Chapter 14 Flashcards
Vaginal examination (8)
- cervical dialtion
- % effacemetn
- fetal membrane status
- presentation
- position
- station
- degree of head flexion
- skull swelling or molding
priority when rupture of membranes occurs
Assess FHR - identify deceleration which could mean cord prolapse or compression
When do fetal membranes typically ruptures
Stage 1 of labor (dilation)
How to confirm rupture
nitrazine yellow dye swab
- vaginal fluid - stays yellow/ olive green
- amniotic -blue
- bloody show - blue (false positive)
fundus firmness = strength test
tip of nose = mild
chin = moderate
forhead = strong
technique to determine presentations, position and lie
Leopold maneuvers
Reasons fetus may pass meconium
transient hypoxia prolonged pregnancy cord compression intrauterine growth restriction maternal hypotension, diabtes, or chorioamnionitis
When is meconium normal
breech position
purpose of evaluating FHR
determine fetal oxygen status
disadvantage of intermittent FHR
cant detect variability
cant detect types of decelrations
Where on mother is FHR normally found
lower abdominal quadrants
guidlines for FHR assessment during active labor
low risk- every 30 min
high risk - every 15 min
guidelines for FHR assessment during second stage of labor
low risk: every 15
high risk: every 5
reasons for continuous internal monitoring
multiple gestation decreased fetal movement abnormal FHR IUGR maternal fever preeclampsai dysfuncitonal labor preterm birth maternal diabetes or hypertension
4 criteria required for use of internal monitor
- dilation of 2 cm
- ruptured membranes
- presenting fetal part low enough for scalp electrode
- skill practitioner
FHR assessment parameters
- baseline rate
- baseline variability
- presence of accelerations
- periodic or episodic decelerations
- changes or trends over time
Normal baseline FHR
110-160
Fetal bradycardia critiera
<110 bpm
>10 minute
causes of fetal brady
fetal hypoxia prolonged maternal hypoglycemai fetal acidosis alangesic drugs to mother hypothermia anesthetic agents (epidural) maternal hypotentsion prolonged cord compression fetal congenital heart block
When is bradycardia ominous
accompanied by decrease in baseline variability and late decelerations
Category I: normal
Good - no action necessary
- moderate baseline variability
- no late or variable decelerations
Category II: intermediate
requires evaluation and surveillance
- fetal tachy
- fetal brady but baseline variability is fine
- minimal or marked variability
- recurrent late decelerations
- recurrent variable decelerations
- prolonged decelerations (2-10 min)
Category III: abnormal
intervention required!
- fetal bradycardia
- recurrent late decel
- sinusoidal pattern
fetal tachy criteria
160bmp
>10 min
