Exam 2 Flashcards
GOAL of
Intrapartum Fetal Assessment
Intrapartum fetal surveillance to enable clinicians to
–>assess adequacy of fetal oxygenation during labor.
-has transitioned from technology went from low to high (better tech.)
What info gathered at bedside abt FETAL ASSESS. assists clinicians?
- Eval. fetal oxygenation.
- Implement corrective measures to position mom for incres. of oxygenation (RESPOSITION)
- Support environment that promotes pt. safety
What are the BENEFITS of Auscultation and Palpation?
- ez to use w/ proper training
- Less invasive than EFM
- Outcomes comparable to EFM in low-risk women
- Inexpensive
- Atmosphere more natural than technologic
- Comfortable for the woman
- Offers women freedom of movement and ability to ambulate to promote normal labor
-1:1 nursing care promotes “doula effect” benefits.
-Allows easy FHR and Uterine Activity assessment during use of hydrotherapy
Non-Electronic Monitoring:
Auscultation and Palpation
-Intermittent auscultation with palpation
Equipment
—>Fetoscope
—>Pinard stethoscope
—>Hand-held Doppler ultrasound
-Palpation- light abdominal touch with fingertips over the fundus as a contraction develops
Descriptive terms: soft, mild, moderate, strong
Leopold’s Maneuvers
What are four maneuvers?
(slide 11 on ch. 14)
1st Maneuver- Fundal palpation
2nd Maneuver- Lateral palpation
3rd Maneuver- Pallach’s maneuver or grip
4th Maneuver- Pelvic palpation
What maneuver do you have to do before putting on a fetal heart monitor?
Leopold Maneuver palpation
–> to determine babies position/ back is located
Electronic Fetal Monitoring (EFM)
What are the uses and what does it measure?
-Used to recognize, analyze, and display FHR, UA, and maternal vital signs
-External, internal, or a combination of both
-External collects data via transducers applied to the abdomen
-Internal uses devices places on a fetal presenting part to monitor FHR or within the uterine cavity to measure intrauterine pressure
Electronic Fetal Monitoring (EFM)
Benefits?
-Noninvasive; easy to apply
-May be used during both the antepartum and intrapartum period
-Sometimes used with telemetry when available
-Does not require ruptured membranes or cervical dilatation
-No known risks to the woman or fetus
-Provides continuous recording of FHR and Uterine Activity (UA)
External Electronic Fetal Monitoring (EFM) and Transducers
Limitations?
-Limits maternal mobility
-Frequent repositioning of transducers is often needed to maintain readable accurate tracing.
-May double-count a slow FHR of <60 bpm; may half-count a FHR of >180 bpm
-Maternal HR may be recorded if monitor placed over maternal arterial vessels, such as the aorta.
-Unable to assess strength or intensity of UA
-Obese women and preterm or multifetal gestations may be difficult to monitor.
Internal Fetal Monitor
*attached to baby’s head=causes scaring/bleeding/damage to baby’s head when it comes off
Fetal scalp electrodes (FSE)
-Requires cervical dilatation and ruptured membranes
-Electrodes applied directly to fetal presenting part (head or buttocks)
Intrauterine pressure catheter (IUPC)
-Sterile, flexible catheter inserted directly into the uterus trans-cervically
-Measures actual uterine pressure in millimeters of mercury (mm Hg)
How dilatated does cervix have to be to receive internal fetal monitoring?
At least 2cm
What does a Intrauterine Pressure Catheter measure (IUPC)?
Measures actual uterine pressure in millimeters of mercury (mm Hg)
Fetal HR Interpretation
Baselines (BL)?
Baseline (BL) Fetal Heart Rate (HR)
Generated by fetal heart SA node and intrinsic pacemaker:
**Normal (BL rate 110 to 160 bpm)
**Bradycardia (BL rate <110 bpm)
**Tachycardia (BL rate >160 bpm)
What is a normal BL and Fetal HR?
Normal BL 110-160 bpm
What is Bradycardia ranges for fetal HR?
Bradycardia BL <110bpm
