EFMR intrapartum

Question 1

why perform fetal heart monitoring

Answer 1

labor is a period of physiologic stress for fets
- FHR is an indirect measure of fetal oxygenation
- the goal is to facilitate promp intervention and prevent an unfavorable outcome
- to monitor uterine frequency, duration, intensity of contractions, uterine resting tone
- may do intermittent auscultation or continuous

Question 2

primary powers

Answer 2

act involuntarily to expel the fetus and placenta from the uterus

Question 3

ways to evaluate contractions

Answer 3

palpation
tocotransducer
intrauterine pressure catheter

Question 4

three components to a contraction

Answer 4

increment
acme
decrement

Question 5

frequency

Answer 5

how often contractions occur
time from beginning of one to the beginning of the next
can be measured by palpatation, tocotransducer, and an IUPC
measured in minutes

Question 6

duration

Answer 6

time between the onset and end of a contraction
can be measured by palpation, tocotransducer, and an IUPC
measured in seconds

Question 7

intensity

Answer 7

the strength of a contraction, measured a t the peak
palpated: mild, moderate, strong
IUPC: measured in mmHg

Question 8

resting tone

Answer 8

between contractions, uterine muscle tension
- relaxation of uterus- very important to assess and document this
- can be measured by palpation and IUPC

Question 9

normal contractions

Answer 9

less then/equal to 5 contractions in 10 minutes, average over 30 min

Question 10

tachysystole

Answer 10

> 5 contractions in 10 min average over a 30 min window

Question 11

equipment used to monitor FHR

Answer 11

fetoscope
ultrasound fetoscope
ultrasound transducer
scalp electrode

Question 12

FHR baseline

Answer 12

normal range 110-160bpm
average rate rounded to the closest 5bpm during a 10min segment excluding periodic or episod changes, periods of marked variability, segments of baseline that differby by >25bpm

Question 13

variability

Answer 13

irregular waves or fluctuations in baseline
expected
reflection of oxygenation and an intact pathway from the cerebral cortex to the midbrain to the vagus nerve and lastly to the heart
- presence of moderate variability is strongly associated with adequate cerebral oxygenation

Question 14

factors associated with decreased variability not related to oxygenation

Answer 14

fetal sleep
arrhythmias
anomalies
medications

Question 15

minimal variability

Answer 15

visually detectable but <5bpm amplitude

Question 16

moderate variability

Answer 16

6-25 bpm amplitude

Question 17

marked

Answer 17

> 25 bpm amplitude

Question 18

accelerations

Answer 18

abrupt increase in FHR

Question 19

prolonged accelerations

Answer 19

> 2min but <10min

Question 20

V C
E H
A O
L P

Answer 20

Variable decelerations
Early decelerations
Accelerations
Late decelerations

Cord compression
Head compression
Ok
Placental Insufficiency

Question 21

early decelerations

Answer 21

gradual onset >30sec from onset to nadir, nadir simultaneous with peak of contraction

-not related to fetal oxygenation: no actions required, document

Question 22

late decelerations

Answer 22

gradual onset >30 seconds from onset to nadir, delayed in timing- nadir after peak of contraction

Question 23

late decel cause

Answer 23

thought to be caused by a relative or absolute deficiency in utero-placental perfusion:
- placental impairment
- decreased utero-placental blood flow

Question 24

Late decel actions

Answer 24

• discontinue oxytocin if infusing
• maternal position change
• administer oxygen @10L/min NRB mask
• hydration with IV fluids; elevate legs
• palpate uterus to assess for tachysystole
• notify provider
• anxiety/pain reduction
• medications

Question 25

variable decelerations

Answer 25

abrupt onset
abrupt decrease in FHR
caused by umbilical cord compression or a decrease in umbilical cord perfusion

Question 26

variable decelerations actions

Answer 26

• discontinue oxytocin if infusing
• maternal position changes
• maternal O2 at 10L/min in NRB mask
• notify provider
• evaluate presenting part/assess for cord prolapse
• assist with amnioinfusion if ordered
• assist with birth if not corrected