Chapter 18 Flashcards
We’ve been able to assess the fetal heart initially described more than how many years?
300
Electronic fetal monitoring debuted in ?
1970s
Research has not shown that intrapartum FHR monitoring leads to ?
Significant decrease in neonatal neurologic morbidity
What is the fetal response?
The oxygen supply must be maintained to prevent fetal compromise
What are 4 things that can decrease fetal response?
Reduction of blood flow through maternal vessels
Reduction in oxygen content in maternal blood
Alterations in fetal circulation
Reduction in blood flow to intervillous space in placenta
What are two monitors we want to have?
Uterine activity
Fetal monitor
What is uterine activity?
Monitoring provides information on uterine contractions
Why do we want to watch the contractions?
To see how the baby is reacting to it
What are some normal findings of a fetal heart rate?
Rate?
110-160
What are accelerations??
So when the babies heart rate will increase 15 beats per minute and stay there for 15 seconds
These are good!! Good oxygen flow
What are early decelerations?
Is this normal?
When the contraction goes up
And then the heart rate goes down
Yes normal
( they like mirror images of each other )
What is a late deceleration?
When the contraction goes up
But then the heart rate goes up
Then goes down
Like the baby is late to the party
What is the cause of early deceleration?
( mirroring !!)
Because of head compression
What does variability mean?
What’s the normal fluctuations of the fetal heart rate?
How the heart changes second to second
6-25beats per minute around the baseline
What does the variability of the heart rate indicate?
A healthy nervous system
Why do we want to see fluctuations of the heart rate between 6-25 ? Instead of like a steady 120?
Because it means we have a healthy nervous system
What’s a normal variability ?
Moderate!
What is fetal bradycardia?
Anything below 110
How do we determine fetal bradycardia or anything abnormal ?
When that heart rate is sustained for 10mins !!
Why does fetal bradycardia happen?(4)
Prolong cord compression
( no oxygen!! )
Umbilical cord prolapse
Anesthetic medications
( morphine ! )
Fetal heart abnormalities
So when we have fetal bradycardia, we have to think that the baby isn’t receiving enough oxygen, so what are some ways we can help baby?
Side lying position
Repositioning the uterus
Iv fluids
Oxygen
Notify the provider
Before you notify a provider, you need to what?
See if you can intervene in your scope of practice
What is fetal tachycardia?
Anything above 160 beats per min
What can cause fetal tachycardia?
Maternal fever /infection !!!
Fetal hypoxia
Maternal hypothyroidism
Stimulants ( cocaine )
Fetal tachycardia accompanied by decreased variability is indicative of?
Severe fetal distress!!!
Heart rate goes up but variability go down
Again
A late deceleration is what? Think of the stripe
Like the baby is slightly off from the mirror contraction of a acceleration
The peak of the contraction is gonna come first
Then the base of the heart rate is later
What’s the biggest cause of late declarations?
Uteroplacenta insufficiency !!!
( decrease blood flow which leads to fetal hypoxia )
How can you treat late declarations ??
Following the anagram ? (6)
L - left lying positions
I - IV fluids
O - oxygen & discontinue oxytocin
N - notify the provider
S - surgery
What is variable decelerations?
They kinda look like a V
Sharp dramatic drop!!
Then comes back
Then goes alone
What’s the cause of variable declarations?
Umbilical cord compression
Increase fetal blood pressure & decreased fetal heart rate
How can we treat variable decelerations? (3)
Put mom in trendelenburg position
( head down and feet up )
( gravity shift the uterus & baby off the cord )
Knee chest position
Amnioifnusion
Why might we give aminoinfusion to patients with fetal variable decelerations?
This is for patients who have oligohydraminios
( meaning too little amniotic fluid )
( amniotic fluid is like a cushion of the baby and the cord and if we don’t have enough, we can get stuck with the cord so, we add to make a cushion )
What’s
V
E
A
L
C
H
O
p
They line up and you can see the cause for each reason !!
Variable
Early decelerations
Accelerations
Late declarations
Cord compression
Head compression
Okay!!
Placental insufficiency
What are some monitoring techniques?
Intermittent auscultation
( listening to fetal heart sounds )
15-30mins in early labor
15mins later labor
5mins when in labor
What is the downside of intermittent ausculstion?
Just like not constant record
Just the documentation is the record
Better if you have it tied to a machine and have constant record
When do we want to listen during intermittent ausculstion?
We want to see how the baby is during a contraction
Hearing for early and lates
Before or as the contraction is starting and all the way through the contraction until the uterus is at rest
Notes
Electronic fetal monitoring
External
- ultrasound transducer
- toco transducer ( contractions )
- wireless external monitoring
Internal monitoring
- spiral electrode
- intrauterine pressure catheter
- Montevideo units
Display
- FHR in upper section
- UA in lower section
- each small square represents 10 sec
There is a 3 stage system of FHR monitoring what are they?
Category 1 - normal
Category 2 - intermediate
Category 3 - abnormal
Average rate during a ___minutue segments
Segments may differ by more than ?
10!!!!!
To have establish baseline
25beats/mins
What does variability mean?
Described as irregular waves or fluctuations in the baseline FHR of two cycles per minutes or greater
We don’t want a straight baseline why?
Because the baby is not having good reserve and hard time
What are the 4 possible categories of variability?
Absent
Minimal
Moderate
Marked
Absent : low/ even line
Minimal : mom may be medicated / baby sleep
Moderate : normal
Marked : high
Accelerations can be considered an indication of what?
( always a what!! )
Fetal well being
Good thing
Accelerations : good
Decelerations : benign or abnormal
Early d : fetal head compression
Late D : uteroplacenfal insuifficency
Variable D : umbilical cord compression
Prolonged d : lashing more than 2 mins but less than 10mins
What’s a category 1
Base line?
Variability ?
Are there late or variable declarations?
Are there early declarations?
There are accelerations?
110-160
Moderate
Nope
Nope
Either present or absent
What is an acceleration again?
15 beats above the baseline for 15 seconds!
What’s category 2
Baseline?
Minimal or marked ?
Accelerations?
Periodic or episode what?
Is this an ominous sign?
Could be Brady or tachy
Can be both
Nope
Decelesrions
Ehh
( mom can be medication or sleep baby )
What’s category 3?
Baseline?
Recurrent or late decelerations ?
Notes
Nonreassuring FHR patterns associated with fetal hypoxemia
Hypoxemia can deteriorate to severe fetal hypoxia
Absence of baseline variability
Recurrent or late delectations
Bradycardia
Sinusoidal patterns
Bradycardia ( absence )
Yes
