Chapter 18: Fetal Assessment During Labor Flashcards
maternal blood flows through ______ into the ________ space to the ________ for fetal oxygenation
uterine arteries; intervillous spaces; umbilical vein
unoxygenated blood returns to the placenta by way of the _______ and diffuses through _______ and returns to the placenta
two fetal arteries; intervillous space
fetal vein carries_______
oxygenated blood
fetal arteries carry_______
deoxygenated blood
when uterine myometrium contracts the flow of oxygenated blood through the ________ is decreased
uterine artery
for internal fetal heart rate monitoring ______ is applied to the presenting part of
spiral electrode
for internal fetal HR monitoring, ______ is applied to asses uterine activity
intrauterine pressure catheter
for external fetal monitoring ______ monitors the fetal HR and _______ monitors the uterine activity
ultrasound transducer; tocodynamometer
what three things cause weak or absent signals for EFM
- obesity
- occiput posterior position of the fetus
- anterior attachment of the placenta
tocodynamometer detects _______ and _______ of uterine contractions
frequency; duration
where is the tocodynamometer placed for EFM
over the fundus of the uterus
where is the ultrasound transducer placed for EFM
over the fetal back
criteria for internal fetal monitoring includes:
1.
2.
3.
- amniotic membranes must be ruptured
- at least 2 cm dilated
- presenting part is down against the cervix
___________ can effectively measure frequency, duration, AND severity of uterine contractions
intrauterine pressure catheter
Montevideo units give us information about what?
if contractions are adequate enough to advance labor
_________ is the average fetal HR during a 10 minute period that does not include episodic changes or variability
baseline fetal HR
normal fetal HR is between ________
110-160 BPM
________ refers to irregular waves or fluctuations of the FHR of two cycles per minute or greater
variability
beat to beat variability in internal fetal monitoring is produced by the :
vagal nerve
_______ can be used to treat category 2 FHR tracing
intrauterine pressure catheter
fetal tachycardia
> 160 bpm
fetal bradycardia
< 110 BPM
baseline variability reflects fetal _______
CNS/PNS
_______ variability is defined as undetectable amplitude range
absent
______ variability is defined as amplitude range of less than 5 BPM
minimal
absent or minimal variability is abnormal or normal?
abnormal
absent or minimal variability can result from: 1. 2. 3. 4. 5. 6.
- fetal hypoxia
- metabolic acidemia
- fetal sleep cycle
- fetal tachycardia
- extreme prematurity
- CNS depression meds
moderate variability is defined as
6-25 bpm
_______ variability is considered normal
moderate
presence of moderate variability suggests:
normal fetal acid-base balance
marked variability is defined as:
greater than 25 BMP
sinusoidal classically occurs with:
severe fetal anemia
_______ is considered an early sign of fetal hypoxemia
tachycardia ( >160 bpm)
fetal bradycardia is often caused by:
fetal cardiac problems/ HF
medications that might cause fetal tachycardia include:
1.
2.
3.
- atropine
- hydroxyzine
- terbutaline
_________ is an abrupt increase in FHR of at least 15 bpm for 15 seconds (less than 2 min)
accelerations
early decelerations are thought to be caused by:
fetal head compressions
the onset, nadir (lowest point) and recovery of early decelerations often corresponds with:
the beginning, peak, and end of contractions
are early decelerations bad?
not really, usually a normal finding
late decelerations are associated with:
placental insufficiency ( not enough oxygen)
the onset, nadir (lowest point) and recovery of a late declaration occurs:
after the onset of he contraction and after the peak of the contraction
variable decelerations are:
a drop in 15bmp at any random time
variable decelerations are associated with:
cord compression
________ is a deceleration of at least 15 bpm that lasts more than two minutes but less than 10
prolonged
_______ are accelerations or decelerations patterns that are not associated with UC
episodic changes in FHR
_________ are accelerations or decelerations that are r/t UC’s that persist over time
periodic changes
three major areas we assess in FHR monitoring:
1.
2.
3.
- FHR baseline
- Periodic and episodic changes
- uterine activity
causes of fetal tachycardia: 1. 2. 3. 4. 5.
- maternal fever
- fetal hypoxia
- intrauterine infection
- medication
- Anemia
fetal HR of 200-220 bpm indicates:
fetal demise
causes of fetal bradycardia:
1.
2.
- profound hypoxia
2. anesthesia
fetal tachycardia with decreased variability and decelerations is a major indicator of:
fetal hypoxemia
decrease Pitocin if fetal HR is _________
tachycardia
sudden fetal bradycardia is________
an emergency
maternal causes of fetal bradycardia: 1. 2. 3. 4. 5. 6.
- supine position
- dehydration
- hypotension
- cardiac problems
- placental abruption
- medications
fetal causes of fetal bradycardia: 1. 2. 3. 4. 5.
- hypoxia/hypoxemia
- umbilical cord occlusion
- head compression
- hypokalemia
- bradyarrhythmia’s
discontinue Pitocin for _______
fetal bradycardia
if baby is bradycardia the nurse should do a vaginal exam for:
prolapsed cord
two major fetal causes of variability:
1.
2.
- sleeping
2. premature
maternal causes of variability: 1. 2. 3. 4.
- cord compression
- uterine tachsystole
- drugs
- supine hypotension
management of variable decelerations: 1. 2. 3. 4.
- IV Bolus- HYDRATION
- d/c Pitocin
- O2 delivery
- change position
- consider internal monitoring
Sinusoidal patterns are associated with: 1. 2. 3. 4.
- fetal anemia
- fetal hydrops
- polyhydramnios
- placental edema
normal accelerations for a preterm fetus:
10:10 (10 bpm increase for 10 minutes)
_______ decelerations are the most ominous and require immediate intervention
late
intervention for late decelerations: 1. 2. 3. 4.
- stop Pitocin
- turn to left side
- increase hydration
- 10-12 L O2
normal fetal pH
pre-acidotic fetal pH
acidotic fetal pH
normal: 7.25
pre-acidotic: 7.20
acidotic: 7.19 or lower
when fetal pH is 7.19 or lower what is the necessary intervention
emergency C-section
for prolonged decelerations consider giving __________
tocolytics (Terbutaline)
amniofusion is sometimes considered for _________
prolonged decelerations
what FHR category do these parameters suggest:
- normal baseline of 110-160 BPM
- baseline variability is moderate
- decelerations are absent
- accelerations are absent or present
- well- oxygenated fetus
- non-acidic (7.25-7.3)
Category 1
which FHR tier do these parameters suggest:
- tachycardia or bradycardia present
- decelerations that return to baseline
- prolonged decelerations (>2 min but <10min)
- minimal or marked variability
category 2
which FHR tier do these parameters suggest:
- non-predictive fetal-acid base
- absent baseline variability
- recurrent late decelerations
- OR recurrent variable decelerations
- OR bradycardia
- sinusoidal pattern
category 3
after performing a fetal scalp massage, we should see:
accelerations of 15 bpm for 15 minutes
3 criteria for cord blood analysis:
1.
2.
3.
- abnormal FHR
- meconium stained amniotic fluid
- infant is depressed at birth
normal fetal blood should have a pH of ______ and anything less suggests ________
7.25; acidosis/ hypoxia
how are Montevideo units measured?
during internal fetal monitoring with an intrauterine pressure catheter
________ Montevideo units is required for advancing labor by bringing about dilation and effacement during the active phase
200
