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Maternal- Newborn & Women's Health Nursing > Chapter 14 pp350- 371 Intrapartum Fetal Surveillance > Flashcards

Chapter 14 pp350- 371 Intrapartum Fetal Surveillance Flashcards

Exam 2

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1
Q

What is the primary goal of intrapartum fetal surveillance?

A

to enable clinicians to assess adequacy of fetal oxygenation during labor

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2
Q

How has fetal monitoring transitioned over the years?

A

from “low” technology to “high” technology

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3
Q

What percentage of births in the US are electronically monitored?

A

89%

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4
Q

Information that is gathered at the bedside assists clinicians with their assessment by:

A

1.) Evaluation of fetal oxygenation
2.) Decision to implement corrective measures to improve fetal oxygenation.
3.) Provision of a mechanism to optimize communication between clinicians and patients.
4.) Support of clinical decision making which promotes as environment of patient safety and quality care.

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5
Q

Five Factors for adequate fetal oxygenation:

A

1.) Sufficient maternal blood flow and volume to the placenta.
2.) Normal maternal oxygen saturation.
3.) Adequate exchange of oxygen and carbon dioxide.
4.) An open circulatory path from placenta to fetus through umbilical cord vessels.
5.) Normal fetal circulatory and oxygen-carrying functions.

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6
Q

Uteroplacental circulation

A

The placenta is a unique vascular organ that receives blood from the circulatory systems of both the pregnant client and the fetus. In other words, there are two separate circulatory systems, maternal–placental (i.e., uteroplacental) blood circulation and fetal–placental blood circulation.

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7
Q

Fetal placental circulation

A

The umbilical cord links the fetal umbilicus to the placenta’s fetal surface. Protected by Wharton’s jelly, an umbilical cord has three vessels: two arteries and one vein. Oxygenated nutrient-rich blood is carried to a fetus by the umbilical vein and is distributed by the fetal heart throughout the body. Deoxygenated blood and waste products circulate back to a placenta via two umbilical arteries. Three anatomic shunts, ductus venosus, foramen ovale, and ductus arteriosus, allow fetal blood to bypass the fetal liver and lungs. The fetal heart circulates oxygenated blood throughout the fetal body.

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8
Q

What 3 systems influence the Fetal Heart Rate regulation?

A

*Autonomic nervous system
*Baroreceptors and Chemoreceptors
*Hormonal influences

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9
Q

A light abdominal touch with fingertips over the fundus as a contraction develops is called what?

A

palpation

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10
Q

Descriptive terms of palpation

A

soft, mild, moderate, strong

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11
Q

Palpation is what when assessing uterine activity?

A

subjective

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12
Q

a uterus that is not taut

A

soft

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13
Q

a uterine fundus that is tense but easily indented, like the tip if a soft nose

A

mild

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14
Q

feel firm and difficult to indent, comparable to touching a chin

A

moderate contractions

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15
Q

often feel rigid and challenging to indent like palpating a forehead

A

strong contractions

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16
Q

Example of Intermittent Fetal Heart Rate Auscultation devices

A

*fetoscope
*pinard stethoscope
*hard-held doppler ultrasound

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17
Q

FHR is heard best where?

A

fetal back

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18
Q

When the fetus is cephalic the FHR is heard best where?

A

lower quadrants below umbilicus

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19
Q

If fetus is breeched the FHR is best heard where?

A

in upper quadrants above the umbilicus

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20
Q

Benefits of Auscultation and Palpation

A
  • widely available and easy to use with proper training
  • less invasive than EFM
  • outcomes comparable to EFM in low-risk women
  • inexpensive
  • atmostphere more natural than technologic
  • comfortable for the woman
  • oftters women freedom of momvement and ability to ambulate to promote normal labor
  • 1:1 nursing care promotes “doula effect” benefits
  • allows easy FHR and uterine activity assessment during use of hydrotherapy
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21
Q

EFM

A

electronic fetal monitoring

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22
Q

These maneuvers provide a systematic method for palpating the fetus through the abdominal wall during the latter part of pregnancy. These maneuvers provide valuable information about the location and presentation of the fetus.

A

Leopold’s Maneuvers

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23
Q

What are the 4 Leopold’s Maneuvers

A

1st maneuver: fundal palpation
2nd maneuver: lateral palpation
3rd maneuver: Pallach’s maneuver/ grip
4th maneuver: pelvic palpation

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24
Q

Limitations of Auscultation and Palpation

A
  • difficult to perform in some situations, such as hydraminos and maternal obesity
  • client may be intolerant of clincian’s touch during contraction
  • doesd not provide a permanent, documented visual record of the FHR or Uterine Activity
  • Counting of FHR is intermittent
  • Cannot assess visual patterns of FHR variablility or periodic and non-periodic changes
  • unable to detemine UA intensity objectively
  • significant events, such as prolonged decelerations, may occur during periods when the FHR is not auscultated
  • may not allow early detection of FHR changes reflective of hypoxemia
  • not recommended for high-risk pregnancies
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25
Q

What is EFM (Electronic Fetal Monitoring) used for?

A

used to recognize, analyze and display FHR, UA, and maternal vital signs

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26
Q

Types of EFM

A

external, internal, or combination of both

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27
Q

What does an External EFM do?

A

collects data via transducers applied to the abdomen

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28
Q

Where is an Internal EFM placed and why?

A

placed on a fetal presenting part to monitor FHR or within the uterine cavity to measure intrauterine pressure

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29
Q

EFM instrumentation

A
  • Non-electronic intermittent auscultation and palpation
  • Electronic bedside fetal monitor and transducers
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30
Q

Non-electronic intermittent auscultation and palpation should be performed how?

A

in a consistent manner and in accordance with professional guidelines

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31
Q

info on Electronic bedside fetal monitor and transducer

A
  • modern labor and delivery units have wireless monitoring systems
  • external fetal heart rate is obtained via Doppler, or ultrasound
  • Uterine activity is acquired via tocodynamometer (toco)
32
Q

Benefits of EFM

A
  • nonivasive, easy to apply
  • may be used during both the antepartum and intrapartum period
  • sometimes used with telemetry when available
  • does not require ruptured membranes or cervical dilation
  • no known risks to the woman or fetus
  • provides continous recording of FHR and uterine activity (UA)
33
Q

Limitations of EFM

A
  • limits maternal mobility
  • frequent repositioning of transducers is often needed to maintain readable accurate tracing
  • may double-count a slow FHR of <60 bpm; may half-count a FHR of >180bpm
  • maternal HR may be recorded if monitor placed over maternal arterial vessels, such as the aorta
  • unbale to assess strength or intensity of UA
  • obese women and preterm or multifetal gestations may be difficult to monitor
34
Q

Which part of the EFM is placed over the uterine fundus?

A

tocodynamometer (toco)

35
Q

How can the information that the toco provide be used?

A

to monitor uterine contractions

36
Q

The part of the EFM that is placed over the area of the fetal back.

A

ultrasound device

37
Q

This device transmits information about the FHR.

A

the ultrasound device

37
Q

Examples of Internal fetal monitoring

A
  • fetal scalp electrodes (FSE)
  • intrauterine pressure catheter (IUPC)
38
Q

What does the FSE (fetal scalp electrode) require in order for to be used?

A

requires cervical dialation (of at least 2cm) and ruptured membrane

39
Q

Where are the electrodes applied?

A

directly applied to fetal presenting part (head or buttocks); a spiral electrode

40
Q

How is the IUPC (intrauterine pressure catheter) placed?

A

a sterile, flexible catheter inserted directly into the uterus trans-cervically

41
Q

What does the IUPC (Intrauterine pressure catheter) measure?

A

actual uterine pressure in milimeters of mercury (mm Hg)

42
Q

Benefits of Internal Fetal Monitoring-fetal scalp electrodes (FSE)

A
  • capable of accurately displaying some fetal cardiac arrhythmias when linked to ECG recorder
  • accurately displays FHR between 30 and 240 bpm
  • maternal position changes do usually affect quality of FHR tracing
43
Q

Benefits of Internal Fetal Monitoring-
Intrauterine pressure catheter (IUPC)

A
  • only true accurate measure of all UA
  • allows for use of amnioninfusion
44
Q

Limitations of Internal Fetal Monitoring- Fetal scalp electrodes (FSE)

A
  • requires ruptured membrane
  • cervix must be dilated sufficiently to allow placement
  • improper insertion can cause maternal trauma such as vaginal lacerations
  • presenting part must be accessible and identifiable
  • may record maternal HR in presence of fetal demise
  • may not have adequate ECG conduction when excessive fetal hair is present
  • possible increased risk for infection
45
Q

Limitations of Internal Fetal Monitoring-
Intrauterine pressure catheter (IUPC)

A
  • requires ruptured membrane
  • cervix must be dilated sufficiently to allow placement
  • improper insertion can cause maternal or placental trauma such as uterine perforation or placental abruption
  • maternal position may change uterine hydrostatic pressure resulting in inaccurate readings
  • different IUPC types may give higher pressure readings than other types
  • possible increased risk for infection
46
Q

Continuous paper tracing

A

-upper grid for recording fetal heart rate; vertically scaled in beats per minute (bpm)
-lower grid for recording uterine activity; vertically scaled in milimeters of mercury (mm Hg)

47
Q

What print on a continuous paper tracing like the ECG strip?

A

Fetal heart rate (FHR) and uterine activity (UA)

48
Q

Other than paper tracing, how else can data be recorded for FHR/ UA tracing?

A

on a computer tracing that is viewed bedside or a remote location

49
Q

Each tracing has an x-axis and a y-axis depicting what?

A

the FHR and contraction pattern

50
Q

Normal FHR/ Baseline (with the blue strip)

A

110- 160 bpm

51
Q

Bradycardic FHR (below the blue strip)

A

<110bpm

52
Q

Tachycardic FHR (above the blue strip)

A

> 160bpm

53
Q

What are some potential causes of FHR bradycardia (fetus)?

A
  • cardiac conduction abnormalities
  • heart block
  • fetal heart failure
  • structural cardiac defects
  • Heterotaxia
  • Hypothyroidism
  • interrupted fetal oxygenation pathway- umbilical cord prolapse
54
Q

What are some potential causes of FHR bradycardia (mother)?

A
  • sympatholytic medications- metyldopa; beta blockers
  • Sjorgren’s antibodies
  • Hypoglycemia
  • Hypothermia
  • viral infections
55
Q

What are some potential causes of FHR tachycardia (fetal)?

A
  • acute blood loss
  • fetal Anemia
  • heart failure
  • Hyperthyroidism
  • Hypoxia/ Hypoxemia
  • increased metabolism tate
  • infection and fetal sepsis
  • tachyarrhythmias
56
Q

What are some potential causes of FHR tachycardia (mother)?

A
  • Beta-sympathomimetic drugs- terbutaline and/ or epinephrine
  • parasympatholytic drugs
  • dehydration
  • fever
  • hyperthyroidism
  • infection
  • cocaine
57
Q

Baseline FHR variability

A
  1. Determined in a 10 min window, excluding periodic and episodic changes
  2. Defined as fluctuations in BL rate which are irregular in amplitude and frequency
  3. Classifications of variability
  4. Predicts neurologic injuries, fetal hypoxemia, abnormal fetal acid-base status
  5. Causes of increased/ decreased variablitity: prematurity, medications (opioids, mag sulfate, analgesics), fetal anemia, fetal cardiac arrhythmias, infection, neurologic injury
58
Q

Classifications of FHR variability

A
  • absent
  • minimal
  • moderate
  • marked
59
Q

absent

classification of FHR variability

A

amplitude range visually undetectable

60
Q

minimal

classification of FHR variability

A

amplitude range visually detectable but 5bpm or less

61
Q

moderate

classification of FHR variability

A

amplitude range 6bpm to 25bpm

62
Q

marked

classification of FHR variability

A

amplitude range >25bpm

63
Q

What is the spontaneous acceleration FHR max?

A

165bpm

64
Q

Why are accelerations important findings?

A

they indicate that the fetus has a functioning ANS and is not experiencing acidosis

65
Q

What are accelerations of a fetus that is older than 32 wks gestation?

A

expected and reassuring

66
Q

Associated with uterine contractions

A

periodic

67
Q

not associated with uterine contractions

A

episodic

68
Q

accelerations can be?

A

periodic and/ or episodic

69
Q

decelerations can be?

A

early, late, variable, prolonged

70
Q

head compression

deceleration

A

early decelerations/ periodic

71
Q

uteroplacental insufficiency

A

late decelerations/ periodic

72
Q

cord compression

A

variable decelerations/ periodic or episodic

73
Q

Prolonged decelerations

A

periodic or episodic

74
Q

VEAL CHOP

A

V- variable
E- early
A- acceleration
L- late

C- cord compression
H- head compression
O- Oxygenate
P- Placental/ Uterus Insufficiency

75
Q

A pattern that are descibed as a visually apparent, smooth, sine wave-like undulating pattern in a FHR baseline. This wavy pattern occurs wit ha frequency of three to five cycles per minute that persist for at least 20 minutes. They are excluded from variability definitions because this pattern is characterized by FHR fluctuations that are regular in amplitude and frequency. They are extremely rare and are indicative of a compromised fetus that requires immediate attention to optimize perinatal outcomes.

A

sinusoidal patterns

76
Q

Lowest point, such as the lowest pulse rate in a series

A

nadir

Maternal- Newborn & Women's Health Nursing (16 decks)

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