EFMR intrapartum Flashcards
why perform fetal heart monitoring
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
primary powers
act involuntarily to expel the fetus and placenta from the uterus
ways to evaluate contractions
palpation
tocotransducer
intrauterine pressure catheter
three components to a contraction
increment
acme
decrement
frequency
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
duration
time between the onset and end of a contraction
can be measured by palpation, tocotransducer, and an IUPC
measured in seconds
intensity
the strength of a contraction, measured a t the peak
palpated: mild, moderate, strong
IUPC: measured in mmHg
resting tone
between contractions, uterine muscle tension
- relaxation of uterus- very important to assess and document this
- can be measured by palpation and IUPC
normal contractions
less then/equal to 5 contractions in 10 minutes, average over 30 min
tachysystole
> 5 contractions in 10 min average over a 30 min window
equipment used to monitor FHR
fetoscope
ultrasound fetoscope
ultrasound transducer
scalp electrode
FHR baseline
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
variability
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
factors associated with decreased variability not related to oxygenation
fetal sleep
arrhythmias
anomalies
medications
minimal variability
visually detectable but <5bpm amplitude
moderate variability
6-25 bpm amplitude
marked
> 25 bpm amplitude
accelerations
abrupt increase in FHR
prolonged accelerations
> 2min but <10min
V C
E H
A O
L P
Variable decelerations
Early decelerations
Accelerations
Late decelerations
Cord compression
Head compression
Ok
Placental Insufficiency
early decelerations
gradual onset >30sec from onset to nadir, nadir simultaneous with peak of contraction
-not related to fetal oxygenation: no actions required, document
late decelerations
gradual onset >30 seconds from onset to nadir, delayed in timing- nadir after peak of contraction
late decel cause
thought to be caused by a relative or absolute deficiency in utero-placental perfusion:
- placental impairment
- decreased utero-placental blood flow
Late decel actions
- 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
variable decelerations
abrupt onset
abrupt decrease in FHR
caused by umbilical cord compression or a decrease in umbilical cord perfusion
variable decelerations actions
- 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
