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OB > Chapter 18: Fetal Assessment During Labor > Flashcards

Chapter 18: Fetal Assessment During Labor Flashcards

1
Q

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

A

uterine arteries; intervillous spaces; umbilical vein

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2
Q

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

A

two fetal arteries; intervillous space

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3
Q

fetal vein carries_______

A

oxygenated blood

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4
Q

fetal arteries carry_______

A

deoxygenated blood

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5
Q

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

A

uterine artery

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6
Q

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

A

spiral electrode

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7
Q

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

A

intrauterine pressure catheter

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8
Q

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

A

ultrasound transducer; tocodynamometer

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9
Q

what three things cause weak or absent signals for EFM

A
  1. obesity
  2. occiput posterior position of the fetus
  3. anterior attachment of the placenta
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10
Q

tocodynamometer detects _______ and _______ of uterine contractions

A

frequency; duration

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11
Q

where is the tocodynamometer placed for EFM

A

over the fundus of the uterus

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12
Q

where is the ultrasound transducer placed for EFM

A

over the fetal back

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13
Q

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

A
  1. amniotic membranes must be ruptured
  2. at least 2 cm dilated
  3. presenting part is down against the cervix
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14
Q

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

A

intrauterine pressure catheter

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15
Q

Montevideo units give us information about what?

A

if contractions are adequate enough to advance labor

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16
Q

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

A

baseline fetal HR

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17
Q

normal fetal HR is between ________

A

110-160 BPM

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18
Q

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

A

variability

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19
Q

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

A

vagal nerve

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20
Q

_______ can be used to treat category 2 FHR tracing

A

intrauterine pressure catheter

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21
Q

fetal tachycardia

A

> 160 bpm

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22
Q

fetal bradycardia

A

< 110 BPM

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23
Q

baseline variability reflects fetal _______

A

CNS/PNS

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24
Q

_______ variability is defined as undetectable amplitude range

A

absent

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25
Q

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

A

minimal

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26
Q

absent or minimal variability is abnormal or normal?

A

abnormal

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27
Q 
absent or minimal variability can result from: 
1.
2.
3.
4.
5.
6.
A
  1. fetal hypoxia
  2. metabolic acidemia
  3. fetal sleep cycle
  4. fetal tachycardia
  5. extreme prematurity
  6. CNS depression meds
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28
Q

moderate variability is defined as

A

6-25 bpm

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29
Q

_______ variability is considered normal

A

moderate

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30
Q

presence of moderate variability suggests:

A

normal fetal acid-base balance

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31
Q

marked variability is defined as:

A

greater than 25 BMP

32
Q

sinusoidal classically occurs with:

A

severe fetal anemia

33
Q

_______ is considered an early sign of fetal hypoxemia

A

tachycardia ( >160 bpm)

34
Q

fetal bradycardia is often caused by:

A

fetal cardiac problems/ HF

35
Q

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

A
  1. atropine
  2. hydroxyzine
  3. terbutaline
36
Q

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

A

accelerations

37
Q

early decelerations are thought to be caused by:

A

fetal head compressions

38
Q

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

A

the beginning, peak, and end of contractions

39
Q

are early decelerations bad?

A

not really, usually a normal finding

40
Q

late decelerations are associated with:

A

placental insufficiency ( not enough oxygen)

41
Q

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

A

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

42
Q

variable decelerations are:

A

a drop in 15bmp at any random time

43
Q

variable decelerations are associated with:

A

cord compression

44
Q

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

A

prolonged

45
Q

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

A

episodic changes in FHR

46
Q

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

A

periodic changes

47
Q

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

A
  1. FHR baseline
  2. Periodic and episodic changes
  3. uterine activity
48
Q 
causes of fetal tachycardia:
1.
2.
3.
4.
5.
A
  1. maternal fever
  2. fetal hypoxia
  3. intrauterine infection
  4. medication
  5. Anemia
49
Q

fetal HR of 200-220 bpm indicates:

A

fetal demise

50
Q

causes of fetal bradycardia:
1.
2.

A
  1. profound hypoxia

2. anesthesia

51
Q

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

A

fetal hypoxemia

52
Q

decrease Pitocin if fetal HR is _________

A

tachycardia

53
Q

sudden fetal bradycardia is________

A

an emergency

54
Q 
maternal causes of fetal bradycardia:
1.
2.
3.
4.
5.
6.
A
  1. supine position
  2. dehydration
  3. hypotension
  4. cardiac problems
  5. placental abruption
  6. medications
55
Q 
fetal causes of fetal bradycardia:
1.
2.
3.
4.
5.
A
  1. hypoxia/hypoxemia
  2. umbilical cord occlusion
  3. head compression
  4. hypokalemia
  5. bradyarrhythmia’s
56
Q

discontinue Pitocin for _______

A

fetal bradycardia

57
Q

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

A

prolapsed cord

58
Q

two major fetal causes of variability:
1.
2.

A
  1. sleeping

2. premature

59
Q 
maternal causes of variability:
1.
2.
3.
4.
A
  1. cord compression
  2. uterine tachsystole
  3. drugs
  4. supine hypotension
60
Q 
management of variable decelerations:
1.
2.
3.
4.
A
  1. IV Bolus- HYDRATION
  2. d/c Pitocin
  3. O2 delivery
  4. change position
  5. consider internal monitoring
61
Q 
Sinusoidal patterns are associated with:
1.
2.
3.
4.
A
  1. fetal anemia
  2. fetal hydrops
  3. polyhydramnios
  4. placental edema
62
Q

normal accelerations for a preterm fetus:

A

10:10 (10 bpm increase for 10 minutes)

63
Q

_______ decelerations are the most ominous and require immediate intervention

A

late

64
Q 
intervention for late decelerations:
1.
2.
3.
4.
A
  1. stop Pitocin
  2. turn to left side
  3. increase hydration
  4. 10-12 L O2
65
Q

normal fetal pH
pre-acidotic fetal pH
acidotic fetal pH

A

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

66
Q

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

A

emergency C-section

67
Q

for prolonged decelerations consider giving __________

A

tocolytics (Terbutaline)

68
Q

amniofusion is sometimes considered for _________

A

prolonged decelerations

69
Q

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)
A

Category 1

70
Q

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
A

category 2

71
Q

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
A

category 3

72
Q

after performing a fetal scalp massage, we should see:

A

accelerations of 15 bpm for 15 minutes

73
Q

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

A
  1. abnormal FHR
  2. meconium stained amniotic fluid
  3. infant is depressed at birth
74
Q

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

A

7.25; acidosis/ hypoxia

75
Q

how are Montevideo units measured?

A

during internal fetal monitoring with an intrauterine pressure catheter

76
Q

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

A

200

OB (7 decks)

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