Cellular Regulation

Question 1

Nonstress test purpose

Answer 1

•Assess fetal well-being by observing changes in the fetal heart rate pattern

Question 2

Nonstress test advantages

Answer 2

• Noninvasive
• Quick to perform
• Easy interpretation
• Inexpensive
• No contraindications or side effects

Question 3

Nonstress test disadvantages

Answer 3

• Can be difficult to get a suitable tracing
• Woman must remain relatively still for at least 20 minutes
• High false-positive rate
• Less sensitive in detecting fetal compromise than the CST or BPP

Question 4

Non stress test position

Answer 4

Reclining chair or bed

•Left-tilted, semi-Fowler’s, or side-lying

Question 5

Nonstress test equipment

Answer 5

• Electronic fetal monitor
• Doppler transducer- fetal ❤️ rate ( normal 110-160)
• Toco transducer- contractions
• Handheld button to mark fetal movement

Question 6

Nonstress Test Interpretation

•Reactive or NonReactive

Answer 6

Want Reactive Result!!
1) Shows at least TWO accelerations of FHR with fetal movements of 15 beats, lasting 15 seconds or more, over a 20 minute time period

•In preterm fetuses an acceleration is 10 beats above baseline for 10 seconds; still test for 20 minutes

2) Nonreactive= NOT at least two accelerations over 20 mins

•If fetal heart rate decelerations are noted, the health care provider needs to be notified

Question 7

Acceleration

Answer 7

Jump UP from the FHR baseline of 15 beats (1.5 boxes up), lasting at least
   15 seconds (1.5 boxes across)

Question 8

Deceleration

Answer 8

Drop DOWN from the FHR baseline of 15 beats (1.5 boxes down), lasting at least
   15 seconds (1.5 boxes across)

Question 9

Nonstress test (NonReactive )

Answer 9

There ARE NOT at least two accelerations of FHR with fetal movements of 15 beats/min, lasting 15 seconds or more, OVER 20 minutes

Question 10

Contraction Stress Test

•Purpose

Answer 10

• Evaluates placental respiratory function

* Identifies the fetus at risk for intrauterine asphyxia

Question 11

Contraction Stress Test advantages and disadvantage

Answer 11

Advantages (compared to NST)
•Earlier warning of fetal compromise
•Less false-positive results

Disadvantages (compared to NST)
•More time consuming
•Expensive
•Invasive

Question 12

Contraction stress test Contraindications

And what can it cause?

Answer 12

Should NOT be performed on women who SHOULD NOT give birth vaginally at the time the test is done

Contraindications
•Preterm Labor
•Placenta Previa
•Vasa Previa
•Cervical Insufficiency
•Multiple Gestation
•Classical Incision from Prior Cesarean Birth

• could induce labor or cause bleeding / uterus rupture

Question 13

CST positions

Answer 13

Semi-Fowler or sits in a reclining chair with a slight lateral tilt

Question 14

CST equipment

Answer 14

• Electronic fetal monitor
• Toco transducer, Doppler transducer
• Oxytocin
• Intravenous equipment and infusion pump

**Have tocolytic medication at the bedside

Question 15

CST

How it’s induce? How long?
How to tell if contractions good?

Answer 15

Contractions likely induced with Oxytocin or self- breast stimulation

• 10-20 minute baseline recording of uterine activity and FHR obtained
• Tracing evaluated for evidence of spontaneous contractions
• If 3 spontaneous CONTRACTIONS of good quality and lasting 40 to 60 seconds occur in a 10-minute window, results are evaluated, and test is concluded

Question 16

Contraction Stress Test Interpretation

Answer 16

Negative
•At least 3 uterine contractions in a 10-min period, with NO late or variable decelerations
•GREAT!!!

Positive
•Late decelerations occur with 50% or more of contractions, even if there are fewer than three contractions in 10 minutes
•May need hospital admission for further evaluation or immediate delivery

Unsatisfactory
•Failure to produce 3 uterine contractions within a 10-min window or inability to trace the FHR
•Further evaluation- prolonged monitoring or repeat next day

Question 17

Labor induction

Why would this need to be done?
What’s contradicted ?

Answer 17

• Stimulation of uterine contractions before the spontaneous onset of labor, with or without ruptured membranes for the purpose of accomplishing birth
• Indications: Diabetes, preeclampsia, eclampsia, premature rupture of membranes (PROM), chorioamnionitis, postterm, intrauterine fetal death, intrauterine growth restriction (IUGR), alloimmunization, nonreassuring antepartum testing
• Any contraindication to spontaneous labor or vaginal birth are contraindications of labor induction

Question 18

Labor readiness ( what 3 things to look at)

Answer 18

•Assess

• gestational age
• amniotic fluid studies to determine lung maturity
• Bishop score

Question 19

Amniotomy - AROM

Answer 19

Breaking the “water”
At least 2 cm of dilated

Color
Odor
Meconium or blood
Consistency
Amount

• Temp q2h
• limit vaginal exams after
• asses for cord prolapse

Question 20

Cervical Ripening

What does this help?
What scale to use to assess cervix?

Answer 20

Effacement and softening of the cervix

Help induce labor or shorten it
- can cause hyper stimulation of uterus

Use bishop scale

Need to lay on side for 1 hour after
- void before

Drugs: cervidil, prepidil, cytotec

Question 21

Membranes stripping

Answer 21

Gloved finger inserted into the internal os and rotated 360 degrees twice to SEPARATE amniotic membranes lying against the lower uterine segment

Could stimulate contractions from prostandglandin release and COULD induce labor

• can cause bleeding

Question 22

Mechanical dilation with intracervical catheter

Answer 22

Cather places to widen
Hard to stay in place
No harm to baby with drugs

Question 23

Hypertonic uterine activity (Tachysystole):

What can it cause baby to do?
What to do if this occurs?

Answer 23

More than 5 contractions in 10 minutes

• FHR non-reassuring patterns: tachycardia, bradycardia, decreased variability and late decelerations
• If either of these situations occurs:

1) Stop oxytocin
2) IV fluid bolus of 500 mL LR’s
3) position mom to side-lying position
4) administer oxygen by face mask at 8-10 L/min.
5) Notify physician. Might give Terbutaline per agency protocol

Question 24

Bishop scale

Answer 24

helps determine how “ready” or “favorability” cervix is for labor

• want at least a score of 8 (favorable and likely to respond to pitocin)
• score of 9 (spontaneous labor is probably going to work by its self)
• less than 8 (not favorable and NEED something to help prepare cervix)