies
- Preexisting neurologic injury
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5
Q

Moderate Variability

A
  • 6-25 bpm
  • Predicts normal acid-base balance
    FHR is not affected by
  • Fetal sleep cycles
  • Tachycardia
  • Prematurity
  • Congenital anomalies
  • Preexisting neurological issues
  • CNS Depression medications
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6
Q

Marked Variability

A
  • > 25 bpm

- Likely normal

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7
Q

Sinusoidal Pattern

A
  • Regular, smooth, undulating wavelike pattern
  • Uncommon and associated with severe fetal anemia

Variations are associated with

  • Chorioamnionitis (bacteria infected amniotic fluid, chorion and amnion)
  • Fetal sepsis
  • Administration of opioid analgesics
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8
Q

Tachycardia

A
  • FHR greater than 160 for 10+ minutes

- Early sign of fetal hypoxemia (especially with late decelerations or minimal variability)

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9
Q

Bradycardia

A
  • FHR lower than 110 for 10+ minutes
  • Rare and not specifically related to fetal oxygenation
    CAUSES
  • Fetal cardiac problem
  • Viral infection (cytomegalovirus)
  • Maternal hypoglycemia
  • Maternal hypothermia

Usually not caused by medication

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10
Q

Tachycardia

A
  • Is abnormal when associated with late decelerations, severe variable decelerations, or absent variability.
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11
Q

Periodic/Episodic Changes in FHR

A

Periodic - Occur with contractions

Episodic - Not associated with contractions (accelerations/decelerations)

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12
Q

Accelerations

A
  • Abrupt (less than 30 seconds) increase in FHR above baseline (at least 15bpm)
  • Lasts 15+ seconds
  • Returns to baseline within 2 minutes of beginning of acceleration
  • Acceleration lasting 10+ minutes is considered baseline change
  • Can be caused by fetal movement, transient compression of umbilical vein
  • Indication of fetal well being
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13
Q

Early Deceleration

A
  • Matches with Uterine Contraction
  • Caused by transient fetal head compression (normal and benign)
  • Usually occurs during 1st stage of labor (4-7cm dilation)
  • Sometimes seen in 2nd stage during pushing
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14
Q

Late Decelerations

A
  • Begins after contraction started.
  • Caused by hypoxemia during uterine contractions
  • Caused by maternal hypotension and uterine hypertonia
  • Can cause metabolic acidemia and hypoxic myocardial depression
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15
Q

Variable Decelerations

A
  • Abrupt decrease in FHR below baseline
  • At least 15 bpm below and lasting at least 15 seconds
  • Returns to baseline in less than 2 minutes of onset
  • Caused by compression of vessels in umbilical cord
  • U,V,W shape
  • If recurrent, it can mean hypoxia, hypoxemia, metabolic acidosis, metabolic acidemia
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16
Q

Prolonged Deceleration

A
  • Deceleration of at least 15 bpm longer than 2 minutes but less than 10 minutes
    Causes
  • Maternal lung apnea during eclamptic seizure
  • Umbilical cord compression, stretch, prolapse
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17
Q

Fetal scalp stimulation, vibroacoustic stimulation

A

Methods of assessment that use digital sound or light stimulation to determine the reaction of the FHR

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18
Q

Tocolysis

A

Relation of the uterus that can be achieved through administration of drugs that inhibit uterine contraction

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19
Q

Brethine

A

The most commonly used is tocolytic

20
Q

Umbilical cord acid–base determination

A

Assessment method used immediately after birth as an adjunct to the Apgar score; it measures pH, pO2, pCO2, and base deficit or excess of the newborns’ blood

21
Q

Intrauterine resuscitation: supplemental oxygen, maternal position change, and an increase in IV fluid rate

A

Group of interventions initiate when an abnormal (nonreassuring) FHT patters is noted to improve uteroplacental perfusion and increase maternal oxygenation and cardiac output

22
Q

Prolonged Late Deceleration

A

1 - Discontinue oxytocin
2 - Assist into left lateral position
3 - Administer 10 L/min oxygen through non-rebreather face mask
4 - Elevate legs (correct hypotension)
5 - Increase maintenance IV fluid rate
6 - Palpate uterus for tachysystole
7 - Notify physician
8 - Consider internal monitoring for more accurate reading
9 - Assist with birth if pattern cannot be corected

23
Q

Variable Deceleration

A

1 - Discontinue oxytocin
2 - Change position (side to side, knee to chest)
3 - Administer oxygen 10 L/min non-rebreather mask
4 - Notify physician
5 - Assist in examination for cord prolapse
6 - Assist amnioinfusion if ordered
7 - Assist with birth if pattern cannot be corrected

24
Q

Nursing Management of EFM

A
  • Evaluation of equipment and accuracy
  • Evaluate FHR tracing every 30 min during active phase of 1st stage of labor
  • Evaluate FHR tracing every 15 min during second stage of labor for low risk patients
  • Every 15 minutes for high risk patients during active phase of 1st stage of labor
  • Every 5 minutes in second stage of labor for high risk
25
Q

Basic Interventions for Abnormal FHR

A
  • Administer 10 L/min O2 for 15-30 min
  • Assist woman into left lateral position
  • Increase IV infusion rate (increasing maternal blood volume)
26
Q

Maternal Hypotension Interventions

A
  • Increase IV infusion rate
  • Change to Lateral or Trendelenburg positioning
  • Administer ephedrine or phenylephrine if other measures unsuccessful
27
Q

Uterine Tachysystole Interventions (Excessive frequent Uterine Contractions)

A
  • Abnormal FHR Pattern during Second Stage of Labor
  • Reduce/discontinue stimulants such as oxytocin
  • Tocolytic such as Terbutaline (Uterine relaxant)
  • Use open-glottis pushing
  • Fewer pushing efforts during each contraction
  • Individual pushing efforts should be shorter
  • Push only every other contraction
  • Women with anesthesia should only push when they have the urge
28
Q

Categories of FHR

A

Category 1 - Normal
Category 2 - In between 1 and 2
Category 3 - Abnormal (immediate evaluation needed)

29
Q

Components of FHR Tracing

A

The below need to be evaluated regularly

  • Baseline Rate
  • Baseline Variability
  • Accelerations
  • Decelerations
  • Changes or Trends over time

Any abnormalities in the above need to be corrected immediately for fetal oxygenation

30
Q

Intrauterine Resuscitation

A 
- Interventions when abnormal FHR pattern is noted 
These include
- Providing Supplemental O2
- Maternal position change
- Increasing IV fluid rate

Others can include

  • Correcting hypotension
  • Reducing uterine activity
  • Altering pushing techniques
31
Q

Variable Deceleration

A
  • Visually abrupt FHR decrease any time during contraction in response to umbilical cord compression
32
Q

Variability

A
  • Expected irregular fluctuation in the baseline FHR of 2 cycles per minute or greater as a result of the interaction of sympathetic and parasympathetic nervous system.
33
Q

Acceleration

A
  • Abrupt increase in FHR at least 15 BPM lasting 15 seconds or more with return to baseline within 2 minutes
34
Q

Late deceleration

A
  • Gradual FHR decrease after start of uterine contraction in response to uteroplacental insufficiency. Lowest point occurs after peak contraction and baseline not regained until the uterine contraction is over
35
Q

Episodic Change

A
  • Changes in FHR from baseline not associated with contractions
36
Q

Tachycardia

A
  • FHR greater than 160 for over 10 minutes
37
Q

Early Deceleration

A
  • Gradual FHR decrease starting with onset of contraction in response to fetal head compression
38
Q

Baseline FHR

A
  • Range 110-160

- 10 minute segment that excludes periodic or episodic changes and periods of marked variability

39
Q

Prolonged Deceleration

A
  • Abrupt/Gradual decrease in FHR 15bpm+ that lasts 2-10 minutes
40
Q

Bradycardia

A
  • Baseline under 110bpm over 10 min
41
Q

Periodic Changes

A
  • Changes in FHR baseline that occur with uterine contractions
42
Q

Fetal Scalp Stimulation/Vibroacoustic Stimulation

A
  • FHR acceleration in response to digital/vibroacoustic stimulation
  • Predictive of normal scalp blood pH (absence of acidemia)
  • Desired result of accelerated FHR 15 bpm+ for 15+ seconds
  • Further evaluation needed if acceleration not noted
  • Do not use during decelerations or bradycardia
43
Q

Umbilical Cord Acid-Base Determination

A
  • Used with APGAR score
  • Sample of cord blood
  • Tested for pH, CO2, O2, base deficit/excess

Artery sample measures fetal condition
Vein sample measures placental function

44
Q

Fetal Scalp Blood Sampling

A
  • Blood sample of fetal scalp through dilated cervix
45
Q

Amnioinfusion

A
  • Infusion of isotonic fluid into uterine cavity due to low amniotic fluid volume
  • Relieves intermittent umbilical cord compression
46
Q

Tocolytic Therapy

A
  • Tocolysis (relaxation of uterus)
  • Medication to inhibit contractions
  • Terbutaline (Brethine)
  • Administered for patients who have excessive contractions
  • Can also be administered for c-sections

OB (96 decks)

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