Chapter 18: Fetal Assessment During Labor

Question 1

maternal blood flows through ______ into the ________ space to the ________ for fetal oxygenation

Answer 1

uterine arteries; intervillous spaces; umbilical vein

Question 2

unoxygenated blood returns to the placenta by way of the _______ and diffuses through _______ and returns to the placenta

Answer 2

two fetal arteries; intervillous space

Question 3

fetal vein carries_______

Answer 3

oxygenated blood

Question 4

fetal arteries carry_______

Answer 4

deoxygenated blood

Question 5

when uterine myometrium contracts the flow of oxygenated blood through the ________ is decreased

Answer 5

uterine artery

Question 6

for internal fetal heart rate monitoring ______ is applied to the presenting part of

Answer 6

spiral electrode

Question 7

for internal fetal HR monitoring, ______ is applied to asses uterine activity

Answer 7

intrauterine pressure catheter

Question 8

for external fetal monitoring ______ monitors the fetal HR and _______ monitors the uterine activity

Answer 8

ultrasound transducer; tocodynamometer

Question 9

what three things cause weak or absent signals for EFM

Answer 9

1. obesity
2. occiput posterior position of the fetus
3. anterior attachment of the placenta

Question 10

tocodynamometer detects _______ and _______ of uterine contractions

Answer 10

frequency; duration

Question 11

where is the tocodynamometer placed for EFM

Answer 11

over the fundus of the uterus

Question 12

where is the ultrasound transducer placed for EFM

Answer 12

over the fetal back

Question 13

criteria for internal fetal monitoring includes:
1.
2.
3.

Answer 13

1. amniotic membranes must be ruptured
2. at least 2 cm dilated
3. presenting part is down against the cervix

Question 14

___________ can effectively measure frequency, duration, AND severity of uterine contractions

Answer 14

intrauterine pressure catheter

Question 15

Montevideo units give us information about what?

Answer 15

if contractions are adequate enough to advance labor

Question 16

_________ is the average fetal HR during a 10 minute period that does not include episodic changes or variability

Answer 16

baseline fetal HR

Question 17

normal fetal HR is between ________

Answer 17

110-160 BPM

Question 18

________ refers to irregular waves or fluctuations of the FHR of two cycles per minute or greater

Answer 18

variability

Question 19

beat to beat variability in internal fetal monitoring is produced by the :

Answer 19

vagal nerve

Question 20

_______ can be used to treat category 2 FHR tracing

Answer 20

intrauterine pressure catheter

Question 21

fetal tachycardia

Answer 21

> 160 bpm

Question 22

fetal bradycardia

Answer 22

< 110 BPM

Question 23

baseline variability reflects fetal _______

Answer 23

CNS/PNS

Question 24

_______ variability is defined as undetectable amplitude range

Answer 24

absent

Question 25

______ variability is defined as amplitude range of less than 5 BPM

Answer 25

minimal

Question 26

absent or minimal variability is abnormal or normal?

Answer 26

abnormal

Question 27

``` absent or minimal variability can result from: 1. 2. 3. 4. 5. 6. ```

Answer 27

1. fetal hypoxia 2. metabolic acidemia 3. fetal sleep cycle 4. fetal tachycardia 5. extreme prematurity 6. CNS depression meds

Question 28

moderate variability is defined as

Answer 28

6-25 bpm

Question 29

_______ variability is considered normal

Answer 29

moderate

Question 30

presence of moderate variability suggests:

Answer 30

normal fetal acid-base balance

Question 31

marked variability is defined as:

Answer 31

greater than 25 BMP

Question 32

sinusoidal classically occurs with:

Answer 32

severe fetal anemia

Question 33

_______ is considered an early sign of fetal hypoxemia

Answer 33

tachycardia ( >160 bpm)

Question 34

fetal bradycardia is often caused by:

Answer 34

fetal cardiac problems/ HF

Question 35

medications that might cause fetal tachycardia include: 1. 2. 3.

Answer 35

1. atropine 2. hydroxyzine 3. terbutaline

Question 36

_________ is an abrupt increase in FHR of at least 15 bpm for 15 seconds (less than 2 min)

Answer 36

accelerations

Question 37

early decelerations are thought to be caused by:

Answer 37

fetal head compressions

Question 38

the onset, nadir (lowest point) and recovery of early decelerations often corresponds with:

Answer 38

the beginning, peak, and end of contractions

Question 39

are early decelerations bad?

Answer 39

not really, usually a normal finding

Question 40

late decelerations are associated with:

Answer 40

placental insufficiency ( not enough oxygen)

Question 41

the onset, nadir (lowest point) and recovery of a late declaration occurs:

Answer 41

after the onset of he contraction and after the peak of the contraction

Question 42

variable decelerations are:

Answer 42

a drop in 15bmp at any random time

Question 43

variable decelerations are associated with:

Answer 43

cord compression

Question 44

________ is a deceleration of at least 15 bpm that lasts more than two minutes but less than 10

Answer 44

prolonged

Question 45

_______ are accelerations or decelerations patterns that are not associated with UC

Answer 45

episodic changes in FHR

Question 46

_________ are accelerations or decelerations that are r/t UC's that persist over time

Answer 46

periodic changes

Question 47

three major areas we assess in FHR monitoring: 1. 2. 3.

Answer 47

1. FHR baseline 2. Periodic and episodic changes 3. uterine activity

Question 48

``` causes of fetal tachycardia: 1. 2. 3. 4. 5. ```

Answer 48

1. maternal fever 2. fetal hypoxia 3. intrauterine infection 4. medication 5. Anemia

Question 49

fetal HR of 200-220 bpm indicates:

Answer 49

fetal demise

Question 50

causes of fetal bradycardia: 1. 2.

Answer 50

1. profound hypoxia | 2. anesthesia

Question 51

fetal tachycardia with decreased variability and decelerations is a major indicator of:

Answer 51

fetal hypoxemia

Question 52

decrease Pitocin if fetal HR is _________

Answer 52

tachycardia

Question 53

sudden fetal bradycardia is________

Answer 53

an emergency

Question 54

``` maternal causes of fetal bradycardia: 1. 2. 3. 4. 5. 6. ```

Answer 54

1. supine position 2. dehydration 3. hypotension 4. cardiac problems 5. placental abruption 6. medications

Question 55

``` fetal causes of fetal bradycardia: 1. 2. 3. 4. 5. ```

Answer 55

1. hypoxia/hypoxemia 2. umbilical cord occlusion 3. head compression 4. hypokalemia 5. bradyarrhythmia's

Question 56

discontinue Pitocin for _______

Answer 56

fetal bradycardia

Question 57

if baby is bradycardia the nurse should do a vaginal exam for:

Answer 57

prolapsed cord

Question 58

two major fetal causes of variability: 1. 2.

Answer 58

1. sleeping | 2. premature

Question 59

``` maternal causes of variability: 1. 2. 3. 4. ```

Answer 59

1. cord compression 2. uterine tachsystole 3. drugs 4. supine hypotension

Question 60

``` management of variable decelerations: 1. 2. 3. 4. ```

Answer 60

1. IV Bolus- HYDRATION 2. d/c Pitocin 3. O2 delivery 4. change position 5. consider internal monitoring

Question 61

``` Sinusoidal patterns are associated with: 1. 2. 3. 4. ```

Answer 61

1. fetal anemia 2. fetal hydrops 3. polyhydramnios 4. placental edema

Question 62

normal accelerations for a preterm fetus:

Answer 62

10:10 (10 bpm increase for 10 minutes)

Question 63

_______ decelerations are the most ominous and require immediate intervention

Answer 63

late

Question 64

``` intervention for late decelerations: 1. 2. 3. 4. ```

Answer 64

1. stop Pitocin 2. turn to left side 3. increase hydration 4. 10-12 L O2

Question 65

normal fetal pH pre-acidotic fetal pH acidotic fetal pH

Answer 65

normal: 7.25 pre-acidotic: 7.20 acidotic: 7.19 or lower

Question 66

when fetal pH is 7.19 or lower what is the necessary intervention

Answer 66

emergency C-section

Question 67

for prolonged decelerations consider giving __________

Answer 67

tocolytics (Terbutaline)

Question 68

amniofusion is sometimes considered for _________

Answer 68

prolonged decelerations

Question 69

what FHR category do these parameters suggest: 1. normal baseline of 110-160 BPM 2. baseline variability is moderate 3. decelerations are absent 4. accelerations are absent or present 5. well- oxygenated fetus 6. non-acidic (7.25-7.3)

Answer 69

Category 1

Question 70

which FHR tier do these parameters suggest: 1. tachycardia or bradycardia present 2. decelerations that return to baseline 3. prolonged decelerations (>2 min but <10min) 4. minimal or marked variability

Answer 70

category 2

Question 71

which FHR tier do these parameters suggest: 1. non-predictive fetal-acid base 2. absent baseline variability 3. recurrent late decelerations 4. OR recurrent variable decelerations 5. OR bradycardia 6. sinusoidal pattern

Answer 71

category 3

Question 72

after performing a fetal scalp massage, we should see:

Answer 72

accelerations of 15 bpm for 15 minutes

Question 73

3 criteria for cord blood analysis: 1. 2. 3.

Answer 73

1. abnormal FHR 2. meconium stained amniotic fluid 3. infant is depressed at birth

Question 74

normal fetal blood should have a pH of ______ and anything less suggests ________

Answer 74

7.25; acidosis/ hypoxia

Question 75

how are Montevideo units measured?

Answer 75

during internal fetal monitoring with an intrauterine pressure catheter

Question 76

________ Montevideo units is required for advancing labor by bringing about dilation and effacement during the active phase

Answer 76

200