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Endo/Repro II Test 1 > 8. Fetal Surveillance During Labor > Flashcards

8. Fetal Surveillance During Labor Flashcards

1
Q

Drawbacks of Fetal Heart Rate Monitoring

A
  1. Incidence of neurologic damage and perinatal death is NOT significantly lower than older methods
  2. No decrease in cerebral palsy
  3. Increases # of c-sections and operative vaginal deliveries
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2
Q

Benefits of Fetal Heart Monitoring (& why we dont go back to old methods)

A
  1. Nomal continous FHR data = 98% chance that there will be a good fetal/neonatal outcome.
  2. 1:1 patient to nurse interaction needed with intermittent ausculatation is a HUGE expense
  3. Even though a non-reassuring continous FHR monitoring is not associated with poor perinatal outcome, it does give a warning of potential problems and fetuses responses to actions taken to help fetus
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3
Q

What are the 2 types of Fetal Heart Rate Monitoring?

A
  1. External monitoring
  2. Internal monitoring
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4
Q

Describe how a External Electronic Fetal Monitoring is done

A
  1. Dopple US transducer is placed on moms abdomen, overlying BB heart and detects fetal HR
  2. Pressure-sensitive toco transducer monitors frequency of contraction, but not strength
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5
Q

Pros and Cons of External Electronic Fetal HR Monitoring

A
  1. Pro: Simple, safe and gives us good info on timing of contractions and fetal response
  2. Con: Not acurate if mom is obsese
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6
Q

Internal Electronic Fetal Heart Monitoring is the most accurate.

How is it performed?

A
  1. Membranes have to be ruptured
    1. FSE (fetal scalp electrode), an internal fetal heart monitor is places on the scalp
    2. IUPC (intrauterine pressure catheter), is an internal contraction monitor that tells us the INTENSITY of the contractions
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7
Q

Using a fetal scalp electrode for internal monitoring should be avoided in which patients?

A

HIV patients

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8
Q

What is the pH of fetal scalp blood that is considered abnormal (fetal acidosis)?

A

pH <7.20

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9
Q

On the Fetal Monitoring Strip

  • Upper tracing monitors _____.
  • Lower tracing monitors _____.
A
  • Upper tracing monitors FHR.
  • Lower tracing monitors uterine contractions.
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10
Q

What is considered normal vs. tachysystole for uterine contractions when monitoring?

A
  • Normal = 5 contractions or less in 10 minutes, averaged over 30 mins
  • Tachysystole = >5 contractions in 10 minutes, averaged over 30 mins
  • May or may not be associated with FHR decelerations
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11
Q

How do we measure contractions on the FHR monitor?

A

Peak => peak.

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12
Q

What is a NL amount of contractions?

A

3 contractions in 8 minutes; should occur on average every 2-3 minutes.

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13
Q

What is a Montevideo unit (MVU)?

How is it measured?

What is NL?

A
  • Montevideo unit (MVU) = done via IUPC to detect the strength of contractions in a 10 minute period (summed together)
    • (Pressure - baseline pressure) + all for 10 minutes
    • >200 MVU’s for at least 2 hours
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14
Q

What is your evaluation of the uterus based on this strip?

A

Tachysystole ( >5 contractions in 10 minutes)

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15
Q

What is the baseline FHR?

A
  • Baseline FHR is the mean HR, rounded to the nearest 5 bpm in a 10 minute period that we take BETWEEN contractions
    • => NL, tachycardia or bradycardia
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16
Q

When detecting baselineFHR (NL, bradycardia, tachy), at what point on the strip do you assess?

A

Between contractions

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17
Q

What is a normal FHR, tachycardia, and bradycardia?

A
  1. Normal = 110-160 bpm
  2. Tachy = >160 bpm
  3. Brady = <110 bpm
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18
Q

Baseline HR?

A

NL; make sure to check between contractions

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19
Q

What is the most common cause of fetal tachycardia?

A

Fetal infections –> Chorioamnionitis

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20
Q

What are fetal bradycardia?

A
    1. Fetal hypoxia (late sign)
    1. Obstetric anesthesia
    1. Pitocin
    1. Maternal hypotension
    1. Prolapsed or prolonged compression of umbillical cord
    1. Heart block
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21
Q

What are fetal tachycardia?

A
  1. Fetal hypoxia (early sign)
  2. Meds (too much oxytocin augmentation)
  3. Arrhythmias
  4. Prematurity
  5. Maternal fever
  6. Fetal infections (chorioamniotitis)
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22
Q

What is baseline FHR variablity?

A

Fluctuations in the baseline HR that are irregular in amplitude and frequency.

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23
Q

How can we label baseline variability?

A
  1. Absent: amplitude range is undetected
  2. Minimal: amplitude range detectable less than or equal 5 bpm
  3. Moderate (NL): amplitude range 6-25 bpm
  4. Marked: amplitude range > 25 bpm
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24
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25
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29
Q

Decreased variability

  • Indicator of __________
  • Omnious if associated with ___________
  • Is associated with: _____ and ______
A
  • Possible fetal stress
  • Persistant late decelerations
  • Hypoxia and acidemia
30
Q

What are causes of decreased baseline variability?

A
  1. Prematurity
  2. Sleep cycle
  3. Fetal tachycardia (chorioamnionitis)
  4. Fetal congenital anomalies (CNS and cardiac)
  5. Maternal fever
  6. Maternal hyperthyroidism
  7. Maternal drugs or substances (caffeine, nicotine, cocaine & meth and narcotics)
31
Q

What are periodic FHR changes?

A
  • FHR that changes with uterine contractions by slowing/accelerating.
    • ​1. No change
    • 2. Acceleration (prolonged acceleration)
    • 3. Deceleration (early, variable, late & prolonged deceleration)
32
Q

Describe the periodic FHR changes.

A

No change: FHR maintains the same characteristics as in the preceding baseline FHR.

33
Q

Describe the periodic FHR changes.

A

Acceleration: abrupt increase in FHR that is NORMAL

34
Q

What is considered an acceleration of FHR at ≥ 32 weeks and at <32 weeks gestation?

A
    • ≥ 32 weeks: HR ≥ 15 bpm above baseline for 15 sec or more (but <2 mins)
    • <32 weeks: HR ≥ 10 bpm above baselines for 10 sec or more (but <2 mins)
35
Q

Describe the periodic FHR changes.

A

Prolonged acceleration: lasts 2 or more minutes

36
Q

What is considered a prolonged acceleration of FHR and how long is considered a change in baseline?

A
  • Prolonged acceleration = ≥ 2 mins
  • Change in baseline = ≥ 10 mins
37
Q

When do you see a change in baseline?

A

If acceleration lasts 10 or more minutes.

38
Q

What can cause acceleration in the FHR?

A
  1. Spontaneous fetal mvoements
  2. Stimulation of the scalp/ Vibroacoustic stimulation
  3. Vaginal exam
39
Q

What are decelerations?

Types of deceleration?

A

Decrease in FHR due to uterine contractions that can be classified as early, variable or late

40
Q

EARLY deceleration

  • Caused by:
  • How is it detected?
A
  • Head compression (no fetal distress)
  • Occurs when the nadir of the deceleration (where it goes down) occurs at the same time as the peak of the contraction (mirror images).
41
Q

Variable deceleration

Caused by:

How is it detected?

A
  • Compression of the umbilical cord
  • Abrupt ↓ in FHR ≥ 15 bpm lasting ≥ 15 sec => 2 min (looks like big ‘V’) that occurs before, during or after contractions start
42
Q

Late decelerations

  • Cause and why are they a bad sign?
  • How is it detected?
A
  • Uterine placental insufficiency (UPI)
    • Most ominous type => repetitive decelerations usually indicate fetal metabolic acidosis and low arterial pH
  • Lowest point of deceleration occurs after peak of the contraction
43
Q

2 other potential causes of late decelerations.

A
  1. Excessive uterine acticity
  2. Maternal supine hypotension
44
Q

Prolonged deceleration

  • Cause
  • How can we detect?
A
  • Maternal pushing
  • Decrease in FHR from the basline that is > 15 bpm lasting in between 2-10 minutes.
45
Q

What is this?

A

Prolonged deceleration

46
Q

What is this?

A

Sinusoidal pattern= often seen with fetal anemia and a smooth wave like pattern with a 3-5 bpm frequency

47
Q

what is this

A

early deceleration

48
Q

what is this

A

late deceleration

49
Q

what is this

A

variable deceleration

50
Q

What kind of variability, accelerations, and decelerations may be seen in category I interpretation of FHR pattern?

A
    • Moderate variability
    • NO late or variable decelerations
    • Accelerations and early decelerations may or may not be present
51
Q

Category II

A
  • 1. Intermittant variable decelerations = NL outcomes
  • 2. Recurrent variable decelerations = d/t compression of umbilical cord
52
Q

Goals and Management for Category II, recurrent variable decelerations (>50% of contractions)?

A

GOAL: alleviate cord compression by 2 ways:

  1. Repositioning amnioinfusion (1st stage of labor) = instillation of NL saline though a transcervical IUPC
  2. Have mom push w/ every other contraction
53
Q

Goals and management of category II, tachysystole, if seen on fetal heart monitoring?

A
  • GOAL: to reduce activity of uterus
    • Lateral positioning + IV bolus + ↓ oxytocin rate or discontinue
    • If no response, give uterine tocolytic (Terbutaline SQ or IV)
54
Q

What seen on fetal heart rate tracing would be considered category III?

A
  1. No baseline variability
    1. Recurrent late decelerations
    2. Variable decels
    3. Bradycardia
  2. Sinusoidal pattern
55
Q

Goals and management for Category 3

A

Goal: prepare mom to deliver

Management:

  1. Reposition mom
  2. IV bolus
  3. O2 supp
  4. Scalp stimulation
  5. If no improvement and scalp stimulation test does not cause acceleration => deliver
56
Q

When would you do fetal scalp stimulation and what is a normal response?

A
  • Differentiate fetal sleep from acidosis, when the fetal tracing shows ↓ variability but no decelerations
  • NL: Stimulate scalp => acceleration of 15 bpm for 15 sec occurs then the fetal pH = 7.2 or greater
57
Q

how many minutes do you have to deliver an emergent c-section

A

30 minutes

58
Q

What is the condition of babies delivered if there is a non-reassuring FHR?

A

most are healthy

59
Q

What are 2 potential causes of late decelerations?

A
  1. Excessive uterine activity
  2. Maternal supine HYPOtension
60
Q

What tracings would we see with cord compression?

A
  1. Variable decelerations
  2. Prolonged deceleration
  3. Fetal bradycardia

Endo/Repro II Test 1 (23 decks)

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