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NURS 4500: Midterm Material > Class 5: Fetal Surveilance > Flashcards

Class 5: Fetal Surveilance Flashcards

1
Q

what is the goal of intrapartum fetal surveillance (2)

A

identify potential fetal decompensation to:
- allow for timely and effective intervention
- prevent perinatal morbidity and mortality

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2
Q

fetal surveilance tells us…

A
  • how the fetus is adatping/coping w the stress of labor
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3
Q

FHR surveillance is always assessed in conjunction with…

A
  • uterine activity (contractions) in labour
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4
Q

the heart rate of a healthy, well-oxygenated fetus, with a well oxygenated brain, can…

certain changes in FHR can indicate…

A
  • can cope w the stress of labor
  • can indicate that the fetus is experiencing hypoxia and is no longer compensating
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5
Q

describe the fetal lungs role in gas exchange

A
  • they do not engage in gas exchange
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6
Q

how does oxygen get to the fetus?

A
  • from the pregnant person
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7
Q

how does CO2 get removed from the fetus?

A
  • removed by pregnant person’s lungs
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8
Q

what types of factors influence FHR

A
  • intrinsic
  • extrinsic
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9
Q

what intrinsic factors impact FHR (4)

A
  • medulla oblongata in the brainstem (CNS)
  • autonomic nervous system
  • baroreceptors
  • chemoreceptors
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10
Q

baroreceptors respond to? what can cause increased/decreased FHR?

A
  • respond to changes in BP
  • high BP = decreased FHR
  • low BP = increased FHR
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11
Q

what do chemoreceptors respond to?

A
  • respend to changes in O2 and CO2 in blood
    ex. hypoxia, acidosis
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12
Q

what impact does the SNS have on the fetal CVS (2)

A

stimulation produces:
- increase in strength of cardiac contraction
- increase in FHR

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13
Q

what impact does the PSNS have on the fetal CVS? (2)

A

stimulation of the vagus nerve:
- slows the SA node rate of firing thus producing a decrease in FHR
- vagal tone increases as gestational age increases and produces a downward effect on the baseline FHR

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14
Q

the “slow down” responses of the PSNS and “speed up” influence of the SNS create a relationship with…

A
  • relationship w baseline variability
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15
Q

what are extrinsic factors

A
  • factors in the fetal enviro that affect the availability of oxygen and the ability to transport oxygen to the fetus = impacting FHR
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16
Q

what are 3 extrinsic factors that influence FHR

A
  • maternal factors
  • uteroplacental factors
  • fetal factors
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17
Q

what maternal factors influence FHR (4)

A
  • decreased maternal arterial oxygen tension
  • decreased maternal oxygen carrying capability
  • decreased uterine blood flow
  • chronic maternal conditions
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18
Q

what can cause decreased maternal arterial O2 tension (6)

A
  • resp disease
  • hypoventilation ** (ex. Mg sulphate, morphine & fentanyl)
  • seizure ** (ex. eclampsia)
  • trauma
  • smoking
  • obesity
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19
Q

what can cause decreased O2 carrying capability (2)

A
  • signif anemia **
  • carboxyhemoglobin
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20
Q

what can cause decreased uterine blood flow (4)

A
  • hypotension
  • regional anaesthesia –> hypotension r/t epidural
  • maternal positioning –> supine hypotension
  • HTN disorders of pregnancy
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21
Q

what type of chronic maternal conditions can impact FHR? what are 3 examples?

A

vasculopathies:
- systemic lupus erythematosus
- DM1
- chronic HTN

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22
Q

what uteroplacental factors influence FHR (2)

A
  • excessive uterine activity
  • uteroplacental dysfunction
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23
Q

what are examples of excessive uterine activity (2)

A
  • tachysystole secondary to oxytocin, prostaglandins, or spontaneous labor
  • placental abruption
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24
Q

what can cause uteroplacental dysfunction (4)

A
  • placental abruption
  • placental infarction
  • chorioamnionitis
  • uterine rupture
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25
Q

placental infarction is dysfunction marked by… (4)

A
  • IUGR
  • oligohydramnios
  • abnormal doppler studies
  • lesions on placenta
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26
Q

what impact do uterine contractions have on FHR?

A
  • uterine arteries and veins pass thru the myometrium
  • contractions = increased pressure in myometrium = compression of blood vessels = blood flow impeded to fetus due to compression of the blood vessels
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27
Q

during labor, O2/CO2 exchange occurs primarily when?

A
  • between uterine contractions when the blood flow is unimpeded
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28
Q

what impact does tachysystole (excessive uterine contractions) have on the resting period between contractions

A
  • decreases the resting period between
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29
Q

what fetal factors influence FHR (2)

A
  • cord compression
  • decreased fetal O2 carrying capacity
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30
Q

what can cause cord compression (2)

A
  • oligohydramnios
  • cord prolapse or entanglement = polyhydramnios
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31
Q

what can cause decreased fetal O2 carrying capacity (2)

A
  • signif anemia
  • carboxyhemoglobin
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32
Q

what can cause signif anemia in the fetus (3)

A
  • isoimmunization
  • maternal-fetal blled
  • ruptured vasa previa
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33
Q

what can create carboxyhemoglobin

A
  • if birther is a smoker
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34
Q

what are methods of fetal surveillance in labor (2)

A
  • intermittent auscultation (IA)
  • continuous electronic fetal monitoring (EFM)
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35
Q

IA includes… (2)

A
  • monitoring of uterine contractions
  • IA of FHR
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36
Q

EFM includes.. (2)

A
  • electronic monitoring of uterine contractions (internal & external)
  • electronic monitoring of FHR (internal & external)
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37
Q

is external or internal monitoring w EFM the standard?

A
  • external = standard
  • internal = bigger risk of infection
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38
Q

how many fetuses can EFM monitor

A
  • two
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39
Q

what FHR assessments are done w IA? (3)

A
  • baseline
  • rhythmn (IA only)
  • changes in FHR
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40
Q

what is assessed r/t rhythm w IA (2)

A
  • regular
  • irregular
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41
Q

what is assessed r/t changes in FHR with IA (2)

A
  • accelerations
  • decelerations (relationships to contractions)
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42
Q

what is assessed r/t uterine contractions when performing IA (4)

A
  • frequency
  • duration
  • intensity
  • resting tone
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43
Q

what FHR assessments are done w continuous EFM (3)

A
  • baseline –> rate
  • variability
  • changes in FHR
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44
Q

what is assessed r/t changes in FHR w EFM (2)

A
  • accelerations
  • decelerations (relationship to contractions)
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45
Q

what is the recommended method of monitoring fetal surveillance for healthy term pregnant persons in spontaneous labor?

A
  • intermittent auscultation
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46
Q

increased use of EFM is linked to?

A
  • rising c-section birth rates
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47
Q

what types of conditions exist that increase the risk of adverse fetal outcomes ? therefore, what type of monitoring is usually recommended in these situation?

A
  • both antepartum (maternal and fetal) and intrapartum (maternal and fetal)
  • continuous EFM
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48
Q

what maternal antepartum conditions are associated w increased risk of adverse fetal outcomes (6)

A
  • HTN disorders of pregnancy
  • DM
  • antepartum hemorrhage
  • maternal medical conditions
  • maternal MVA/trauma
  • birth perception of decreased fetal mvmt
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49
Q

what fetal antepartum conditions are associated w increased risk of adverse fetal outcomes (7)

A
  • IUGR
  • prematurity
  • oligohyramnios
  • abnormal umbilical artery doppler
  • isoimmunication
  • multiple pregnancy
  • breech presentation
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50
Q

what maternal intrapartum conditions are associated w increased risk of adverse fetal outcomes (9)

A
  • vaginal bleeding in labor
  • intrauterine infection/chorioamnionitis
  • previous c-section
  • prolonged membrane rupture (>24 hrs at term)
  • induced labor
  • augmented labor
  • hypertonic uterus
  • preterm labour
  • postterm labor (>42 weeks)
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51
Q

what fetal intrapartum conditions are associated w increased risk of adverse fetal outcomes (2)

A
  • meconium-stained amniotic fluid
  • abnormal FHR on intermittent auscultation
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52
Q

what is included in nursing care with both IA and EFM (6)

A
  • leopold’s maneuver
  • assess uterine activity and FHR characteristics
  • interpretation/classification of FHR pattern
  • interventions as needed
  • communication & documentation
  • continued supportive care in labour
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53
Q

what is the freq of assessment of FHR and uterine activity in 1st stage of labour; latent vs active

A
  • latent phase: hourly of w signif change
  • active labour: q15-30 min
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54
Q

what is the freq of assessment of FHR and uterine activity in 2nd stage of labour; latent vs active

A
  • latent: q15-30 min
  • active: q5 min
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55
Q

what might change the freq of assessment of FHR and uterine activity during the 1st and 2nd stage of labour (3)

A
  • rupture of membranes
  • admin of meds and anaesthesia
  • changes in clinical picture/complications or changes of FHR pattern
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56
Q

we should always assess FHR after… why?

A
  • ROM
  • d/t concern of cord compression/prolapse
57
Q

describe the procedure for leopold’s maneuver (5)

A
  • wash hands
  • empty bladder
  • supine position, knees slightly flexed (slight R or L tilt)
  • 4 maneuvers
  • document (based on facility protocol/guideline)
58
Q

what is intermittent auscultation? what kind of assessment?

A
  • assessing fetal heart sounds at periodic intervals
  • auditory only, not visual
59
Q

what are the 7 steps of intermittent auscultation

A
  1. explain
  2. leopold’s maneuver
  3. palpate contractions at fundus
  4. place IA US fetoscope device over area of maximal intensity
  5. compare to maternal radial pulse
  6. listen for 60 seconds immediately after uterine contraction
  7. interpert findings and document
60
Q

what is include in the palpate step of IA (2)

A
  • uterine activity
  • note freq and duration of contractions and palpate resting tone
61
Q

when should you listen for 60 seconds during IA

A
  • immediately after uterine contractions
62
Q

what is included in the listening step of IA (3)

A
  • record FHR baseline
  • note rhythm of FHR (regular? irregular? must do for 60 sec)
  • identify presence of acceleration or decelerations –> relationship to contractions?
63
Q

what is included in the interpret & document step of IA (4)

A
  • is FHR normal or abnormal?
  • communicate
  • interventions
  • decision making
64
Q

what are the steps for EFM? (9)

A
  • leopold’s maneuver
  • seperate transducers for assessment of FHR & uterine contractions
  • cotinuous strip of fetal monitor paper
  • record FHR baseline
  • note FHR variability
  • identify presence of accelerations & decelerations –> relationship to contractions
  • interpret findings and document
  • is the FHR tracing/pattern normal, atypical, or abnormal?
  • communicate, interventions, decision making
65
Q

for uterine contractions, where is the tocotransducer placed with EFM? what does this monitor?

A
  • on the fundus above the umbilicus
  • monitors freq and duration
66
Q

how is the intensity and resting tone of uterine contractions assedssed w FHR?

A
  • by palpation
67
Q

what is the FHR transducer placed with EFM? what does it do?

A
  • placed over area of maximal intensity (external)
  • continuous printout of fetal heart rate
68
Q

what does the continuous fetal monitor paper printed from EFM record? this is sometimes called?

A
  • records both FHR and uterine activity (contractions)
  • sometimes called FHR tracing
69
Q

how is uterine activity/contraction freq and duration assessed w IA? EFM?

how is intensity and resting tone of contractions done in both methods?

A
  • manual counting of freq and duration –> IA
  • monitor EFM –> freq and duration
  • intensity and resting tone –> palpations –> both EFM and IA
70
Q

what is the freq of normal uterine activity (2)

A
  • contractions not more than q2min
  • max of 5 contractions in a 10 min period, averaged over 30-min time period
71
Q

frequency of uterine contractions is measured in minute from ____ to ____

A
  • from start of 1 contraction to start of another
72
Q

what is the duration of normal uterine activity? duration is in seconds from __ to ___

A
  • lasting less than 90 sec
  • start of 1 contraction to end of same contraction
73
Q

what is the resting tone of normal uterine activity

A
  • min 30 sec of rest in between
74
Q

what is the intensity of normal uterine activity (2)

A
  • mod to strong
  • allow for uterine relaxation
75
Q

what is considered tachysystole

A

> 5 contractions in 10 min, averaged over 30 min time period

76
Q

what is needed to determine baseline FHR with EFM

A
  • need 10 min of FHr tracting
77
Q

baseline FHR excludes…

A
  • accelerations
  • decelerations
78
Q

what is normal baseline FHR at term

A

110-160

79
Q

what is considered fetal tachycardia

A

> 160 bpm for >10 min

80
Q

what can cause fetal tachy

A
  • maternal fever
  • maternal infection
81
Q

what is considered fetal bradycardia

A

<110 bpm for >10 min

82
Q

what can cause fetal bradycardia

A
  • late/post term
83
Q

baseline FHR should be present for..

A
  • at least 2 min in any 10-min segment to be determined
84
Q

rhythm of FHR can only be assessed with?

A
  • IA
85
Q

variability of FHR can only be assessed with?

A
  • EFM
86
Q

define: variability

A
  • fluctuation or range in the baseline FHR
87
Q

what are 4 categories of variability

A
  • absent
  • minimal or decreased
  • mod or average, normal
  • marked or increased
88
Q

what range is considered absent variability

A

0-2 bpm

89
Q

what range is considered minimal or decreased variability

A
  • < or equal to 5bpm
90
Q

what range is considered moderate or average/normal variability

A
  • 6-25 bpm
91
Q

what range is considered marked or increased variability

A

> 25 bpm

92
Q

periodic changes in FHR occur with?

A
  • occur w uterie contractions
93
Q

what are episodic (or non-periodic) changes in FHR

A
  • not associated w uterine contractions
94
Q

what is an acceleration of FHR

A
  • abrupt increase in FHR above baseline
95
Q

how many bpm is considered an acceleration? min time? max time?

A
  • at least 15 bpm above baseline
  • lasts 15 sec or longer
  • less than 2 min
96
Q

FHR accelerations are an indiciation of ?

A
  • fetal well being
  • classified as normal
97
Q

FHR accelerations are documented as? (2)

A
  • present
  • absent
98
Q

decelerations are described by their relationship with…

A
  • contractions and shape
99
Q

what are early decelerations?

A
  • gradual decrease and return to baseline of the FHr during a contraction
100
Q

with early decelerations the lowest point of the deceleration occurs?

A
  • at the same time as the peak of the contraction
101
Q

describe the relationship between the deceleration and contraction with early decelerations

A
  • mirror each other
102
Q

early decelerations are associated w?

A
  • head compression
103
Q

how can head compression cause decreased HFR

A
  • puts pressure on vagus nerve = decreased FHR
104
Q

early decelerations are generally…

A
  • normal and benign
105
Q

describe the appearance of late decelerations (3)

A
  • uniform
  • repetitive
  • shallow
106
Q

what are the onset of late decelerations

A
  • occur after beginning of the contraction
107
Q

when does the lowest point of late decelerations occur?

A
  • after peak of contraction
108
Q

what do late decelerations return to baseline?

A
  • after the contraction ends
109
Q

what do late decelerations mean?

A
  • ominous sign
110
Q

late decelerations are classified as…

A
  • atypical or abnormal
111
Q

late decelerations indicate

A
  • uteroplacental insufficiency
112
Q

what is a variable deceleration

A
  • abrupt decrease in FHR
113
Q

what is classified as a variable deceleration

A
  • decrease in FHR > or equal to 15 bpm
  • lasting for > or equal to 15 secs
  • and < 2 min in duration
114
Q

how do variable decelerations appear?

A
  • dramatic, rapid response
  • appearance of an icicle
  • U, V, or W shaped
115
Q

what do variable decelerations occur

A
  • during or between contractions
116
Q

variable decelerations often occur with?

A
  • cord compression –> not always dangerous compression (could just be a position change)
117
Q

how does cord compression cause decreased FHR

A

= activates SNS = increased HR = HTN = decreased FHR

118
Q

variable decelerations are either…

A
  • complicated
  • uncomplicated
119
Q

variable decelerations are classified as.. (3)

A
  • normal
  • atypical
  • abnormal
120
Q

what makes a variable deceleration considered normal

A
  • if 1 time occurrence
121
Q

if variable decelerations have a relationship w contractions, what is the concern?

A
  • concern of prolapse
122
Q

what does it mean if variable decelerations are reoccurring?

A
  • atypical/abnormal, of concern
123
Q

what are prolonged decelerations

A
  • visually apparent decrease (either gradual or abrupt) of at least 15 bpm below the baseline and lasting more than 2 min but less than 10 min
124
Q

what is included in normal classification of FHR with IA r/t baseline, rhythm, decelerations, accelerations

A
  • baseline 110-160
  • rhythm = regular (no skipped beats)
  • no decelerations
  • accelerations may be present
125
Q

what is included in normal classifications of FHR with EFM r/t baseline, variability, decelerations, accelerations

A
  • baseline 110-160
  • variability 6-25 bpm or <5 bpm for <40 min
  • decelerations = none present OR occasional uncomplicated variables or early decelerations
  • accelerations = spontaneous accelerations present OR accelerations present w fetal scapl stimulation
126
Q

what is intrauterine resuscitation

A
  • is sometimes used to refer to specific interventions initiated when an atypical or abnormal FHR patter is noted
  • mngmt of atypical and abnormal FHR with corrective measures
127
Q

what are the goals of intrauterine resus (4)

A
  • improve umbilical blood flow
  • improve umbilical circulation
  • improve O2 sat
  • reduce uterine activity
128
Q

what can improve uterine blood flow & decompress umbilical cord

A
  • moving mother side to side
  • position changes
129
Q

what are examples of intrauterine resus interventions (8)

A
  • stop or decrease oxytocin
  • change maternal position
  • IV fluid bolus
  • perform vaginal exam
  • consider amniofusion
  • reduce maternal anxiety
  • coach birther to modify breathing or pushing techniques
  • assist physician w fetal scalp sampling
130
Q

what is amniofusion

A
  • injection of fluid into membranes
131
Q

fetal scalp sampling is used to?

A
  • guide decision making concerning fetal status
132
Q

what is collected from a fetal scalp sample?

A
  • collect a capillary fetal blood sample
133
Q

what is the min gestational age for fetal scalp sampling

A
  • must be >34 weeks gestations
134
Q

how dilated does the cervix need to be to collect a fetal scalp sample

A
  • 4-5 cm
135
Q

how is a fetal scalp sampling sample collected? what must have happened for this?

A
  • thru the dilated cervic with small incision to fetal scape
  • membranes must be ruptured
136
Q

when is fetal scalp sampling done?

A
  • when FHR tracing is atypical or abnormal
  • AND birth is not imminent
137
Q

what is assessed w fetal scalp sampling

A
  • pH
138
Q

what does a pH of <7.20 mean? what is indicated?

A
  • risk of fetal acidemia
  • delivery is indicated
139
Q

what does a pH of >7.20 mean?

A
  • may continue and reassess within 30 min

NURS 4500: Midterm Material (19 decks)

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