Ch 14 Fetal monitoring Flashcards
what method of EFM:
- high risk
- ptns on oxytocin (induction of labor)
- epidural
- NOT home births, birth centers
- ONLY in patient settings
continuous
what method of EFM:
- ptns who are ambulatory, low risk
- Can be done w/ doppler if only - FH is required or EFM short strip is only needed
intermittent
how long are fetal monitoring strips kept?
21 years total
18 + 3 years to file suit
how do you monitor uterine contractions?
palpate
ACOG
Reassuring. No further action needed at this time
Cat 1
ACOG
Indeterminate. Warrants further observation. → most strips are likely here
Cat 2
ACOG
Abnormal. Immediate and prompt intervention required. → delivery within 30 min or DEATH
Cat 3
110-160
normal fetal hr
Baseline
Must be able to observe a portion of tracing without ___________________ or without variations of </>## bpm
Must be able to observe a portion of tracing without periodic/episodic changes or without variations of >25 bpm
Fluctuations or ‘waviness’ of the baseline FHR
Variability
amplitude peak to trough UNDETECTABLE
like asystole
absent variability
due to meds, fetal sleep cycle, anesthesia
amplitude >undetectable but <5
minimal variability
normal variability
amplitude >6 and <25
moderate
may be related to hypoxia or fetal seizure activity
amplitude >25
marked
what is the predictor of oxygenation and acidosis level of the fetus?
variability
Smooth, undulating wave form
Can be indicative of severe fetal anemia or of use of certain types of medications (Stadol) (especially if it goes away in a short pd of time)
sinusoidal
Transient or sustained fetal heart rate under 110 bpm
Must determine which it is because interventions different
if true - may be cardiac defect
if transient, may be r/t hypoxic event
bradycardia
Baseline of over 160 bpm for more than 10 minutes
Prolonged accelerations can be confusing-can be caused by fetal movement
True __________ can be caused by maternal and/or fetal infection, maternal meds, illicit drugs
tachy
most common causes of fetal tachy
infection
dehydration
drug abuse
what stops uterine contractions, esp b/c they are close together due to oxytocin?
terbutaline
fetal heart rate changes that occur WITH contractions
periodic
fetal heart rate changes not associated w/ contractions
episodic
15 x 15 rule
32 weeks, 15 beats above baseline for at least 15 seconds
10 x 10 rule
<32 weeks criteria for accelration becomes 10 x 10
normal, or sign of head compression (cephalopelvic disproportion)
early decel
occur after contraction
usually b/c of uteroplacental insufficiency
bad sign - no oxygen / cut off oxygen - fetal acidosis / hypoxemia. requires immediate intervention
interventions: position, give mom o2, IVF, stop pitocin, c-section
late decel
can be with or without contraction; usually transient; don’t let it linger down below
generally V in shape
cause: cord compression
intervention: positioning; amnioinfusion may be indicated if recurrent to provide cushion to prevent cord compression
variable decelerations
Lasts between 2-10 minutes.
Many causes of disruption to fetal oxygen supply.
Cord compression, pushing, hypotension after epidural, prolonged uteroplacental insufficiency (abruption, tachysystole)
prolonged deceleration
Predictive of normal acid/base balance
Baseline FHR 110-160 bpm
Baseline variability moderate
Present or absent accelerations
Present or absent early decelerations
No late or variable decelerations
cat 1
Not predictive of abnormal fetal acid/base status
Fetal tachycardia present
Bradycardia not accompanied by absent baseline variability
Absent baseline variability not accompanied by recurrent decelerations
Minimal or marked variability
Recurrent late decelerations with moderate baseline variability
Recurrent variable decelerations accompanied by minimal or moderate baseline variability. Overshoots or ‘shoulders’
Prolonged decelerations >2 min. but
Cat 2
Predictive of abnormal fetal acid/base status
Fetal bradycardia
Recurrent late decelerations
Recurrent variable decelerations
Sinusoidal pattern
Cat 3
