Exam 2: Fetal Assessment During Labor Flashcards
Cloudy or smelly amniotic fluid =
infection
green amniotic fluid =
meconium
pH of amniotic fluid
alkaline (turn blue)
Leopold’s maneuver will answer what 4 questions
fetal presentation
fetal position
confirm presentation
altitude
FHR: cephalic presentation best heard
in lower quadrants
FHR: breech presentation best heard
on or above umbilicus
External monitoring: FHR and UC
FHR: ultrasound transducer
UC: tocotransducer
Guidelines for assessing FHR: initial
10 to 20 minute continuous FHR assessment on entry into labor/birth area
Guidelines for assessing FHR: intermittent auscultation
every 30 minutes during active labor for low risk women
every 15 minutes for high risk women
Guidelines for assessing FHR: during the second stage of labor
intermittent auscultation every 15 minutes for low risk
every 5 minutes for high risk
4 specific criteria must be met for continuous interval monitoring of FHR
ruptured membranes
cervical dilation of at least 2 cm
presenting fetal part low enough to allow placement of the scale electrode
skilled practitioner available to insert spinal electrode
Baseline FHR
average during 10 minutes
normal = 110-160 BPM
Causes of bradycardia
congenital heart block
maternal hypotension
severe hypoxia
prolonged hypoglycemia
second stage of labor
anesthetics
maternal hypothermia
causes of tachycardia
premature
maternal fever
chorioamnionitis
fetal anemia
cardiac arrhythmias
maternal hyperthyroidism
fetal hypoxia
drugs
Irregularities in FHR
absent: fluctuation undetectable
minimal: fluctuation range observed less than 5 bpm
moderate (normal) fluctuation range between 6-25 bpm
marked: fluctuation rate over 25 bpm
Why are variability important
reflects intact neurological system
optimal fetal oxygenation
measure of fetal oxygenation reserve
single MOST important characteristics of FHR
Nadir
FHR lowest point
Guidelines for assessing FHR –> accelerations increased baseline
more than 15 bpm above baseline
over 15 seconds but less than 2 minutes
Guidelines for assessing FHR –> accelerations are signs fo fetal well being
movement
contractions
vaginal exam
Do we treat early decelerations
no
Late decelerations begin
after the peak of the contraction and return to baseline FHR after the end of the contraction
Late decelerations require
immediate intervention –> wrong with the placenta
Late decelerations management
notify HCP
decrease or discontinue pitocin
repoisiton
provide O2 (8 to 10 L/min)
IV fluid bolum
Vaginal exam
Variable decelerations are from
umbilical cord compression
Variable decelerations: shaped
U, V, W
Variable decelerations treatment
reposition
increase IV fluids
provide O2
vaginal exam
Three tier FHR interpretation system
cat 1: normal tracing
cat 2: indeterminate tracing –> further investigation
cat 3: an abnormal tracing –> need interventions
What are the 5 essential components of FHR tracings
baseline rate
baseline variability
accelerations
deceleration’s
change or trends over time
Most concerning FHR patterns (3)
bradycardia
minimal/absent variability
late decelerations
T/F can a doppler flow study detect fetal compromise
yes it can
Nuchal translucency screening
11-14 weeks
subcutaneous accumulation of fluid behind the fetal neck, using ultrasound
Alpha fetoprotein analysis
elevation: neural tube defects, turners syndrome, hydrocephaly
low: down syndrome (trisomy 21)
Done between 15-20 weeks maternal blood sample
Triple marker screening test
AFP, hCG, unconjugated estriol
Quadruple screen test
AFP, hCG, unconjugated estriol, hormone, inhibin A
Do screen test diagnose
no they don’t diagnose a problem they only signal that further testing should be done
What are we looking for to test fetal lung maturity
L/S
lecithin, sphinogomyelin
2 or higher = lung maturity
1.5 or lower = RDS
chorionic villus sampling
diagnostic test for chromosome abnormalities and other inherited disorders
Harmony test
early as 10 weeks
analyze free DNA in blood –> trisomy’s
NST
non invasive test that doesn’t require contractions
How often are NST recommended?
twice weekly after 28 weeks for clients with diabetes and other high risk conditions
Reactive vs non reactive NST result
reactive: 2 FHR accelerations from baseline of at least 15 bpm for at least 15 seconds (within 20 min recording period)
5 parameters of a biophysical profile
body movement
fetal tone
fetal breathing
amniotic fluid volume
non stress test
