Electronic Fetal Monitoring Flashcards
5 essential components of electronic fetal monitoring
Baseline fetal heart rate, variability, accelerations, decelerations, and changes in fetal heart rate over time
Main goal of fetal monitoring
Maximize oxygenation
What does a continuous electronic fetal monitor measure?
Uterine contraction and fetal heart rate,intermittent or continuous monitoring, and can be used to monitor the fetal heart rate internally
Noninvasive tool used to monitor the fetus externally
Tocotransducer for uterine contractions (is used transabdominally)
how is an internal fetal monitor placed?
Membranes must be ruptured, cervix needs to be wide enough and presenting part of fetus must be low
What are the two types of internal fetal monitors?
Spinal electrode for fetal heart rate,internal uterine pressure catheter for uterine contractions
How can contractions be assessed?
Palpation
How would you assess it a contraction is mild, moderate, or strong?
Mild: uterus is easily dented with palpation 1+
Moderate: uterus is slightly dented with palpation 2+
Strong: uterus cannot be dented with palpation 3+
What is the downside of using a doppler/fetoscope?
Variability
Can you tell contraction strength from the monitor strip?
No. an interuterine pressure catheter would have to be present
What may be seen on a woman that receives an epidural? Why?
Pulse ox, because epidurals may cause respiratory depression
When is the fetal heart rate considered variable?
When there are irregular fluctuations in the fetal heart rate of 2 cycles per minute or greater
What can cause fetal tachycardia?
Maternal fever/dehydration, fetal hypoxia, certain drugs, , fetal anemia, fetal/maternal infection, maternal hyperthyroidism, fetal heart failure or dysrhythmia
When is tachycardia non-reassuring?
When associated with late decelerations, severe variable decelerations or absence of variability
When is bradycardia non-reassuring?
When associated with loss of variability or late decelerations
What can cause fetal bradycardia?
Fetal hypoxia late sign), maternal supine position or hypotension, prolonged umbilical cord compression or cord prolapse
Can variability predict the presence of hypoxemia or metabolic activity?
No
What is moderate variability associated with?
Adequate cerebral oxygenation
What is the variability in heart rate for fetuses with absent, minimal, average/ moderate or marked variability?
Absent: undetectable
Minimal: detectable, but ≤ 5bpm
Average/moderate: 6-25bpm
Marked: > 25bpm
Is absent variability assuring or non-reassuring?
Nonreassuring
If minimal variability is seen in a fetal monitor, what are the things that should be considered?
“Three ss”: sleep? sedation? sick?
Is minimal variability reassuring or nonreassuring?
Non reassuring
Is a sinusoidal pattern considered assuring or non reassuring?
Non reassuring
Changes in the fetal heart rate associated with uterine contractions are classified into which categories?
Accelerations or decelerations
What are early decelerations caused by?
Head compression resulting in vagal reflex
What do early decelerations look like?
Uniform in shape, onset, and recovery
Inversely mirror contraction in the beginning, end, and nadir/peak
What causes late decelerations?
Uteroplacental insufficiency
What do late decelerations look like?
Fetal heart rate returns to baseline after contraction ends. Will have a uniform shape, gradual onset and recovery
When are late decelerations considered non-reassuring?
Always!
What does a nurse do when late decelerations begin?
Reposition, hydrate, give oxygen, discontinue oxytocin, notify provider
What causes variable decelerations?
Umbilical cord compression
Shape of variable decelerations
“V” or “u”
When are variable decelerations non-reassuring?
If they are repetitive, prolonged, severe, or slow return to baseline
What should a nurse do to counteract variable decelerations?
Reposition, hydrate, give oxygen, notify provider, do an amnioinfusion
What is usually the cause of prolonged deceleration?
Prolonged cord compression
When is prolonged deceleration considered non-reassuring?
Always!
What does a prolonged deceleration look like?
Abrupt decrease in fetal heartrate of at least 15bpm below baseline, lasting 2-10 minutes
What is uterine tachysystole?
More than 5 contractions in 10 minutes
What is intrauterine resuscitation?
Interventions for none assuring FHR patterns
What kind of drug is oxytocin?
Uterotonic
When should pitocin be discontinued?
When there is uterine tachysystole
