Cellular Regulation Flashcards
Nonstress test purpose
•Assess fetal well-being by observing changes in the fetal heart rate pattern
Nonstress test advantages
- Noninvasive
- Quick to perform
- Easy interpretation
- Inexpensive
- No contraindications or side effects
Nonstress test disadvantages
- 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
Non stress test position
Reclining chair or bed
•Left-tilted, semi-Fowler’s, or side-lying
Nonstress test equipment
- Electronic fetal monitor
- Doppler transducer- fetal ❤️ rate ( normal 110-160)
- Toco transducer- contractions
- Handheld button to mark fetal movement
Nonstress Test Interpretation
•Reactive or NonReactive
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
Acceleration
Jump UP from the FHR baseline of 15 beats (1.5 boxes up), lasting at least 15 seconds (1.5 boxes across)
Deceleration
Drop DOWN from the FHR baseline of 15 beats (1.5 boxes down), lasting at least 15 seconds (1.5 boxes across)
Nonstress test (NonReactive )
There ARE NOT at least two accelerations of FHR with fetal movements of 15 beats/min, lasting 15 seconds or more, OVER 20 minutes
Contraction Stress Test
•Purpose
- Evaluates placental respiratory function
* Identifies the fetus at risk for intrauterine asphyxia
Contraction Stress Test advantages and disadvantage
Advantages (compared to NST)
•Earlier warning of fetal compromise
•Less false-positive results
Disadvantages (compared to NST)
•More time consuming
•Expensive
•Invasive
Contraction stress test Contraindications
And what can it cause?
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
CST positions
Semi-Fowler or sits in a reclining chair with a slight lateral tilt
CST equipment
- Electronic fetal monitor
- Toco transducer, Doppler transducer
- Oxytocin
- Intravenous equipment and infusion pump
**Have tocolytic medication at the bedside
CST
How it’s induce? How long?
How to tell if contractions good?
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
Contraction Stress Test Interpretation
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
Labor induction
Why would this need to be done?
What’s contradicted ?
- 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
Labor readiness ( what 3 things to look at)
•Assess
- gestational age
- amniotic fluid studies to determine lung maturity
- Bishop score
Amniotomy - AROM
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
Cervical Ripening
What does this help?
What scale to use to assess cervix?
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
Membranes stripping
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
Mechanical dilation with intracervical catheter
Cather places to widen
Hard to stay in place
No harm to baby with drugs
Hypertonic uterine activity (Tachysystole):
What can it cause baby to do?
What to do if this occurs?
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
Bishop scale
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)
